Competing medical abortion regimens differ in efficacy

Medicine is a continuously evolving science, and as new evidence emerges based on good study data, it is critical that medical practice also evolve to provide the best possible care for people. By insisting that medical practitioners continue to use an outdated treatment regimen, legislators are trying to restrict access to best care for women.

All fields of medicine use medications in evidence-based ways that are not FDA approved when subsequent data supports that. The newer regimens for medical abortion are more effective, can be used later in pregnancy, and have fewer negative side effects, especially if you consider how many more women are able to avoid a surgical procedure because of greater efficacy of the medical regimen.

A Cochrane review found that oral misoprostol may be associated with more frequent side effects such as nausea and diarrhoea, compared with the vaginal route. Sublingual and buccal routes also had higher rates of side effects, compared with vaginal administration (Cochrane Database Syst. Rev. 2011;11: CD002855 [doi:10.1002/14651858.CD002855.pub4].

Everyone I know who practices medical abortion (including me) uses the evidence-based method unless they are legally constrained from doing so.

Dr. Sarah W. Prager is associate professor of ob.gyn. at the University of Washington, Seattle. She provided these comments in an interview. Dr. Prager conducts trainings for insertion/removal of the implantable contraceptives Implanon and Nexplanon; she reported having no other financial disclosures.