Abortion through drugs is common in the United States. Here’s what you should know – National

Medical abortions became the preferred method of terminating a pregnancy in the US long before the Supreme Court Roe v. Wade picked up. This includes taking two prescription drugs days apart — at home or at a clinic.

Abortion procedures are an invasive medical technique that drains the uterus. They are sometimes referred to as surgical abortions, even though they don’t involve surgery.

Abortion by pills involves the drugs mifepristone and misoprostol. As more states move toward abortion limits, demand for the pills is expected to increase.

Mifepristone is taken first and swallowed orally. The drug dilates the cervix and blocks the effects of the hormone progesterone, which is needed to maintain a pregnancy.

Misoprostol, a drug also used to treat stomach ulcers, is taken 24 to 48 hours later. The pill is designed to dissolve when placed between the gums and teeth or in the vagina. It causes the uterus to spasm and contract, leading to bleeding and shedding of pregnancy tissue.

Abortion drugs are approved up to the 10th week of pregnancy.

The pills can be taken at a doctor’s office or clinic, where patients sometimes have an ultrasound or lab test beforehand. Some providers also offer the pills via telemedicine visits and then mail the medication to patients.

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The use of the pills has increased in recent years. They accounted for 54% of all US abortions in 2020, according to preliminary data from the Guttmacher Institute. The group’s final estimate is due later this year.

Studies and real-world evidence show that the pills are safe and 99% effective when taken together. Side effects can include nausea, vomiting, and diarrhea.

Bleeding is normal. Very heavy bleeding — soaking more than two pads an hour for more than two hours — is uncommon but requires medical attention.

dr Stephanie Rand, a New York City gynecologist and abortion specialist with the advocacy group Physicians for Reproductive Health, says pregnancy tests shouldn’t be used immediately to determine if a medical abortion was successful because the pregnancy hormone can linger in the body for a few weeks. Bleeding with clots that contain lighter colored tissue are signs of success, she said.

Serious complications are very rare. The Food and Drug Administration says more than 3.7 million US women have used mifepristone since it was approved more than 20 years ago. The agency has received 26 reports of deaths in women taking the drug, including two with ectopic pregnancies growing outside the womb.

The drugs are not recommended for certain patients, including those with suspected ectopic pregnancy or those with implanted IUD contraceptives.

Costs vary by location, but are similar to abortion procedures and can exceed $500. Health insurance coverage varies, with some plans making the pills free or low-cost and others not covering them at all.

Mifepristone is sold under the brand name Mifeprex and misoprostol under the brand name Cytotec, but both pills are available as generics.

The FDA approved mifepristone for pregnancy termination in 2000 when used with misoprostol. At that time, several restrictions on the prescription and dispensing of the drug were imposed.

In December, the agency dropped its biggest restriction: a requirement that patients pick up the drugs in person. The FDA said a scientific review of the drug’s use — including during the COVID-19 pandemic — showed women could safely receive the pills in the mail after an online consultation, without an increase in side effects or complications .

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The decision allowed the pills to be mailed nationwide, a change long sought by medical professionals and abortion rights advocates.

Still, millions of women will have difficulty accessing the pills because of a patchwork of state laws targeting abortion in general and the pills specifically. About half of US states are expected to ban or severely restrict abortion.

Legal experts predict years of court battles over access to the pills as abortion-rights advocates bring test cases to challenge government restrictions.

Experts note that there are strong arguments and precedents on both sides, although there is little certainty as to which side might prevail.

The Biden administration’s Justice Department has already signaled plans to challenge state restrictions on medical abortions. And federal prosecutors are also likely to be joined by outside parties, including abortion rights groups like Planned Parenthood and even the companies that make the pills.

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The main argument against pill restrictions is probably the long-standing principle that federal laws, including FDA decisions, pre-empt state laws. In fact, few states have ever attempted to outright ban an FDA-approved drug based on previous decisions in favor of the agency.

Still, states with blanket abortion bans are likely to interpret them as bans on abortion pills. Many of the laws do not distinguish between abortion procedures and medical abortion.

“In the short term, states that ban abortion will assume that their bans will include medical abortion, and that will be banned,” said Greer Donley, professor of reproductive health at the University of Pittsburgh Law School.

Even when blanket bans are successfully challenged, more than 30 states have laws specifically restricting access to abortion pills. For example, 19 states require clinicians to be physically present when the drug is administered.

These laws could withstand a court challenge. States have long had authority over how physicians, pharmacists, and other providers practice medicine.

States also set the rules for telemedicine consultations used to prescribe medication. Generally, this means that healthcare providers in states with restrictions on abortion pills face penalties such as fines or license suspension if they attempt to ship pills through the mail.

Women have already traveled across state lines to places where access to abortion pills is easier. This trend is expected to increase.

Meanwhile, some women are still getting the drugs through online pharmacies in Canada and abroad, often with telemedicine consultations from overseas doctors. The practice is technically illegal but essentially unenforced, and proponents believe women will increasingly choose this method as more states ban abortions.

“Anti-abortionists will do everything in their power to restrict medical abortion, but in practice people have and will access it through the mail from international pharmacies,” Donley said.

Donley anticipates lawsuits based on various legal theories will drag on for a number of years before clear decisions are made.

A key question is how the country’s highest court might decide if and when to start these trials. While the Supreme Court has rejected a constitutional right to abortion, conservative judges have also generally deferred the FDA’s primacy over drug decisions.