Abortion pills are safe and effective when used very early in pregnancy, according to a new study published in the New England Journal of Medicine. Traditionally, clinics and hospitals delay medication abortions until an ultrasound confirms the pregnancy, usually around the sixth week, but this research challenges that practice, finding that earlier administration is both safe and successful.

Lead researcher Dr Karin Brandell, a gynaecologist at Karolinska University Hospital in Sweden, explained the relevance of the findings: “Women often find out very early if they’re pregnant, and many also know if they want a termination. If so, they prefer it to happen as quickly as possible.” The study offers promising data suggesting that women can safely take abortion pills before the sixth week, potentially allowing them to address unwanted pregnancies sooner.

Typically, doctors recommend waiting for an ultrasound to rule out the risk of an ectopic pregnancy. An ectopic pregnancy, which occurs when an embryo implants outside the uterus (often in the fallopian tubes), is not resolved by a medication abortion and can be dangerous. However, in cases of undiagnosed ectopic pregnancies, researchers found that the safety of early medication abortions remained uncompromised.

The study analyzed over 1,500 women from 26 clinics across nine countries, all of whom sought abortions before ultrasound-confirmed pregnancy. These women were divided into two groups: one received the medication early, and the other waited until pregnancy confirmation via ultrasound. Results showed that in both groups, more than 95 per cent of women had complete and successful abortions. Only minor differences were observed between the groups—4.5 per cent of women in the delayed group required surgery for an incomplete abortion, compared to 1.8 per cent in the early group.

Notably, participants in the early group reported less pain and bleeding compared to the delayed group, underscoring the comfort benefits of earlier access. Researchers also noted that 1% of all study participants had an ectopic pregnancy. Despite the condition, early medication abortion was found to be safe and effective.

Dr Kristina Gemzell-Danielsson, a professor of obstetrics and gynaecology at Karolinska Institute, commented on the broader impact of the findings: “Early medical abortion was just as effective and safe to perform, even in cases of undiagnosed ectopic pregnancies.”

The study highlights differences in access and policies worldwide. “In Sweden, a woman can repeat the procedure a week after a failed early abortion, whereas, in Texas, abortion is banned after six weeks,” Brandell noted.

Researchers are now exploring the possibility of developing a new drug combination that could treat ectopic pregnancies and investigating mifepristone, one of the drugs used in medication abortions, as a potential weekly contraceptive in lower doses to prevent unwanted pregnancies.

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