Physicians and patients navigating the complex landscape of medication abortion face a myriad of legal and medical considerations. At the American College of Physicians (ACP-IM) Internal Medicine Meeting 2024, a panel of clinicians provided insights into supporting patients opting for medication abortion, a method available until the 10th week of gestation.
Since their approval in 2000, abortion pills have emerged as the predominant method for ending pregnancies in the United States, constituting 63% of all abortions in 2023. The looming scrutiny of access to medication abortions by the US Supreme Court underscores the urgency of clarifying regulations, with a decision anticipated in the coming months.
As of February, the Guttmacher Institute reports that 29 states impose restrictions on medication abortion, ranging from limitations or bans on drug usage to constraints on prescribing authority and circumstances.
The Initial Steps: Determining Gestational Age Dr. Cynthia Chuang, an internist and professor at Penn State College of Medicine, underscores the importance of establishing gestational age, typically achievable through a woman’s self-reported last menstrual period. Confirmation through ultrasound is recommended if uncertainty exists regarding the last menstrual period date, or if conditions like irregular periods or suspected ectopic pregnancy are present, or if state laws mandate ultrasound.
Eligibility Criteria and Medication Components Certain medical conditions preclude individuals from receiving abortion pills, including bleeding disorders, intrauterine device usage, adrenal insufficiency, chronic steroid intake, or hemoglobin levels below 9 g/dL. Dr. Chuang advises opting for procedural abortion if the individual’s hemoglobin is below the threshold.
The medication protocol typically commences with 200 grams of oral mifepristone, followed by 800 mcg of misoprostol within 48 hours, administered vaginally or buccally. Dr. Chuang notes that while mifepristone generally induces minimal side effects, patients can expect heavy cramping and bleeding post-misoprostol ingestion, tapering off over the subsequent week or two. For pregnancies beyond 9 weeks, a second misoprostol dose can enhance efficacy.
In the absence of mifepristone, misoprostol alone can be administered in three doses spaced 3 hours apart, according to Dr. Chuang.
Monitoring and Support Physicians advise patients to contact the clinic if certain symptoms arise, such as excessive bleeding, minimal bleeding, or doubts regarding medication efficacy post-regimen completion. Dr. Mindy Sobota, an internist and professor at Brown University, recommends utilizing evidence-based resources for effective patient communication regarding medication abortions, such as continuing medical education sites and the Plan C website for telehealth services and pricing information.
Supporting Patients Through Every Step Dr. Alexandra Bachorik from Boston University emphasizes the importance of offering comprehensive support to patients, including guidance on financial assistance for accessing abortion services in less restrictive states, facilitated by organizations like the National Network of Abortion Funds.
Even in states with stringent regulations, clinicians can provide valuable support by offering resources and counseling on reproductive healthcare options. Dr. Adelaide McClintock of the University of Washington encourages clinicians to familiarize themselves with abortion-access resources and remain readily available to address patient needs, given the prevalence of abortion requests among women.
In conclusion, navigating the landscape of medication abortion necessitates not only medical expertise but also a compassionate and informed approach to patient care. By staying abreast of legal developments and leveraging available resources, clinicians can effectively support patients in their reproductive healthcare decisions.
- : public
