Abortion Pill Reversal

I am saddened that I have to write about this topic. As of March 31st 2020, it has been legal in Northern Ireland to procure an abortion by means of medication under 9 weeks. This is a tragic and dreadful state of affairs. But I have written elsewhere about that. I felt the need to write some Northern Ireland based advice on what to do if somone to changes their mind.

TL;DR – it is often possible to reverse the effects of the first abortion pill.

Medical abortion is a process which is initiated by taking Mifepristone tablets, which blocks the action of progesterone in the womb of the pregnant woman. Use of this medication alone results in abortion in up to 90% of cases; addition of mifeprostol a few days later increases this to 99%.

But supposing someone changes their mind? Or supposing, as I’ve had experience with, they were coerced into taking the first pill against their will? If this person presents to their GP, their midwife, their obstetrician, is there anything we can do?

Yes.

If the woman can be given progesterone medication within 72 hours of taking the first pill, there is a 68% chance that the baby will survive. (Delgado et al, Issues in Law and Medicine, 2018, full text available free of charge). This is a safe and effective treatment, with very little risk to mother or baby.

Treatment options:

• Progesterone 400mg orally as soon as possible after the first pill, then 400mg twice daily for three days, then 400mg once daily until the end of the first trimester.
• If the oral route isn’t an option, e.g. due to vomiting, then Progesterone 400mg pessaries per vagina three times daily for five days, then 400mg twice daily for five days, then 400mg once daily for five days, or until end of first trimester
• Both of these medications are readily available in local pharmacies, either through NHS script, or private prescription (private cost will be around £50)
• [Note that Progesterone is not licensed for this use, per se. We prescribe many medications on a daily basis for off-license use, and it is up to the prescriber to make the judgement of risks vs benefits. The risks with progesterone use are very low, and the side effects unremarkable.]

Are women requesting medical abortion counselled about this option? What to do if they change their mind? Of course not. I could talk about what constitutes properly informed consent, cooling off periods etc. here, but I’m not going to.

Here’s a link to a US based provider, for information https://www.abortionpillreversal.com/

Here’s a link to some more in-depth info on the pharmacology https://americanpregnancy.org/abortion-pill/abortion-pill-reversal/