Disclaimer: Opinions expressed in this guest post are solely those of the guest author.
Giving mifepristone and misoprostol (combination drugs used for chemical abortion) to a patient who is late on her period without first obtaining a pregnancy test to exclude a pregnancy carries several clinical, ethical, and legal concerns, along with potential harms.
Skirting abortion restrictions, putting women at risk
In an attempt by abortion advocates to circumvent abortion restrictions, a new potentially dangerous, and ethically concerning, practice has arisen: the prescribing of these meds as “period pills“ following a missed menstrual period.
This is not referring to the standard prescribing of a progestin to trigger a withdrawal bleed in patients seeking care for irregular menstrual cycles. Use of oral medroxyprogesterone acetate, or a similar compound, has long been the standard for the evaluation and treatment of amenorrhea (missed cycles), or a delayed cycle. This is done in conjunction with a urine pregnancy test, as well as an evaluation for any other endocrine disorder which may be at play.
But in an attempt to redefine the practice of medical (chemical) abortion, abortion advocates are proposing mifepristone and misoprostol before pregnancy test completion in patients who are late on their menstrual cycle.
Proponents of this equate this to empiric therapy given for other conditions.
Empiric therapy refers to the practice of initiating treatment based on a likely diagnosis before disease confirmation. For example, clinicians often order antiviral medication like oseltamivir (Tamiflu) in patients with flu-like symptoms during peak influenza season; this can reduce illness severity and complications, even before confirmatory testing.
However, not all empiric treatments carry the same risk-benefit profile.
Administering mifepristone and misoprostol solely for a “late period” without confirming pregnancy is not equivalent. Unlike Tamiflu, which has a low risk profile, these drugs induce uterine contractions and carry potential risks such as hemorrhage or incomplete abortion. Clinicians must weigh the benefits of early intervention against the potential harms, ensuring that empiric therapy is both safe and appropriate for the clinical context.
However, this requirement is not satisfied with the mifepristone-misoprostol regimen.
Clinical Concerns
In their upcoming September 2025 publication in the journal Contraception, Ushma Uphadhyay et al state, “Period pills are a method used to induce bleeding when a menstrual period is late and pregnancy is suspected but not confirmed.” They conclude that “clinicians should consider offering them to patients as an additional option to control their fertility.”
In an attempt to expand abortion, the field of medicine has not only been placed on a slippery slope, but it is moving quickly down that slide.
Clinical concerns arise when mifepristone and misoprostol are administered without confirming pregnancy. These drugs offer no therapeutic benefit to a non-pregnant patient and expose them to unnecessary drug effects such as cramping, bleeding, nausea, and diarrhea without medical justification.
A delayed period can be due to various causes, including:
- anovulation
- stress
- polycystic ovary syndrome (PCOS)
- thyroid dysfunction
- perimenopause
Administering abortifacient drugs without confirming pregnancy may not only fail to address the underlying issue but may also obscure or delay its diagnosis.
Furthermore, giving these drugs without first obtaining a baseline beta-hCG can lead to dangerous misinterpretations of a clinical concern, such as missing an ectopic pregnancy, mistaking drug-induced bleeding for a miscarriage, or overlooking a molar pregnancy.
Physical and Psychological Harms
There are also potential physical and psychological harms.
Misoprostol in particular can cause severe cramping, heavy bleeding, gastrointestinal upset. Psychologically, a patient may experience emotional distress if she believes she terminated a pregnancy that never existed.
Additionally, if drug-induced bleeding is misattributed, genuine complications such as a miscarriage or ectopic pregnancy may go undiagnosed, delaying appropriate care.
Ethical and Legal Implications
Finally, ethical and legal implications must be considered.
True informed consent requires confirmation of a medical diagnosis when pregnancy is a possibility; administering abortion-inducing drugs without confirming pregnancy may violate that principle and could be seen as non-consensual if the patient was misled or misinformed.
Legally, many jurisdictions require documentation of a positive pregnancy test and gestational dating before abortifacients can be dispensed. Administering these drugs without such documentation could expose the provider to allegations of malpractice or negligence.
Eroding Standards to Expand Abortion
With over two decades of experience in direct patient care and a longstanding commitment to promoting safe and ethical pregnancy outcomes, I am deeply concerned about the erosion of traditional medical standards under the guise of expanding abortion access.
The proposal to provide abortion drugs without first confirming pregnancy introduces serious ethical dilemmas and compromises patient safety. As clinicians, our primary responsibility must remain the well-being of our patients, and we must hold ourselves to the highest standards of care. We can, and must, do better.
Bio: Hector O. Chapa, M.D. is an OBGYN and Diplomate for the American Board of Obstetricians and Gynecologists.
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