Old white guys reversing abortions

We know that a lot of policy changes regarding reproductive medicine come from old white guys and not certified medical professionals. We often see just how absurd things can get at a state level specifically when it comes to abortion bans and the outlandish ideas that we can just remove and “re-implant” an embryo from the fallopian tube to the uterus. But what about the states that allow abortions, specifically medical abortions?

A medical abortion involves the use of mifepristone followed by misoprostol to expel the pregnancy. Mifepristone binds to progesterone receptors antagonistically, preventing the normal binding of progesterone that is needed to maintain pregnancy. Anti-abortion activists claimed that women could start taking progesterone to reverse the binding of mifepristone, before they took misoprostol if they changed their minds about the abortion. A case series showed that the effects of adding progesterone was safe and effective leading to an overall reversal rate of 48% (Delgado et al., 2018). However, this was not a randomized controlled trial. 

The first randomized clinical study on the reversal of abortion using progesterone had to stop early due to 3 of 12 participants experiencing severe bleeding requiring ambulance transport to the ED. The researchers had originally planned to enroll 40 women that were planning abortions, and stopped after safety concerns.  Of those that required emergency assistance, 2 were placebo and the other was on the progesterone treatment. Since the study was cut short and the sample size was so small, it is difficult to evaluate the extent of hemorrhage risk and the efficacy of progesterone. It was published yesterday, December 5, in the journal of Obstetrics and Gynecology. The lead researcher, Creinin, advised that women who use misefpristone for a medical abortion and do not follow it with misoprostol can have severe hemorrhaging even if they try following up with progesterone.

Of course at the legislature level, there are issues. Some states that allow medical abortions also require physicians to counsel their patients that should they change their minds, there is a treatment available to reverse the abortion (through the use of progesterone). This is riddled with all sorts of problems. There is no consistent data to support this claim that abortions can be reversed safely in this manner. A law requiring physicians to suggest a potentially harmful treatment plan to a patient goes against beneficence and non-malfeasance. The patient’s autonomy to make a fully informed decision can only remain intact if the physician mentions that progesterone, although not well researched and could result in hemorrhage, could be made available if they decide to attempt an abortion reversal. Maybe the decisions about women’s reproductive rights should stay between a woman and her physician and leave the old white guy out of the room.    

References:

Delgado, G., Condly, S., Davenport, M., Tinnakornsrisuphap, T., Mack, J., Khauv, V., & Zhou, P. S. (2018). A case series detailing the successful reversal of the effects of mifepristone using progesterone. Issues L. & Med., 33, 21.

University of California - Davis Health. (2019, December 5). Study seeks to answer whether effects of 'abortion pill' can be reversed. ScienceDaily. Retrieved December 6, 2019 from www.sciencedaily.com/releases/2019/12/191205171347.htm