Medication abortions are just as safe when women have virtual visits to get prescriptions as when they make in-person appointments, a study found.
Abortion pills have been legal in the United States for more than two decades as an option for ending pregnancies up to about 10 weeks’ gestation. But for most of this time, the U.S. Food and Drug Administration (FDA) has required women to get these pills prescribed at in-person visits, effectively limiting access.
FDA Requirement Temporarily Lifted Due to the Pandemic
When the COVID-19 pandemic hit, the FDA temporarily lifted this requirement, allowing women to get abortion pill prescriptions from telemedicine visits and receive the medications by mail instead of going to a pharmacy. This not only helped women get needed medical care during the pandemic, it also enabled researchers to collect evidence about the safety and effectiveness of offering medication abortions without in-person visits.
“We suspected for a long time that we could use patients’ medical history to determine whether medication abortion was right for them, and we had substantial data that people seeking abortion could accurately report the date of their last menstrual period, allowing for accurate dating of their gestational duration,” says the lead study author, Ushma Upadhyay, PhD, MPH, an associate professor and reproductive health researcher at the University of California in San Francisco.
“But it wasn’t until the COVID-19 pandemic, when providers began to use this new protocol to minimize in-person contact, that we could actually test the safety of these new protocols,” Dr. Upadhyay says.
About One-Third of Study Participants Received Pills in the Mail
For the study, researchers examined data on 3,779 women from 34 states who got medication abortions during the pandemic. None of them had ultrasounds or pelvic exams first, and roughly one-third of the participants received medications by mail instead of going to a pharmacy.
Overall, 95 percent of the abortions were effective at ending early pregnancies, and this didn’t differ whether women picked up medications in person or received pills through the mail, the researchers reported in JAMA Internal Medicine. This effectiveness rate is comparable to what’s seen with medication abortions that require screening ultrasounds in advance, the researchers noted.
Only 12 abortions — 0.54 percent — resulted in serious adverse events that required hospitalization, surgery, or a blood transfusion. This is also similar to what’s seen when women have in-person exams before medication abortions, the study team noted.
There were nine patients — 0.40 percent — who turned out to be more than 10 weeks pregnant when abortion pills were dispensed. Two of these women had effective medication abortions, while six required surgical procedures to terminate their pregnancies, and one delivered a stillborn fetus. This indicates that doctors should educate women about this possibility, the researchers point out.
Another concern is that four women had ectopic pregnancies, a potentially life-threatening condition that happens when a fertilized egg implants outside the uterus, often in the fallopian tubes.
While this suggests that a small proportion of women may have undetected ectopic pregnancies at the time of their abortions, the risk of this may be outweighed by the broader benefits of expanded access to care and earlier treatment, the study team concluded.
“Medication abortion is safe and effective,” Upadhyay says. “In the past 20 years, 13 deaths among the approximately 3.7 million patients who have used medication abortion care are possibly related to the abortion.”
More than half of abortions today are done using medication — a regimen that includes the drugs mifepristone and misoprostol.
Broader access to medication abortions without ultrasounds or in-person appointments should be an option for women who want it, says Jennifer Karlin, MD, PhD, a coauthor of an editorial accompanying the study and an assistant professor in family and community medicine at the University of California in Davis.
Many women may find it easier to access timely care with medication abortions facilitated by telemedicine visits, and this option should be available to them, Dr. Karlin says. In-person exams, including ultrasounds, should also be available for women who need this, including people with a history of ectopic pregnancies or irregular menstrual cycles.
“The evidence shows that in-person appointments for most people are not necessary,” Karlin says.