The Real Reason Some Abortion Pill Patients Go to the Emergency Room

Today, the U.S. Supreme Court heard oral arguments in a major case that could limit medication abortion nationwide.

A central issue in the case is the safety of the drug mifepristone, the first drug in a two-pill regimen used for abortions. The drug blocks hormones needed for pregnancy and has been approved by the U.S. Food and Drug Administration since 2000.

The FDA approval is being challenged by the Hippocratic Medical Alliance, a coalition of anti-abortion doctors and activists, which is calling for the drug to be removed from the market. The organization claims mifepristone is dangerous to patients, citing a 2021 study that found higher rates of emergency room visits after medical abortions. However, the study was retracted in February after an independent review found problems with the way the authors analyzed and presented the data.

One of the main questions raised by the justices during Tuesday’s arguments was about emergency room visits following the use of mifepristone and whether the FDA’s loosening of regulations on the drug in recent years has led to an increase in those visits.

“I think emergency room visits are definitely the wrong thing to do from a safety standpoint,” said Michael Belmonte, an obstetrician-gynecologist and fellow at the American College of Obstetricians and Gynecologists. “It’s important to realize that the vast majority of people who go to the emergency room do so for reassurance rather than a real safety concern.”

The more important measure, Belmont said, is serious adverse events, which are extremely rare with medical abortion. “Adverse events can occur with any drug or procedure, and frankly, the adverse events that occur with these drugs are extremely rare compared to the drugs we use every day,” he said.

Major adverse events included hospital admission, transfusion, infection, and death. A 2013 peer-reviewed study found that of 233,805 medical abortions provided in 2009 and 2010, these major adverse events or outcomes were reported in 1,530, or less than 1%.

“A lot of women might go [to the ER] Because they are experiencing heavy bleeding, which is similar to a miscarriage, they may just need to know if they have complications,” U.S. Deputy Attorney General Elizabeth Prelogar, defending the FDA, said during oral arguments Tuesday.

It’s important to note, Belmonte said, that abortion pills can cause bleeding and cramping. While these effects may be unsettling to some patients, they are a function of the drug and a sign that it is effective. “Mifepristone really just prepares the uterus to empty, so essentially, mifepristone alone won’t cause any bleeding, cramping or other side effects,” he said. Misoprostol, the second drug used in medical abortion, can cause bleeding and cramping.

Ushma Upadhyay, a public health social scientist at the University of California, San Francisco, who studies medical abortion, said many patients who go to the emergency room after a medical abortion are shocked by bleeding caused by the drug, but that doesn’t mean they are experiencing a medical abortion. serious adverse events. “When people have medical abortions, they go through it alone and don’t have a provider with them to ask questions,” she said. “People go to the emergency room to learn whether the bleeding they are experiencing is normal and to evaluate whether the medication is working.”

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