The real reason some abortion pill patients go to the ER

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Today the Supreme Court of the United States heard oral arguments in a resulting case that threatens to ban access to medication abortion nationwide.

A central issue in the case is the safety of the drug mifepristone, the first two-pill drug used to induce an abortion. This drug blocks hormones necessary for pregnancy and has been approved by the US Food and Drug Administration since 2000.

The FDA's approval is being challenged by the Alliance for Hippocratic Medicine, a coalition of anti-abortion doctors and activists, which is seeking to remove the pill from the market. The group alleges that mifepristone is dangerous for patients, citing a 2021 study that found higher rates of emergency room visits after medication abortion. However, that study was retracted in February after an independent review found problems with the way the authors analyzed and presented the data.

During Tuesday's arguments, the main question from the justices was about ER visits following the use of mifepristone and whether these visits have increased in recent years as a result of the FDA's loosening of regulations on the drug.

“I think ER visits are definitely the wrong solution given safety,” says Michael Belmonte, MD, an obstetrician-gynecologist and fellow of the American College of Obstetricians and Gynecologists. “It's important to recognize that most people going to the emergency room are simply going for reassurance rather than out of a real safety concern.”

Belmonte says the more important measure are serious adverse events, which are extremely rare with medication abortion. “There are adverse events with any drug or procedure and, frankly, adverse events with these drugs are extremely rare compared to things we use every day,” he says.

Important adverse events include hospital admission, blood transfusion, infection, and death. A 2013 peer-reviewed study found that, among 233,805 medication abortions given in 2009 and 2010, these significant adverse events or outcomes occurred in 1,530 cases, which is less than 1 percent.

“Many women can go [to the ER] Because they're experiencing heavy bleeding that mimics a miscarriage, and they may just need to know if they're going to have any complications,” said U.S. Solicitor General Elizabeth Preloger, who is defending the FDA. are, said at oral argument Tuesday.

Belmonte says it's worth noting that the abortion pill causes bleeding and cramping. Although those effects may be bothersome for some patients, this is a function of the medication and a sign that it is working. “Mifepristone actually prepares the uterus for evacuation, and so, naturally, mifepristone alone does not cause any bleeding, cramping, or other side effects,” he says. Misoprostol, another drug used in medical abortion, causes bleeding and cramping.

Ushma Upadhyay, a public health social scientist at UC San Francisco who studies medication abortion, says that many patients who go to the emergency department after a medication abortion are concerned about bleeding caused by the medication, but that does not mean It's not that they're having an experience. Serious adverse event. “When people get a medication abortion they're experiencing it alone, and they don't have a provider to ask questions,” she says. “People are going to the ER to understand whether the bleeding they are experiencing is normal and to assess whether the medications are working.”