A 2017 Utah law requires health care providers to tell women seeking abortions that it may be possible to reverse those induced by medication — but new research questions whether that treatment may actually be dangerous, according to a California doctor.
And while a Utah OB-GYN argues legislators should now consider erasing the mandate, sponsor Rep. Keven Stratton said he believes no change is necessary.
Researchers at University of California, Davis, began testing the effectiveness of reversing abortions that are triggered by the use of two drugs: mifepristone, which is taken first, followed by misoprostol. Women who have taken only first drug have been able to continue their pregnancies by then taking progesterone, according to the Utah Department of Health.
But the California study of that process was halted early due to safety concerns, after three patients hemorrhaged. The findings were published earlier this month in the journal Obstetrics and Gynecology, and it remains an “unproven treatment,” said Mitchell Creinin, a professor of obstetrics and gynecology at UC Davis.
“I know that there’s legislators who want to pass a lot of laws about abortion. That’s fine. But do stuff that’s based on science. This is not based on science," Creinin said. “You’re potentially putting people at harm.”
Michelle Debbink, a clinical fellow in maternal fetal medicine at the University of Utah, said she was "surprised, actually, by their findings, mostly that they were as dramatic as they are.”
Even before the study, she said, "the vast majority of us who provide abortions (know) there’s no data that this actually works,” Debbink said. And with the new findings, “I would strongly encourage the state legislators this year to take a look at that and take a look at the information that we provide in our abortions.”
Debbink noted that her comments were made on her own behalf and are not a position taken by the U.
In 2017, Utah Gov. Gary Herbert signed an expanded informed consent law requiring “specified medical personnel to inform a woman seeking an abortion of the options and consequences of aborting a medication-induced abortion.” It also required the state Department of Health to publish information on this topic. Other states, including Kentucky, Nebraska and Oklahoma, have passed similar laws, according to NPR.
Stratton, R-Orem, the sponsor of Utah’s bill, said, “Obviously, terminating a pregnancy is a big deal. It’s a very difficult decision. I don’t want to minimize that at all.”
But Utah’s law doesn’t need to be updated, he said, because it was written to allow for medical providers to give patients the most "up-to-date information” about their options, which could include the new research findings. The law doesn’t require patients to choose a certain procedure, just to receive the information that’s available, he said.
The combination of mifepristone and misoprostol is a “safe and effective evidence-based regimen,” according to the American Congress of Obstetricians and Gynecologists. “Medication abortion is more effective when both drugs are used because mifepristone alone will not always cause abortion.” The ACOG, though, “does not support prescribing progesterone to stop a medical abortion.”
“Claims regarding abortion ‘reversal’ treatment are not based on science and do not meet clinical standards,” according to the ACOG. Reports of individual cases, which reversal supporters suggest show the treatment could possibly work, “are among the weakest forms of medical evidence,” the ACOG said.
The state health department website says, “Observations have suggested that women who take mifepristone, but not yet misoprostol, might reverse the effects of mifepristone by taking the medication progesterone.” While “successful pregnancies have been observed after taking mifepristone alone and then progesterone,” the department adds, “at present, there is insufficient evidence to prove that progesterone is an effective treatment.”
The department also provides contact information for the Abortion Pill Reversal Hotline for people “to locate a doctor in your area who is knowledgeable about mifepristone reversal.”
For Creinin’s study, researchers planned to enroll 40 patients who were planning to have a surgical abortion. The patients took mifepristone and then were either given progesterone or a placebo, but patients and researchers did not know who was given which treatment.
The study was stopped in July, after just 12 patients were enrolled, because three of the patients hemorrhaged and had to be taken by ambulance to a hospital. One had received progesterone, and two received placebos.
“This was not medical abortion bleeding," Creinin said. “I’ve been providing medical abortions for decades. ... These women just briskly hemorrhaged.”
There are still “no studies, no full reports, no proof of safety, let alone no proof, that it works,” Creinin said. The passage of laws requiring doctors to tell patients that it could possibly work “is an unmonitored experiment,” he said.
“So, even legislators or anti-choice people who say, ‘Well, it’s better to give it than not to give it because maybe it will (work).’ Well, but it might be dangerous,” Creinin said.
Patients should be able to trust that what their doctor tells them will not hurt them, he said. Plus, the idea that women second-guess having an abortion is very rare in Creinin’s and Debbink’s experiences, they said.
“It makes me feel very uncomfortable” to have to tell patients about the “abortion pill reversal” procedure, Debbink said.
“The state can mandate the things that I have to say, but it can’t mandate the things I say in addition,” she said. While “the state requires me to tell you that this thing exists ... I feel medically, ethically obligated to tell you that there’s no science behind it. And that I don’t know if it works.”
Now, after this new research, Debbink said, “I will have even more reason to say, ‘And I think that there is some emerging data that it may be dangerous to you.’”
Becky Jacobs is a Report for America corps member and writes about the status of women in Utah for The Salt Lake Tribune. Your donation to match our RFA grant helps keep her writing stories like this one; please consider making a tax-deductible gift of any amount today.