Update on medical abortion

PURPOSE OF REVIEW: Medical abortion using mifepristone and misoprostol comprises a growing proportion of abortions performed in the United States. Simplifying the process of medical abortion can optimize use of resources and improve care for women. RECENT FINDINGS: Medical abortion using evidence-based protocols is effective through 70 days' gestation. The requirement of a follow-up office visit with a transvaginal ultrasound to ensure completion of medical abortion is safely and effectively replaced with self-administered low-sensitivity or semiquantitative urine pregnancy tests and remote communication with women. Most contraceptive options can be initiated the same day as mifepristone administration to improve contraceptive use after medical abortion. State legislatures continue to pass laws that threaten evidence-based medical abortion practices. Such efforts ultimately limit access to well-tolerated and effective medical abortion services. SUMMARY: Research supports simplification of the follow-up protocol for medical abortion, and provision of the contraceptive implant and progestin injectable for postabortion contraception the same day as mifepristone administration. With disregard to its documented safety and efficacy, legislative challenges persist as significant challenges to provision of evidence-based medical abortion.