After Texas Ruling, What Does a Misoprostol-Only Abortion Look Like?

Abortion providers in Ohio are still going to offer abortion medication to patients despite a recent national ban on one of the key drugs used in the process, Planned Parenthood announced April 11.

Just before Easter weekend, a conservative federal judge in Texas, Judge Matthew J. Kacsmaryk, released a decision to pause the Food and Drug Administration’s 2000 approval of the abortion drug mifepristone (brand name Mifeprex) which ends a pregnancy within the first 10 weeks of gestation.

The legality behind Kacsmaryk’s decision to effectively ban mifepristone is murky, and judges in other states have issued contradictory rulings that may protect the use of the drug for some states while appeals play out in Texas.

Medical abortions are still on the table in Ohio

In the meantime, Kacsmaryk’s order is scheduled to go into effect at midnight CT on April 15, and Dr. Adarsh E. Krishen, chief medical officer for Planned Parenthood of Greater Ohio, said doctors are prepared to make adjustments in order to continue offering abortions to patients who want to choose pills over a surgical procedure.

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“Should Judge Kacsmaryk’s ruling stay in place, there is an alternative regimen that we can use for patients that choose to have a medication abortion that involves just misoprostol only,” he said. “It’s still a safe and effective regimen, it’s just not as patient-convenient or patient-centric as the current regimen.”

The current regimen for medicated abortions includes both mifepristone and misoprostol. Mifepristone ends the pregnancy by blocking progesterone, the hormone needed to keep the pregnancy going. Then, 24-48 hours later, misoprostol helps to expel the fetal tissue from the body.

Dr. Krishen said the combination of the two drugs allows the patient to have a lot more predictability of when their pregnancy is going to end, and bleeding and cramping usually lasts about a day.

“We usually recommended somebody rest the day they have the passage just to allow them a chance to recover, but usually by the next day they are able to resume normal activity,” he said.

The physical experience of a misoprostol-only abortion

But in a misoprostol-only abortion regimen, Dr. Krishen said there’s a lot more variation in timing of when that pregnancy may end, as well as prolonged bleeding and cramping.

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“If you’re a person who needs to work or need to do other things in your life, it will make that much more complicated,” Dr. Krishen said. “You start by taking the first of your four doses of misoprostol in the [abortion clinic] and then every three hours afterward you take four more tablets. Bleeding will start anywhere from 1-4 hours after that first dose and about 80% of people will pass tissue within the first 24 hours and the bleeding may last up to one to two weeks.”

In addition to prolonged bleeding, Dr. Krishen said more side effects are likely with the misoprostol-only regimen.

“Because of the type of medication misoprostol is, there’s more likely to be nausea from taking the medication,” he said. “Usually your pain and cramping lasts longer with the misoprostol. That has more to do with the physiological effects, that’s what misoprostol does is it causes the cramping and contraction of the uterus, though it’s a more prolonged process.”

Dr. Krishen assures that both regimens are equally safe, with both having a complication rate of less than one percent. He said the misoprostol-only regimen is standard in some countries where mifepristone is already sparse.

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“If you look across the world, about half the countries where abortion is legal and accessible, they do not have access to mifepristone for any variety of reasons, cost being the most common one of them,” he said.

Abortion is still accessible in Ohio up until 22 weeks gestation. Booking the appointment for the state-mandated abortion consultation, which takes place at least 24 hours before the actual abortion appointment, can take up to four weeks in some Ohio cities. Planned Parenthood said the potential restrictions on prescribing mifepristone shouldn’t impact appointment wait times.

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This article appears in Apr 5-18, 2023.