Written by Rachel Chisausky, DO

Missed-period pills are a new take on the age-old practice of “bringing down” a late period. Menstrual regulation (MR), or the use of a variety of methods to “establish nonpregnancy after a missed period,” was traditionally the purview of midwives, and was generally accepted until “quickening.”* Later, the self-help movement of the 1970s used “menstrual extraction” as a means to bring a delayed period.¹ Today, state programs in Cuba and Bangladesh (where abortion remains illegal) offer MR, generally via uterine aspiration or mifepristone and/or misoprostol, to people whose pregnancy has not been confirmed.^2-4

While the use of misoprostol with or without mifepristone to trigger a bleed may sound synonymous with medication abortion, a period can be missed for a variety of reasons other than pregnancy, and MR exists within this space of uncertainty. A recent study in Contraception found that period pills would serve a specific niche by “avoiding pregnancy” or “ensuring [I] am not pregnant.”⁵ For example, participants stated:

“It would be easier on my emotional well-being to not know I was actually pregnant but to alleviate the issue which is my missed period.”

“I feel like there would be more reason for women to come to a place where they can just spur their period on. It would be a psychological cushion, in a sense, for those women who may be unsure of their own feelings on abortion…”**

Medically, period pills are neither contraception nor abortion. Therefore, they occupy a legal gray area, with minimal precedent or case law. Politicians may construe period pills as intent to facilitate abortion even without known pregnancy and advocate to restrict them to the same extent as abortion.⁶ The National Working Group on Period Pills in the US (periodpills.org) is actively exploring increasing access to period pills, which are currently available in all 50 states, typically as “advance provision” under telemedicine medication abortion providers. This is in line with the National Abortion Federation’s 2024 Clinical Practice Guidelines, provided the patient would be eligible for medication abortion.⁷*** Though not yet widely studied, safety can be inferred from studies of self-managed abortion and telemedicine medication abortion.

Period pills represent the use of modern medication in a long tradition of community-driven fertility control, offering an additional option to manage the uncertainty and stress of a missed period. Currently seated in the telemedicine medication abortion sector, we may see these become their own entity, although it is legally unclear how that will progress. Research on patient interest in period pills is ongoing at UCSF.

**“Quickening” was used to confirm/define pregnancy as the cause of a missed period

**The research cited in this Insights uses the term “women.” RHAP recognizes that this language is not inclusive of all people who may have abortions. A person’s biology does not determine their gender.

***NAF CPG: Providers can prescribe and dispense abortion medications for patients who are at risk for pregnancy for future use (advance provision) or for use in the setting of suspected, but not confirmed, pregnancy (menstrual regulation or “missed period pills”). Once the patient either confirms or suspects they are pregnant and uses medication abortion, the guidelines in CPG 6 for Early Medication Abortion apply. Standard 7.1 Prior to prescribing and dispensing medication, the patient must be evaluated, either in-person or remotely, and eligibility for medication abortion must be confirmed.

RHAP Resources:

How To Use Misoprostol-Only for a Medication Abortion

How To Use Abortion Pills Fact Sheet

Sources:

1. Home. Period Pills. https://www.periodpills.org/

2. Hossain, A, Singh S, Remez L, Maddow-Zimet I. Menstrual Regulation, Unsafe Abortion And Maternal Health in Bangladesh. Guttmacher Institute. Published February 24, 2016. Accessed July 10, 2024. https://www.guttmacher.org/report/menstrual-regulation-unsafe-abortion-and-maternal-health-bangladesh

3. MCH Services Unit, Directorate General of Family Planning (DGFP). Bangladesh National Comprehensive Menstrual Regulation (MR) and Post-Abortion Care (PAC) Services Guidelines.; 2021. Accessed July 10, 2024. https://dgfp.portal.gov.bd/sites/default/files/files/dgfp.portal.gov.bd/miscellaneous_info/b9fe53f4_f584_4339_88f2_fd3e1f44390d/2023-08-17-08-07-39bebdebc46b89694d1b6e036044173b.pdf

4. Acosta D. HEALTH-CUBA: Abortion Competes With Contraceptives. Inter Press Service. Published June 1, 2006. Accessed July 10, 2024. https://www.ipsnews.net/2006/06/health-cuba-abortion-competes-with-contraceptives/

5. Sheldon WR, Mary M, Harris L, Starr K, Winikoff B. Exploring potential interest in missed period pills in two US states. Contraception. 2020 Dec;102(6):414-420. doi: 10.1016/j.contraception.2020.08.014. Epub 2020 Sep 9. PMID: 32916168.

6. Lint SG. The Legal Limbo of Menstrual Regulation: Implications of Expanding Reproductive Health Options in the United States. Berkeley Journal of Gender, Law & Justice. 2021;36(1). doi:https://doi.org/10.15779/Z38SB3X024

7. Prager S, Chaiten L, Diedrich JT, et al. 2024 Clinical Policy Guidelines for Abortion Care. National Abortion Federation. Published February 2024. Accessed April 16, 2024. https://prochoice.org/providers/quality-standards/

Pharma-free: The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or products. The information in the Insights is unbiased, based on science alone.

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