The Royal College of Obstetricians and Gynaecologists (RCOG), the Faculty of Sexual and Reproductive Healthcare (FSRH), the Royal College of Midwives (RCM) and the British Society of Abortion Care Providers (BSACP) have published a joint position statement saying there is ‘no reputable evidence’ in the use of progesterone to ‘reverse’ an abortion.
It comes after recent reports found that some doctors in the UK are prescribing progesterone to women in order to ‘reverse’ a medical abortion so that they can continue a pregnancy.
A medical abortion involves taking two different medications to end a pregnancy; mifepristone and then misoprostol. So-called abortion ‘reversal’ treatment involves prescribing doses of progesterone after a woman has taken the first medication (mifepristone) with the objective of reversing the effect.
The organisations state that there are no reputable national or international clinical guidelines that recommend the use of progesterone to reverse the effect of mifepristone, and no evidence that it increases the likelihood of a pregnancy continuing.
The statement also outlines best practice for healthcare professionals when a woman does wish to continue a pregnancy after taking mifepristone, as well as ensuring they are provided with evidence-based and non-biased information so they can make informed decisions around pregnancy choices.
Dr Edward Morris, President of the Royal College of Obstetricians and Gynaecologists, said: “We’ve become increasingly concerned about reports that healthcare professionals in the UK are prescribing progesterone to women and advising that this will successfully ‘reverse’ an abortion.
“The General Medical Council (GMC) states that when prescribing a drug for a purpose that it isn’t licensed for then a doctor must be satisfied that there’s sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy. We don’t believe this to be the case when using progesterone in this way.
“We know that, for the majority of women, accessing abortion care in a timely and effective way is a relief. However it is vital that on the rare occasion an individual does change their mind after taking mifepristone, they should be supported and offered non-directive, neutral counselling with the benefits and risks of each of their options discussed.”
Dr Tracey Masters, abortion care lead at the Faculty of Sexual and Reproductive Healthcare (FSRH), said:
"No reputable medical body recommends progesterone treatment for this indication.
“We are concerned about this off-license provision of progesterone, especially when supplied in non-standard clinical settings. We often hear that those clinicians involved fail to give objective counselling on the very limited evidence behind this “treatment”. We also hear that they fail to support them to an abortion pathway if the woman later returns to this choice.
“On the rare occasions when women change their minds after initiating an abortion, they need to be offered genuine, unbiased support and choice around their options, whether it be continuing with the pregnancy (if still viable) or opting to return to abortion".
Birte Harlev-Lam, Executive Director, Midwife at the Royal College of Midwives, said: “This is a worrying development. It is vital when women are making decisions about their care that they have evidence-based information on which to make those important decisions. It is also crucial that the advice and support they get from health professionals and others is unbiased and lays out the options they have without pressure or suggestion, so that women can make the choice that is right for them. Failing to do this is failing the women we are all here to care for.”
Dr Jonathan Lord, Co-Chair of the British Society of Abortion Care Providers (BSACP), said: “We are concerned that there are anti-abortion groups recommending progesterone and as a medical organisation we wish to make it clear that this approach isn’t supported by clinical evidence.
“Individuals who prescribe these untested treatments act outside regulated care systems and it’s likely they won’t offer impartial advice to women about all of their options. This is distressing and confusing for the women involved at a time they may be especially vulnerable.
“Healthcare professionals working in abortion care are experts in the provision of evidence-based information and non-directive counselling, and are best placed to provide the support, counselling and safeguarding for whatever choice is best for their needs, whether that is continuing with the pregnancy or proceeding with an abortion.”
For media enquiries please contact the RCOG press office on +44 (0)7740 175342 or email firstname.lastname@example.org.
Notes to Editor
To view the full position statement, visit: https://www.rcog.org.uk/media/nbahkgvo/rcog-fsrh-abortion-reversal-position-statement.pdf
Q&A on abortion reversal
What is the process of an early medical abortion?
A medical abortion occurs by taking two medications, mifepristone, and then misoprostol. The process starts by firstly taking mifepristone. One to two days after this, one or two doses of misoprostol will be taken a few hours apart.
Mifepristone prepares the uterus to make its response to the second medication more effective. The second medication, misoprostol, will cause the womb to contract to bring on cramping and bleeding, resulting in the loss of pregnancy in almost all cases.
Can an abortion be reversed by taking progesterone?
Anti-abortion groups claim that early medical abortions can be reversed by taking progesterone after the first prescribed medication of mifepristone.
There is no evidence to suggest that taking progesterone will reverse an abortion, and the RCOG and Faculty of Sexual and Reproductive Healthcare (FSRH) does not recommend using any progesterone in this way. The suggestion that an abortion can be ‘reversed’ by using progesterone is misleading and is not offered by NHS services, or licensed for this purpose in the UK. It is not recommended by any responsible medical body.
Is it dangerous to take progesterone after the first abortion medication (mifepristone)?
Although progesterone is a commonly used medication for other reasons (such as period control or as part of IVF), it does commonly cause side effects and is expensive. Those that prescribe it following mifepristone use very high doses, and without any evidence of benefit it means the only effects are negative ones such as bowel disturbance, bloating and mood disorder.
Are there any dangers associated with not taking the second abortion medication?
On its own, mifepristone may prevent a pregnancy from continuing and cause a miscarriage, but studies have shown that even in higher doses than now used in abortion care, many pregnancies continue and are not affected after the first tablet. There is no evidence that mifepristone causes birth defects.
Is it concerning that some groups are recommending progesterone?
It is concerning that some organisations and individuals are recommending progesterone as an abortion reversal medication despite the lack of evidence of effectiveness and the likelihood of side effects. This is an off-label prescription and is not licenced for abortion reversal. The people recommending abortion reversals are associated with anti-abortion activist groups, and they have no access to the range of services that NHS services can provide. They are unlikely to offer impartial, non-judgemental advice or discuss your full range of options. We wish to stress that this practice is not supported by medical evidence and is not endorsed by any authoritative national or international best-practice guidelines.
All drugs have side-effects and by suggesting progesterone can reverse an abortion without evidence to support this, these people are providing false reassurance to vulnerable women and girls which could be distressing and confusing for the women involved.
Where can you find trusted advice?
It is vital that women and girls are able to access truly impartial support and information. They should speak to non-judgemental healthcare professionals to make an informed decision, such as NHS approved abortion providers BPAS, NUPAS or MSI Reproductive choices.
Anyone who is concerned or has questions about their abortion care should speak to the clinic or service from which they received treatment.
I’ve taken the first tablet but I am considering still going ahead with the pregnancy – what should I do?
We would recommend you contact the abortion provider who gave you the mifepristone. They can offer non-judgemental advice and counselling and will support you whether your decision is to continue the pregnancy or to proceed with an abortion. Nobody minds if you change your mind, and we know that whilst most people are certain of their decision, for a few it can be much harder. If you want to continue the pregnancy an ultrasound scan is usually recommended. If you want to continue with the abortion, this can usually continue with tablets or a minor operation. Nobody minds what your decision is, and NHS services will make sure that you have unbiased information to help you make the best choice for whatever your circumstances are.