New research suggests a possible alternative to the abortion drug mifepristone, which continues to be the target of lawsuits and bills from abortion opponents.
But this alternative is also a key ingredient in the morning-after contraceptive pill, potentially further complicating the politics of reproductive health.
The new study, published Thursday in the journal NEJM Evidence, involved a drug called ulipristal acetate, the active ingredient in the prescription birth control pill Ella, one of two morning-after pills approved in the United States. I was doing it. (Another, Plan B One-Step, does not require a prescription, but scientific evidence shows it contains other drugs and is not effective in terminating a pregnancy.)
In this study, 133 women up to nine weeks pregnant received a double dose of ulipristal acetate in gills, followed by misoprostol, the second drug used in typical medical abortion therapy. ingested. All but four of the women completed their abortions without further intervention. Completion rate was 97%, similar to that with mifepristone. (Others received additional medications and treatments to finish the process.)
There were no serious complications, and the study concluded that the use of ulipristal acetate in dual-drug abortion therapy is safe.
Dr. Beverly Winikoff, lead author of the study and president of the Ginuity Health Project, a reproductive health research organization, said the role of ulipristal acetate will continue to grow after the Supreme Court overturns national abortion rights in 2022. He said he began to have doubts about the possibility of , has a similar chemical structure to mifepristone.
“I was wondering if there was anything else I could do,” she said. “Another option. And this is already on the market.”
The political implications of this study are complex, as the line between public perceptions of emergency contraception and abortion may be blurred. Abortion opponents have opposed the morning-after pill for years, saying it can cause abortion, and reproductive health experts say the pill does not abort a pregnancy, but prevents pregnancy after sex. They have argued against it by pointing to scientific evidence that it is effective.
Some reproductive health experts say research showing ingredients in the morning-after pill can be used for abortion could spark a crackdown on emergency contraceptives and create confusion that strengthens a large-scale anti-abortion strategy. Some people are concerned.
Christy Hamrick, a spokeswoman for Students for Life of America, said the organization would “absolutely” consider filing a lawsuit over Ella.
“The pro-life movement needs to be legitimized,” Hamrick said. “We've been discussing Ella's role as an abortionist for years.”
Mary Ziegler, a law professor and abortion expert at the University of California, Davis, said the study could pose challenges for both sides of the abortion debate.
“This will give wind to anti-abortion advocates who have been claiming that contraceptives can be abortion drugs,” she said, adding, “I think this study that will be published will be difficult for abortion rights supporters to deal with. ” he added.
But Ziegler said the study's findings are “politically risky” for abortion opponents because public support for contraception is high and many voters in conservative states support ballot measures that protect abortion rights. ” may be involved. “I think this is one of the things that tempts social conservatives to push toward regulating contraception faster than politics currently allows,” she said. “And I think that could backfire.”
Reproductive health experts said the study does not refute the science that morning-after pills do not induce abortions because they contain different doses of the drug.
Abortion opponents said they were not surprised by the study's findings.
“After years of denying that ulipristal acetate could end the life of a fetus, abortion advocates are now beginning to use ulipristal acetate as an alternative to the abortion drug mifepristone,” American Pro-Life Association study says Dr. Donna Harrison, director of the department. Obstetricians and gynecologists said in a statement: “The reason is simple: ulipristal and mifepristone work the same way.”
Eller had already become a target of some conservatives. Project 2025, a right-wing policy blueprint with strong ties to the new Trump administration, states that Ella should be excluded from insurance coverage required for contraception under the Affordable Care Act because she is “abortive.'' He said that.
Mifepristone, the first pill in the standard two-drug abortion therapy, is the only drug specifically approved for abortion in the United States. Mifepristone, which is usually used until the 12th week of pregnancy, stops the pregnancy from progressing by blocking the hormone progesterone. The second drug, misoprostol, is taken 24 to 48 hours later and causes labor pains similar to a miscarriage.
Ulipristal acetate, which is in the same class of drug as mifepristone, also inhibits the activity of progesterone, the hormone that prepares the uterus to accept and hold an embryo, says Daniel, a reproductive health physician and researcher at the University of California. Dr. Grossman said. San Francisco is not involved in the new study.
In this study, 60 milligrams of ulipristal acetate (twice as much as Ella's 30 milligrams) was used in place of mifepristone, followed by misoprostol. Misoprostol has a variety of medical uses and has not been targeted by abortion opponents. (Although misoprostol alone promotes abortion, combination therapy is thought to be more effective.)
Reproductive health experts say the search for alternatives to mifepristone comes as anti-abortion advocates are working to significantly restrict abortion drugs across the United States, particularly with a federal lawsuit against the Food and Drug Administration. He said he would welcome it. The Supreme Court dismissed the case last year, ruling that the original plaintiffs lacked standing to sue, but the case has since reopened with three states as plaintiffs.
Dr. Grossman, who wrote an editorial about the study, said the potential for an alternative to mifepristone is “certainly an encouraging finding.” However, he added: “If ulipristal acetate were to be removed from the market as an emergency contraceptive because of new evidence that it can cause abortion at high doses, it would be really It's bad,” he added.
Perrigo, the company that makes Ella, issued a statement saying that because the new study tested ulipristal acetate at higher doses than one tablet of Ella and in combination with misoprostol, “there is still no evidence that it does so alone.” did. , gills cause abortion. “Ella is an FDA-approved emergency contraceptive that works before pregnancy occurs,” the company added.
The study was conducted in Mexico City and co-led by local researchers.
Experts said that because this study was a relatively small initial study without a comparable patient population, further research is warranted before using ulipristal acetate as a replacement for mifepristone in two-drug therapy. He said research was needed. “We cannot change clinical practice based on this study,” said researcher Kelly Cleland, executive director of the American Emergency Contraception Association.
Scientists have long understood that hormone-based drugs can perform different functions at different doses along the spectrum of a woman's reproductive health cycle.
In Europe, researchers including Dr. Rebecca Gompertz, a Dutch doctor and founder of a telemedicine organization that provides abortion pills around the world, are studying low-dose mifepristone as a weekly contraceptive. There is. Dr. Gomperts said he believes the new research on ulipristal acetate is sufficient to prescribe the drug off-label in combination with misoprostol.
“The more uses these drugs have, the harder it will be for people to take them out,” said Dr. Paul Blumenthal, professor emeritus of obstetrics and gynecology at Stanford University, who was on the study's advisory group. Ta.
Plan B is the much more widely used morning-after pill in the United States, but Ella is thought to be more effective for some women, including those who are overweight. Plan B is meant to be taken within three days after unprotected sex, while Ella can be taken within five days.
Both pills have been shown in scientific studies to prevent pregnancy by blocking ovulation, the release of an egg from the ovary that occurs before the egg is fertilized.
The argument by some abortion opponents that the morning-after pill is an abortion pill is based on the theory that it may also prevent a fertilized egg from implanting in the uterus. Most scientific studies have not found such a fact.
Despite years of scientific evidence to the contrary detailed in a New York Times investigation, the FDA-approved Plan B One-Step label and packaging claim that although the pill is effective in blocking ovulation, , it was stated that it may interfere with implantation. . In 2022, the agency changed the language to clarify that Plan B only works before conception and “does not work if you are already pregnant and does not affect existing pregnancies.”
Ella's FDA label states that its “probably primary mechanism of action” is to stop or delay ovulation. The label adds that the drug may also affect implantation. However, recent research suggests that gills do not function by preventing fertilized eggs from implanting in the uterus.
