When people talk about medically managed abortions in the United States that don’t require surgery, they usually talk about a one-two punch involving two medications: mifepristone and misoprostol.
But one study and a growing body of consensus from around the world suggest that mifepristone may not be necessary at all, and misoprostol may be more effective when used alone.
Misoprostol is a readily-accessible drug that many already have in their own medicine cabinets for other conditions, which could make it a boon in a post-Roe v Wade world where abortions are becoming increasingly difficult to access. For point of reference, Misoprostol is often provided for treating stomach ulcers and treatment-resistant acid reflux conditions.
One study in Nigeria and Argentina found a misoprostol-only abortion was 99% effective, a higher rate than clinically managed abortions in the US using both drugs.
Mifepristone is significantly more challenging for providers to get their hands on and for patients to access, so shifting to a misoprostol-only regimen could not only increase access but effectiveness.
The use of misoprostol alone started in Brazil, where access to abortions has always been and remains restricted to citizens.
As the off-label use for abortions rose in Brazil, a 1991 study was already tracking its effectiveness in significantly reducing abortion-related complications. In reaction to this growing awareness of the drug’s effectiveness as an abortifacient, the drug was banned in Brazil.
But one expert in the US cautions that even though it’s a hopeful sign for access to abortions in regions where the combination treatment is problematic, both may still be the best course. Elizabeth Raymond, a senior medical associate at Gynuity and the lead author of a systematic review of clinical trials on the use of misoprostol alone for early abortion, told The Atlantic, “I think [the study from Nigeria and Argentina is] an intriguing study, and it’s true that misoprostol alone is more effective than we thought. But I think a general feeling is that if you can get both drugs, you should do that. The combination is more effective and may cause less cramping and bleeding.”