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.”
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Notes to Editor
To view the full position statement, visit: https://www.rcog.org.uk/media/nbahkgvo/rcog-fsrh-abortion-reversal-position-statement.pdf