Women and STEM: A guide to abortion pills

Credit: Anabelle Kang/ Credit: Anabelle Kang/

The abortion pill has been all over the news recently, so I thought I would write a little explainer to clear up any questions or misconceptions that might have come up for interested parties in the past few weeks.

The pill everyone has been talking about is mifepristone. A little secret is that the “abortion pill” is not just one pill — it’s a coordinated system of two drugs: mifepristone and misoprostol. A patient needs both to have a successful abortion, but only mifepristone can actually end the life of a fetus, which is why legislators are focusing on it right now.

If you’ve read my guide to birth control, you know that pregnancies require one basic hormone: progesterone. So in order to end pregnancies, mifepristone stops the body from recognizing progesterone. Essentially, it sits in the receptors that the body would normally use to see progesterone and blocks it from binding. The body does not have the tools it needs to support a pregnancy and the fetus is lost within a short period of time.

It should be noted that abortion is not the only use for mifepristone. It’s used in related situations, such as to ease a difficult miscarriage (the unintentional loss of a pregnancy) or to help with uterine fibroids (buildup of tissue in or near the uterus), but also can block the overproduction of the steroid hormone cortisol similarly to how it blocks progesterone. Mifepristone is prescribed to patients with Cushing’s Syndrome and high blood pressure, both of which are caused by high cortisol. It cannot be used in the case of an ectopic pregnancy, which happens when a fertilized egg starts developing into a fetus anywhere other than in the uterus, usually the fallopian tube.

Mifepristone is the first pill given to those seeking a medical abortion, which is the term for using pills to abort a pregnancy. It can be used up to 10 or 11 weeks into the pregnancy, though it gets less effective the longer you wait. The FDA has assigned it a special Risk Evaluation and Mitigation Strategy (REMS) designation, which means that doctors need to go through a specific training before they can prescribe it.

48 hours after a patient takes mifepristone, they are directed to take misoprostol. Misoprostol is kind and wonderful and doctors love it. The more I read about it, the more I love it. Its original use was to decrease acid production in the stomach. This is really useful for people who regularly take aspirin or other medicines that can damage the stomach and cause ulcers because a less acidic stomach is a good defense against ulcers.

However, if you want to reap the antacid benefits of misoprostol, you’ll need a negative pregnancy test. It just so happens that misoprostol also causes mad cervical dilation — it opens up the base of the uterus, which usually only happens during labor, and can damage a fetus if you’re unaware that you have one in there. Nowadays, though, there are so many instances where the cervix needs to be opened: to induce labor, to release blood from a postpartum hemorrhage, to release a miscarried fetus, and maybe even to insert an IUD. Before gynecologists get up there with one of those scary speculum things, they can use misoprostol to make things a little easier and less painful. In the case of abortions, misoprostol allows your body to release the developing fetus, resulting in heavy bleeding and cramps for a few weeks after it’s taken.

Some patients seeking abortions choose the mifepristone plus misoprostol route (the medical abortion) because it can be done with little to no time in a clinic and presents no risk for infection. Alternatively, other patients opt for a surgical abortion, or aspiration, which uses a vacuum to physically remove the fetus, takes less time overall — assuming a clinic is nearby — and results in less bleeding.

You might be asking yourself, “How is the abortion pill, or pills, different from Plan B?” The answer to that is they are different in the same way that the abortion pill is different from the birth control pill. Plan B and other associated “morning-after” pills contain levonorgestrel, the synthetic form of progestin (NOT progesterone), which they use as a hard brake on ovulation. These pills assume that you haven’t actually gotten pregnant yet, but that there are sperm swimming around in there that need to be kept away from any eggs.

The abortion pill mifepristone knows that you are already pregnant and knows exactly how to stop it. When paired with misoprostol to release the contents of the uterus, mifepristone can be a welcome alternative to surgical abortions.