Cosmopolitan's 'guide' to misoprostol-only abortions downplays risks

Cosmopolitan Magazine has published a "guide" for an unapproved abortion drug regimen using misoprostol alone (instead of mifepristone and misoprostol in combination via the abortion pill regimen), but the pro-abortion publication left out important information women deserve to know.

This is part two of Live Action News' three-part series discussing misoprostol-only abortions (read part one here).

Key Takeaways:

• Cosmopolitan's "complete guide" to unapproved misoprostol-only abortions left some things out that women need to know.

• Misoprostol is the second drug in the abortion pill regimen, but is used off-label for abortion; it is actually contraindicated during pregnancy.

• The guide misleads women into thinking that they won't see an embryo, that misoprostol-only abortions' risks are extremely small, and that its efficacy is similar to that of mifepristone-misoprostol in combination.

The Backstory:

In 2000, the U.S. Food and Drug Administration (FDA) approved the abortion pill mifepristone (Mifeprex) for use in an abortion regimen with a second drug — misoprostol. Due to the potential for serious adverse events when using mifepristone, that drug has been under a safety system (REMS) which monitors use and regulates those certified to prescribe and dispense the drug. Because the FDA has kept the drug under stricter oversight due to the REMS, abortion industry leaders and allies are promoting other chemical abortion drugs to women.

Misoprostol (Cytotec) was FDA-approved to lower the risk of stomach ulcers caused by nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) in certain people, according to GoodRx.

Misoprostol is not subject to the REMS safety system, which is likely why bad actors in the abortion industry are pivoting toward the unapproved single drug for chemical abortion versus the approved two-drug regimen. Technically, using misoprostol in the abortion pill regimen is considered off-label use and the drug is contraindicated for pregnancy.

Following the fall of Roe in 2022, abortion advocates have scrambled to expand access to abortion. But pro-life states, granted the power to restrict abortions by the U.S. Supreme Court in the Dobbs decision, have filed multiple lawsuits challenging both the approval of the abortion pill Mifeprex/mifepristone (200mg) as well as the 2023 REMS, which eroded safety requirements to allow for mail-order and pharmacy dispensing.

Their legal strategy took a turn earlier this month when the Fifth Circuit Court of Appeals agreed with the State of Louisiana in pausing mail-order dispensing of Mifeprex/mifepristone (200mg) while the FDA conducted a full safety review of the drug. Immediately, makers of the drug submitted an emergency application, and the Appeals Court ruling was overturned by the Supreme Court, which allowed mail-order dispensing to continue as the lawsuit proceeds.

This was the backdrop for Cosmopolitan's promotion of a more risky abortion drug protocol.

Cosmo's guide to 'misoprostol-only abortions' downplays risks

Politico recently referred to "misoprostol-only abortions" as "one weapon" in the "post-Roe arsenal" of those who target preborn children for death.

Meanwhile, Cosmopolitan Magazine headlined an article, "Your Complete Guide to Misoprostol-Only Abortions," which endorsed the unapproved misoprostol-only protocol, writing in part:

While mifepristone definitely cuts down on the time and symptoms involved in a medication-induced abortion (keep reading for the full deets on that later), it’s not a necessary part of the equation—aka you *can* safely and successfully end a pregnancy just with misoprostol, the other drug in the two-step abortion pill process.

“In countries where mifepristone is not available or abortion is severely restricted, it is not uncommon to use misoprostol on its own up until the 24th week of pregnancy,”  Physicians for Reproductive Health president and CEO Jamila Perritt, MD, told Cosmo.

"If you take misoprostol by itself, a pregnancy will typically end within 24 hours of taking it (but usually within the first 12 hours)," Alisa Goldberg, MD, MPH, an associate professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School stated.

Goldberg's online bio indicates that she is a certified Complex Family Planning subspecialist and a director at the Department of Research at Planned Parenthood League of Massachusetts (PPLM) who also served on the Board of Directors of the National Abortion Federation (NAF) and "currently serves on the Board of Directors of the Society of Family Planning (SFP)."

Cosmo's chosen experts and sources were extremely biased toward abortion, with the magazine citing the pro-abortion World Health Organization as well as SFP in step by step instructions for women, including potentially dangerous vaginal insertion of the drug, which can increase the risk of infection.

Claim #1: The woman won't see an embryo

Oh, and don’t expect to see the embryo itself pass, especially if the abortion happens early in the pregnancy because it is “mixed in with blood and clots,” explains Dr. Goldberg. If the abortion happens around 11 or 12 weeks, aka toward the end of the first trimester, there’s a chance you may see a small embryo.

This repeated falsehood negates the real life testimonies of women who saw the bodies of their children after chemical abortions.

Even in early clinical trials, the Washington Post acknowledged this fact, writing in 1997:

Some women may dislike this stage of a "medical abortion" because in contrast to a suction abortion, they have an opportunity to view the fetus. As Blumenthal noted, "one of the features of this kind of termination is that a patient may actually see the products of conception and may actually see the tiny, tiny fetus."

My Abortion Pill Story - Natalia - I Saw My Baby

Claim #2: Misoprostol-only abortion = 'strong cramping'

Cosmo diminished the risks of the unapproved regimen, writing:

Strong cramping (almost like a mild contraction) is expected—that’s misoprostol doing its job. That said, you may notice more side effects with misoprostol-only abortions — like diarrhea, fever, and chills — than you would when also taking mifepristone because you’re ingesting more doses.

...“Sometimes people think that just because you’re taking more medication, that means it’s less safe or less effective, and that’s not true — it just works differently,” says Dr. Perritt.  The risks are extremely small, she adds, even tinier than “the risk of hemorrhage, infection, and pain when compared to giving birth.”

Yet, Gynuity's guide states: "Bleeding and uterine contractions (cramping) are the intended effects of using misoprostol for inducing an abortion. Cramping will be stronger than for an ordinary menstrual period and may be painful."

While Cosmo diminished the risks, pro-abortion author Jessica Valenti acknowledged that misoprostol-only abortions have problems:

And while it’s important to spread the word that miso-only abortions are available, let’s be real: there’s a reason that the recommended regimen is mifepristone and misoprostol.

Miso-only abortions are often longer and less comfortable. A few advocates I spoke to worried that we’d see more ER visits because of miso-only abortions — not because the regimen isn’t safe, but because patients will be in more pain.

Under "patient information" Daily Med wrote:

"Misoprostol tablets may cause the uterus to tear (uterine rupture) during pregnancy. The risk of uterine rupture increases as your pregnancy advances and if you have had surgery on the uterus, such as a Cesarean delivery. Rupture (tearing) of the uterus can result in severe bleeding, hysterectomy, and/or maternal or fetal death."

This concern was not included in the Cosmo "guide."

Even online abortion dispensaries like Hey Jane acknowledge that "Misoprostol is a relatively safe abortion medication, but it may cause a rare, life-threatening condition known as uterine rupture. Misoprostol can trigger multiple uterine contractions, which can tear the muscular walls of the uterus.'

In addition, a 2023 San Francisco Chronicle article (reprinted by Planned Parenthood) stated (emphases added):

Mini Timmaraju, president of NARAL Pro-Choice America, has heard concerns from providers across the country that a misoprostol-only regimen is a “much more unpleasant procedure.”

It creates a “miscarriage-like medical situation, which is painful, uncomfortable, unpleasant,” Timmaraju told The Chronicle. “A lot of physicians have said they haven’t used that protocol. So they’re a little bit like, ‘Well, we know it can medically work, but this has not been the preferred protocol.’ So, we’re all trying to figure it out in real time, and that’s anxiety-inducing.”
Creating anxiety among those who are seeking abortions may be part of the reason behind the drive to remove mifepristone from the market, some advocates say....

Abortion rights advocates fear that this physically painful change in medication abortions will viscerally illustrate something that they’ve been trying to tell Californians ever since the Supreme Court overturned the constitutional right to obtain an abortion established in Roe v. Wade: California may be a haven for abortion rights, but it is not immune from federal laws restricting the procedure.

It should be acknowledged that women have experienced a tremendous amount of pain when taking mifepristone/misoprostol in combination, as well as when taking misoprostol alone.

Claim #3: Efficacy for misoprostol alone is the same as the abortion pill combination

Cosmo claimed that efficacy rates for misoprostol-only are 'similar' to the rate for mifepristone/misoprostol together. But is this true? Cosmo states:

Misoprostol-only abortions are similar to the 95 to 99 percent efficacy rate that comes with using mifepristone.

Yet, Planned Parenthood's website acknowledges a miso-only abortion regimen will work 85-95% of the time, which means that between 5-15% of the time, the drug will fail.

Using the 732,000 estimated abortion pill abortions nationally, this could translate to between 36.6K to 109.8K women annually having incomplete abortions.

1st Trimester Abortion | The Abortion Pill | What Is Abortion?

Claim #4: The risks are 'tiny'

Cosmo claimed:

The risks are extremely small... even tinier than “the risk of hemorrhage, infection, and pain when compared to giving birth.”

Pro-life OBGYN Dr. Ingrid Skop disputed this, writing at the Charlotte Lozier Institute (CLI):

"The medical evidence evaluating misoprostol only abortion documents failure to expel all the pregnancy tissue in 15-38.8% of cases... ongoing living pregnancies in in 6-16% placing children at risk for misoprostol induced birth defects, the possibility that infants will be born alive in 11-50% of cases when used in the second trimester, and a potential for uterine rupture in women with previous cesarean sections.

These frequent and devastating complications demonstrate this regimen is “unsafe and ineffective,” especially when used without medical oversight, as abortion advocates are increasingly recommending.

Live Action News previously documented the death of a 16-year-old girl in Papua New Guinea (PNG) who died after purchasing misoprostol on the street, later taking it to abort her pregnancy. 

Claim #5: It's fine to use misoprostol vaginally

Cosmo stated:

If you go the vagina route, there is no applicator (like how there is when taking a suppository for a yeast infection), so you’ll hold each pill between your fingers and push them inside one by one. 

Notably, vaginal use of the misoprostol has been suggested as a potential ‘causal factor’ in early deaths from a rare infection called C. sordellii. According to one report, “4 women in the United States who developed this condition after medical abortion had used misoprostol vaginally.”

A consent form published by the Center for Women’s Health states:

Serious infection has resulted in death in a very small number of cases; in most of these cases misoprostol was used in the vagina. Nothing indicates that use of Mifeprex or oral misoprostol caused these deaths.

According to adverse events data reported to the FDA for the two-drug regimen of mifepristone and misoprostol, “Deaths were associated with sepsis in 13 of the 36 reported fatalities (9 cases tested positive for Clostridium sordellii, 1 case tested positive for Clostridium perfringens, 2 cases had negative blood cultures, and 1 case did not have blood culture data).”

“Ten of the 13 fatal sepsis cases reported vaginal misoprostol use; 2 cases reported buccal misoprostol use; 1 case did not report the route of misoprostol use,” the FDA wrote.

The Bottom Line:

Media outlets like Cosmo, which publicly 'guide' women toward unapproved chemical abortion methods, are acting recklessly and showing no concern for the potential harms their suggestions might bring.