The American Medical Association recently joined in a lawsuit against the state of North Dakota for laws that AMA President Patrice Harris says, “would force doctors who perform abortions to lie to patients (and) put physicians in a place where we are required by law to commit an ethical violation.” One of those laws requires physicians to tell patients that medication abortions can be reversed.

A Toxic Mix

The AMA objects to the off-label use of progesterone to help sustain a pregnancy if a woman changes her mind after ingesting the first component of the medical abortion regimen. In other less socially divisive situations the AMA is willing to advocate for off-label medication use as long as a woman has been counseled thoroughly.

Mifepristone blocks the receptors of the hormone, progesterone, which sustains a pregnancy. When mifepristone is administered, it causes the lining of the uterus to break down resulting in death of the unborn human. Since it does not reliably cause uterine contractions, mifepristone must be paired with misoprostol, usually 24-48 hours later, to cause contractions to expel the pregnancy tissue.

For many reasons, some women change their minds at this point and seek to stop the abortion process.

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Progesterone Can Reverse the Process

Researchers discovered from animal studies that natural progesterone would reverse the effects of mifepristone by outcompeting for the progesterone receptors. A review of the world’s literature revealed that less than 1 out of 4 embryos will continue to live after mifepristone alone if misoprostol is not taken.

These researchers began to offer supplemental progesterone to women, with their full understanding and consent, who desired to reverse the abortion-causing action of mifepristone.


Progesterone supplementation during pregnancy is a standard intervention for other indications. Progesterone is almost universally prescribed for women who have conceived through assisted fertility and may also be recommended for women with low progesterone levels, bleeding or prior pregnancy losses. It is also used at later gestational ages to prevent preterm births. The American Society for Reproductive Medicine has stated that there are no known risks to the mother or to her unborn child from using progesterone in pregnancy.

Reversal of mifepristone’s effects succeeded in several cases. Publication of these cases, combined with the understanding of the physiologic effects of natural progesterone, launched the Abortion Pill Reversal network of physicians willing to help women who change their minds.

A retrospective study of over 750 women who sought Abortion Pill Reversal has been performed. That study demonstrated that two-thirds of the women had continuing pregnancies after receiving the most effective progesterone protocols to “reverse” the effects of mifepristone. The study showed no increase in the rate of birth defects in the children born after reversal.

To be sure, not every unborn baby will survive, but it appears progesterone supplementation may increase the chances for survival from 25% to 68%. At the very least, the woman who changes her mind can be assured that she did what she could to save her baby.

This poses a dilemma for advocates of “choice.” If they want widespread abortion accessibility to allow a woman to choose to end a pregnancy, do they support a woman’s choice to continue a pregnancy?

Skop is a fellow of the American College of Obstetrics and Gynecology, and a board member of the American Association of Pro-Life Obstetricians and Gynecologists.