Over the past several years, the legal battles surrounding the abortion drug mifepristone— particularly its access and availability—have escalated following the Supreme Court’s decision to overturn Roe v. Wade. The pill, approved by the FDA for terminating pregnancies that are less than 60 days in duration when combined with misoprostol, has emerged as the most widely accepted method for medication abortions. According to the Guttmacher Institute (a pro-abortion rights research group), it accounted for over 60% of all abortion procedures in the United States in 2023.
Even though mifepristone has been successful, it’s still difficult or even impossible to obtain it legally in half of the states in the country after the 1973 landmark ruling on the right to an abortion was repealed in 2022. As a result, many federal lawsuits have threatened access to the pill for those who need it, but now, a new study might have found another option that could work just as well.
A known medication called Ella, its active ingredient is ulipristal acetate, it is one of the two types of “morning-after” pills approved by the FDA (the other is Plan B One-Step— it’s active ingredient is levonorgestrel), is at the center of a new study that shows it could be a viable alternative to mifepristone for terminating pregnancies up to ten weeks.
Published last week in the New England Journal of Medicine, the examination was conducted by researchers at Gynuity Health Projects (a reproductive-rights non-profit), where more than 100 women who were up to nine weeks pregnant took two doses of Ella, followed by misoprostol, which which is a medication commonly used in the standard abortion procedure.
The results showed that the method was 97% effective in ending their pregnancies. The data also revealed that there were no serious health issues and concluded that using Ella in this two-drug abortion method was safe.
The few women who didn’t succeed completed the process with other medications or procedures.
“The success rate of this combined regimen as an abortifacient with minimal additional care needed for ongoing pregnancy, incomplete abortion, or adverse effects is encouraging,” the authors wrote.
The goal of the study was to determine if the combined use of Ella and misoprostol could provide a safe and effective alternative to current medication abortion regimens, Manuel Bousiéguez, Consulting Associate at Gynuity Health, told MedPage Today. Right now, Ella is only approved by the FDA as an emergency “morning after” pill. However, this study shows that it could be a good alternative to mifepristone and can also safely end an early pregnancy.
Another positive point is that Ella has a solid background. Not only has it been approved by the FDA, but it has also been available for ten years.
“The findings open up the possibility that an ulipristal-misoprostol regimen may be a promising option for early medical abortion, with potential for broader application in clinical settings,” Bousiéguez said, adding that this would be especially beneficial “in settings where mifepristone might be inaccessible or restricted.”
While the research is promising, it might make the already divided views on abortion even more confusing. This is because Ella has mostly been used as emergency contraception, which could lead to misunderstandings about how it differs from abortion. For years, abortion opponents have claimed that “morning-after” pills can cause abortions. In response, experts in reproductive health have pointed out that scientific evidence shows these pills do not end a pregnancy; instead, they prevent pregnancy after sexual intercourse.
In a related article, Daniel Grossman, MD, from the University of California San Francisco, said that although the “study is promising, a larger trial is needed, preferably one that compares the effectiveness with either the mifepristone-misoprostol or misoprostol-only regimen.” He emphasizes that just looking at the study’s results is not enough “to justify the use of ulipristal acetate in medication abortion outside of a research setting” and that more research is needed.
Nevertheless, Grossman did point out that exploring alternatives may be helpful if mifepristone becomes even more restricted in the U.S.
“However, there is a risk that the findings of this study could be misapplied and used by politicians to try to restrict ulipristal for emergency contraception,” he wrote. “Any efforts to limit access to ulipristal’s use as an emergency contraceptive would be detrimental to patients.”
Perrigo, the maker of Ella, released a statement explaining that the recent study used a higher dose (two doses) of ulipristal acetate than what is in one Ella pill and also combined it with misoprostol. They emphasized that “There continues to be no evidence to show that, on its own, Ella causes an abortion.” Perrigo also added that “Ella is an F.D.A.-approved emergency contraception pill that acts before pregnancy can occur.”
Additionally, The Times has reported that in Europe, researchers like Dr. Rebecca Gomperts, a Dutch doctor who started telemedicine groups that supply abortion pills worldwide, are looking into using low doses of mifepristone as a weekly birth control pill. Dr. Gomperts mentioned that she thinks the new study on Ella is enough to allow her to prescribe the drug for purposes other than what it’s officially approved for, along with misoprostol.
Dr. Paul Blumenthal, an emeritus professor of obstetrics and gynecology at Stanford University, who was in an advisory group for the study, agrees.
“The more uses we have for these medications,” he says to The Times, “the harder it will be for people to take them away.”
