Abortion pills are safe without in-person reviews

Medical abortions are just as safe when women have virtual visits to get prescriptions as when they make in-person appointments, study finds.

Abortion pills have been legal in the United States for more than two decades as an option for terminating pregnancies up to about 10 weeks gestation. But for most of that time, the US Food and Drug Administration (FDA) required women to be prescribed these pills during in-person visits, limiting access.

FDA requirement temporarily lifted due to pandemic

When the COVID-19 pandemic hit, the FDA temporarily waived this requirement, allowing women to get prescriptions for abortion pills during telemedicine visits and receive the drugs by mail instead of going to a pharmacy. This not only helped women get the medical care they needed during the pandemic, but also allowed researchers to gather evidence on the safety and effectiveness of offering medical abortions without in-person visits.

“We have long suspected that we could use patients’ medical histories to determine whether medical abortion was right for them, and we had substantial data indicating that people seeking an abortion could accurately state the date of their last menstrual period, allowing a precise dating of their gestational length,” says the study’s lead author, Ushma Upadhyay, PhD, MPH, associate professor and reproductive health researcher at the University of California, San Francisco.

“But it wasn’t until the aftermath of the COVID-19 pandemic, when providers started using this new protocol to minimize in-person contact, that we were able to test the safety of these new protocols,” says Dr Upadhyay.

About a third of study participants received pills in the mail

For the study, researchers looked at data from 3,779 women from 34 states who had medical abortions during the pandemic. None of them first underwent an ultrasound or pelvic exam, and about a third of the participants received medication by mail instead of going to the pharmacy.

Overall, 95% of abortions were effective in ending early pregnancies, and it did not differ whether women picked up medicine in person or received pills in the mail, researchers reported in JAMA internal medicine. This rate of effectiveness is comparable to that seen with medical abortions requiring prior screening ultrasounds, the researchers noted.

Only 12 abortions – 0.54% – resulted in serious adverse events requiring hospitalization, surgery or blood transfusion. This is also similar to what is seen when women undergo in-person examinations before medical abortions, the study team noted.

There were nine patients – 0.40% – who turned out to be more than 10 weeks pregnant when the abortion pills were distributed. Two of these women had successful medical abortions, while six required surgeries to terminate their pregnancies and one delivered a stillborn fetus. This indicates that physicians should educate women about this possibility, the researchers point out.

Another concern is that four women had ectopic pregnancies, a life-threatening condition that occurs when a fertilized egg implants outside the uterus, often in the fallopian tubes.

Although this suggests that a small proportion of women may have undetected ectopic pregnancies at the time of their abortion, the risk may be outweighed by the wider benefits of expanded access to care and earlier treatment. , concluded the study team.

“Medical abortion is safe and effective,” says Upadhyay. “Over the past 20 years, 13 deaths among the approximately 3.7 million patients who have used medical abortion care are possibly related to abortion.”

Today, more than half of abortions are performed using medication – a regimen that includes the drugs mifepristone and misoprostol.

Wider access to medical abortions without ultrasounds or in-person appointments should be an option for women who want them, says Jennifer Karlin, MD, PhD, co-author of an editorial accompanying the study and assistant professor of family medicine and community at the University of California, Davis.

Many women may find it easier to access timely care with medical abortions facilitated by telemedicine visits, and this option should be available to them, Dr. Karlin says. In-person exams, including ultrasounds, should also be available for women who need them, including people with a history of ectopic pregnancy or irregular menstrual cycles.

“Evidence shows that in-person appointments for most people are not necessary,” says Karlin.

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