For Healthcare Professionals
Medical Abortion
Medical abortion is the prescribing of the progesterone antagonist; Mifepristone (also known as RU-486) followed 24-48 hours later by the prostaglandin analogue; Misoprostol. Mifepristone acts primarily by competitively binding to progesterone receptors in the endometrium causing detachment of the developing placenta leading to fetal demise. Misoprostol acts by causing uterine contractions to expel the fetal sac, placenta and membranes.
Abortion Pill Reversal
It is possible to reverse the anti-progestogen effects of Mifepristone by prescribing progesterone replacement for several weeks. Progesterone should be taken as soon as possible following Mifepristone and has a success rate of 50-70% for foetal survival and a later live birth.(1,2) It is not possible to reverse medical abortion if the second drug Misoprostol has already been taken.
Many women describe immediate regret on taking Mifepristone and are given a second chance by taking the abortion pill reversal and this in keeping with the principles of patient autonomy. The American Association of Prolife Obstetricians and Gynaecologists AAPLOG states that Abortion Pill Reversal offers a medically sound choice to attempt to reverse the effects of Mifepristone, to women who have changed their minds about abortion after taking the first pill of the abortion regime.(3)
Utrogestan Oral
In The UK, progesterone is available in oral form under the brand name Utrogestan oral. Abortion pill rescue therapy can be provided by prompt administration of high dose oral Progesterone micronised capsules. It is available in The UK as Utrogestan 100mg capsule doses. The recommended dosing regimen in APR, determined by the Delgado and Davenport study (1), is 400mg as soon as possible after ingestion of Mifepristone, the first abortion-inducing pill, followed by 400mg bd for 3 days and then 400mg nocte until 14 weeks gestation.
In cases where pregnancy has already advanced to the 2nd trimester before Mifepristone has been taken, we recommend 400mg as soon as possible after the Mifepristone has been taken, followed by 400mg bd for 3 days and continuing 400mg nocte for at least a further 2 weeks.
Utrogestan oral is licenced in The UK for adjunctive use with Oestrogen in post-menopausal women as hormone replacement therapy.
Click here for Utrogestan product specification UK
Cyclogest Vaginal
In Ireland and The UK progesterone is available as Cyclogest; a vaginal pessary. Cyclogest is licenced for use in the UK for pre-menstrual syndrome, post-natal depression and Assisted Reproductive Technology (ART) programmes. It is also commonly prescribed for threatened miscarriage and to support high-risk pregnancies.(4,5,6)
Cyclogest is not licenced for use in Ireland but is widely prescribed by GPs, fertility specialists and Obstetricians and dispensed by local pharmacies.
Click here for Cyclogest product specification UK
Responsible Prescribing
Progesterone is prescribed by a medical practitioner registered by the General Medical Council in The UK or the Irish Medical Council in Ireland. The doctor will conduct a consultation with the patient and take appropriate measures to protect confidentiality and keep medical records in line with good professional medical practice. Progesterone is prescribed to the woman with her informed consent and she will be advised to arrange an early pregnancy ultrasound to confirm a viable pregnancy. The woman will be offered medical follow up and provided with a copy of the prescription for her GP’s records.
Progesterone can cause some minor adverse effects for the mother, particularly nausea and tiredness. These adverse effects, if they occur, are usually less noticeable from day 4 of treatment onwards. The vast majority of women receiving Progesterone do not suffer any significant adverse effects. Progesterone is known to be safe for the developing child in utero.
For further details on a clinical protocol for use of Progesterone for abortion pill reversal in Ireland and The UK click here.
For client consent form (click here PDF)
Responsible dispensing
Progesterone is obtained from a pharmacy registered with the General Pharmaceutical Council in The UK and Pharmaceutical Society of Ireland in Ireland according to the principals of responsible prescribing.
Medical Links
To join the international network of abortion pill reversal medical providers in Ireland and The UK: Email: [email protected]
Clinical protocol for use of Progesterone for abortion pill reversal in Ireland and The UK click here PDF
For client consent form click here PDF
Research on the efficacy and safety of progesterone in threatened miscarriage
- A Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone
George Delgado 1, Steven J Condly 2, Mary Davenport 3, Thidarat Tinnakornsrisuphap 4, Jonathan Mack 4, Veronica Khauv, Paul S Zhou. Isssueslawmed: Spring 2018;33(1):21-31
https://issuesinlawandmedicine.com/product/spring-2018-full-issue/ - American Association of Prolife Obstetricians and Gynaecologist: The reversal of the effects of Mifepristone by progesterone . https://aaplog.org/wp-content/uploads/2020/01/FINAL-PB-6-Abortion-Pill-Reversal-1.pdf
- American Association of Prolife Obstetricians and Gynaecologist statement on abortion Pill Reversal https://aaplog.org/wp-content/uploads/2019/02/2019-AAPLOG-Statement-on-Abortion-Pill-Reversal.pdf
- Effect of progestogen for women with threatened miscarriage: a systematic review and meta‐analysis L Li Y Zhang, H Tan, Y Bai, F Fang, A Faramand, W Chong, Y Hai, 23 April 2020, British Journal of Obstetrics and Gynaecology April 2020. https://doi.org/10.1111/1471-0528.16261
- Lek SM, Ku CW, Allen JC Jr, et al. Validation of serum progesterone <35nmol/L as a predictor of miscarriage among women with threatened miscarriage. BMC Pregnancy Childbirth. 2017;17(1):78. Published 2017 Mar 6. doi:10.1186/s12884-017-1261-4
- Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH. Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev. 2018;8(8):CD005943. Published 2018 Aug 6. doi:10.1002/14651858.CD005943.pub5