What is mifepristone, and why is it in the news right now?

Reproductive Health

A: Mifepristone is a synthetic hormone (made outside the body) that blocks progesterone and cortisol. Progesterone and cortisol are two hormones that the body makes.

Progesterone is a hormone that helps in many normal processes, including keeping the uterus from contracting during early pregnancy.

As a progesterone blocker, mifepristone leads to uterine contractions and is part of the medication duo that is used to safely end a pregnancy in the first 10 weeks. Most terminations occur in the first 8 weeks of pregnancy, and mifepristone is the most commonly used method for these early terminations. See our post on the demographics of terminations here.

It is also used with some people who are having a miscarriage to help the uterus contract and empty.

Cortisol is a hormone that helps us with our stress response, metabolism, and immune system. As a cortisol blocker, mifepristone is used for people with Cushing disease who have high blood sugar because of high cortisol levels.

Why is this hormone in the news?

It is in the news because U.S. District Judge Matthew Kacsmaryk in Texas ruled that the Food and Drug Administration “exceeded its authority” by approving mifepristone in 2000. He wrote that the agency used a sped-up process meant for drugs to treat “life-threatening diseases.” He also wrote that the drug does not provide a “meaningful therapeutic benefit” for patients. *Interestingly, he carved out and protected its use for Cushing disease.

This judge issued a *nationwide* injunction pausing the FDA’s approval, which is set to take effect on April 14, 2023. (An injunction is an order issued by a judge that forces a person or entity to perform an action or stop taking a certain action. In this case, it is an order to make the FDA stop its approval of mifepristone.)

If this ruling stands:

it will affect every state in the U.S.

it will affect people having miscarriages who need this medicine.

it will affect people seeking to end their pregnancies in the safest, most effective manner during the first 10 weeks.

it will affect people who want to avoid surgical procedures to end their pregnancies. They will have to rely on a less effective medication.

it will *not* affect people with Cushing disease with high blood sugar who need this medicine.

The second medication typically used in medical abortion is misoprostol. It is usually given 24 hours after mifepristone. It can still be used alone to help end a pregnancy or to manage a miscarriage, but it has higher failure rates when used alone. The mifepristone-misoprostol treatment works in 95 out of 100 pregnant people. The misoprostol-only treatment works in 76 out of 100 pregnant people. Source

You can still end pregnancies surgically in states where the procedure is legal. See an interactive map here.

TL;DR: If you are sexually active, of reproductive age, and do not want to be pregnant, talk to your clinician *next week* about what options are available to you. Things to consider: having a backup supply of emergency contraception (not the same as mifepristone and available over the counter), getting an IUD, using a barrier method and spermicide *every time* you engage in sexual activity, or talking to your partner(s) about vasectomies. See past posts for more on emergency contraception and other options:

Is emergency contraception the same as abortion?

What are my options if I don’t want to be pregnant right now?

We are following this issue closely. We will have more information in our post on Friday Apr 14, 2023.

Stay safe. Stay strong. Stay informed.

Those Nerdy Girls

References and Resources:

Understanding mifepristone:

FDA: What is mifepristone and how does it work?


Understanding the ruling:
Roll Call: Dual court rulings throw confusion into abortion drug debate

Read the ruling itself:
NY Times: Read the Court Decision Ordering the F.D.A. to Keep Mifepristone Available

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