• Posted January 24, 2025

Abortion Pill Alternative Found in Morning-After Pill

When one abortion pill faces lawsuits, another may be waiting in the wings, a new study suggests.

The study, published Jan. 23 in the journal NEJM Evidence, has found a potential alternative to the abortion pill mifepristone, offering yet another option at a time when access to reproductive health care faces increasing legal and political challenges.

Researchers tested ulipristal acetate, the active ingredient in the emergency contraceptive pill Ella, as a substitute for mifepristone in the medication abortion regimen. 

The study found that when ulipristal acetate was used at double the typical dose of Ella followed by misoprostol, the regimen was 97% effective in terminating pregnancies up to nine weeks. No serious complications were reported among the 133 women who participated.

All but four completed the termination of their pregnancies without further intervention, researchers reported.

The findings dovetail with ongoing lawsuits targeting mifepristone, the only drug specifically approved for abortion in the United States.

Typically, it works by blocking progesterone, a hormone necessary for pregnancy, and is followed by misoprostol, which causes contractions to end the pregnancy.

Lead author Dr. Beverly Winikoff, president of the reproductive health research organization Gynuity Health Projects, told The New York Times that the U.S. Supreme Court’s 2022 decision to overturn Roe v. Wade increased her interest in exploring alternatives to mifepristone.

“I was thinking, there’s maybe something else we can do,” Winikoff said. “Another option. And this one is already on the market.”

It's important to note, however, that reproductive health experts warn that the study could fuel political controversy, because Ella is also marketed as a prescription morning-after pill to prevent pregnancy following unprotected sex.

Abortion foes have long argued that morning-after pills like Ella can act as abortifacients, substances that cause abortion. These claims have been strongly debunked. Evidence shows that Ella, when taken at its standard 30-milligram dose, works by delaying ovulation, preventing fertilization.

This study, which used a 60-milligram dose of ulipristal acetate combined with misoprostol, does not debunk the science of emergency contraception. But it may blur public perceptions of the line between contraception and abortion.

“It’s going to put wind in the sails of abortion opponents who have been saying things like contraceptives can be abortifacients,” Mary Ziegler, a law professor and abortion expert at the University of California, Davis, told The Times. “This study being released will be difficult, I think, for abortion rights supporters to manage.”

Kristi Hamrick, a spokeswoman for Students for Life of America, said her organization would “absolutely” consider litigation over Ella.

“The pro-life movement should be vindicated,” Hamrick told The Times. “We’ve been arguing for years that Ella acts as an abortifacient.”

While the results are promising, experts say more research is needed before ulipristal acetate could replace mifepristone.

“We can’t change clinical practice based on this study,” Kelly Cleland, executive director of the American Society for Emergency Contraception, told The Times.

Dr. Daniel Grossman, a reproductive health researcher at the University of California, San Francisco, called the findings “promising.”

But he warned that “if because of this new evidence that at higher doses, ulipristal acetate could cause an abortion, that were to lead to ulipristal acetate being taken off the market for emergency contraception, that would be really, really bad.”

The study was conducted in Mexico City and was co-led by researchers there.

“The more uses we have for these medications, the harder it will be for people to take them away,” Dr. Paul Blumenthal, an emeritus professor of obstetrics and gynecology at Stanford University who was in an advisory group for the study, concluded.

More information

Planned Parenthood has more on medication abortion.

SOURCES: NEJM Evidence, Jan. 23, 2025; The New York Times, media report, Jan. 23, 2025