Period Pills: Another Option for Fertility Control

missed-period-pills-fertility-control
Mifepristone interrupts the flow of the hormone progesterone that creates and sustains a pregnancy. People take it, followed by misoprostol, if their period is late and they suspect they’re pregnant, but don’t want to be. (Robin Marty / Flickr)

Period pills—also known as “missed period pills” or “late period pills”—are medications that you can take if your period is late and you suspect you’re pregnant, but don’t want to be. The pills end a pregnancy if present, but either way they will bring on menstruation.

“If people want their periods to return and do not want to be pregnant, these medicines provide a benefit for them, regardless of their pregnancy status,” said Dr. Teresa DePiñeres, a physician who advocates for missed period pills. “Offering more options for fertility control is a good thing.”

Research shows period pills provide psychological and emotional benefits, especially in social contexts where abortion-related stigma exists. They can relieve the anxiety of waiting for a period to come, and the stress of taking a pregnancy test when you don’t want to be pregnant.

Period pills are now available via telemedicine in six states—California, Colorado, Massachusetts, New Mexico, Oregon and Washington—and in the District of Columbia as part of a pilot study run by the University of California, San Francisco. The pills can be taken even if menstruation is just a few days late.

“These medications are extremely safe and effective,” said DePiñeres, who works with the organization Period Pills to share information about this option and conduct research to show its safety. “They’ve been shown to be safe over and over and over again.”

The National Working Group on Period Pills is advocating for making period pills more accessible in the U.S. Formed in 2019. The group has 21 members, including medical clinicians, lawyers, reproductive justice leaders and researchers. The working group also has 14 organizational members, including five universities.

Advocates say some people prefer not to know if they are pregnant and others simply want to avoid waiting to confirm a pregnancy or schedule an abortion. They support missed period pills as another option for fertility control at a time when options are narrowing due to the recent Supreme Court decision reversing Roe and newly-adopted abortion bans in many states. Missed period pills can provide “reassurance and peace of mind if someone doesn’t want to be pregnant,” according to Period Pills.

“There’s not a right or wrong way. It’s just another option for getting the care we need, and to practice bodily autonomy,” said DePiñeres. “Most studies show that when people have options, they feel more satisfied with the care they receive.”

To restore menstruation, patients take 200 mcg of mifepristone, which interrupts the flow of the hormone progesterone that creates and sustains a pregnancy, and then 24 to 48 hours later, they take 800 mcg of misoprostol, which causes contractions to expel the contents of the uterus. Misoprostol can also be used alone to restore menstruation. Most healthcare providers currently require a positive pregnancy test before prescribing these medications.

DePiñeres notes that people often choose to take medicines that they may not need in order to prevent an unwanted condition, such as emergency contraception after unprotected sex or anti-malarial pills if they travel to a country with malaria cases. These medications have the psychological benefit of reducing stress and anxiety about an unwanted condition.

There’s not a right or wrong way. It’s just another option for getting the care we need, and to practice bodily autonomy. Most studies show that when people have options, they feel more satisfied with the care they receive.

Dr. Teresa DePiñeres

Research has indicated strong interest in missed period pills. A 2020 study of 678 people in two states found that 70 percent of those who did not want to be pregnant said they would prefer period pills instead of a test to confirm pregnancy. The researchers noted missed period pills could alleviate the impact of restrictive social norms and abortion-related stigma, which is associated with “increased anxiety, stress, depression, social isolation, negative self-evaluation and somatic symptoms.”

“If such a service were available, demand could be substantial,” they concluded.

Researchers at the University of California, San Francisco, are now conducting a missed period pill study to evaluate women’s experiences of using misoprostol alone to bring back a missed period. Participants are taking misoprostol after missing a period but without knowing whether they are pregnant. The study’s goal is to assess “the feasibility and acceptability of this traditional concept of menstrual regulation.”

Carol Downer, pictured here holding a Del-Em Kit for menstrual extraction, with her cat, Red. (Courtesy of Carol Downer)

Menstrual regulation has a long history in the United States where, for centuries, women have used a wide range of herbs and medicinal teas to “induce” or “bring down” a late period when they did not want to be pregnant. Before Roe, feminists did “menstrual extraction” using a manual vacuum aspiration technique before a pregnancy was confirmed.

Advocates believe period pills can help avert the negative consequences of new abortion bans, now in effect in over a dozen states across the country after the Supreme Court in June overturned Roe v. Wade and eliminated the constitutional right to abortion.

“In the United States, we are going to see increased maternal mortality because there are going to be more unwanted pregnancies under conditions that are not safe,” said DePiñeres. “More people are going to need abortions in places where they don’t have that option. This is a way to potentially mitigate or circumvent some of that.”

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About

Carrie N. Baker, J.D., Ph.D., is the Sylvia Dlugasch Bauman professor in the Program for the Study of Women and Gender at Smith College. She is a contributing editor at Ms. magazine. You can contact Dr. Baker at cbaker@msmagazine.com or follow her on Twitter @CarrieNBaker.