In Episode 3 of our series on safe abortion, learn how an abortion with pills works and how you can safely self-manage a medical abortion at home. This video is part of an eight-chapter instructional series co-produced by Doctors Without Borders/Médecins Sans Frontières (MSF) and HowToUseAbortionPill.org. The intention behind these videos is to help ensure that abortion with pills is conducted in a safe, accessible, secure, and respectful manner. In these videos, we’ll be taking you through a helpful guide on what to expect before, during and after an abortion with pills.

To get free access to safe abortion information, click here – https://www.howtouseabortionpill.org

HowToUseAbortionPill.org also offers this video series in 26 additional languages at https://bit.ly/3EkMTkz

To find resources specific to your country, click here – https://www.howtouseabortionpill.org/abortion-laws-by-country/

Read more about how to ensure a safe abortion with pills from MSF at https://bit.ly/30XJVnC

The information and materials provided by MSF in these videos are intended for general information, general discussion, and education only. Nothing contained in these MSF materials is intended to be a substitute for professional medical care. By providing this information, MSF is not engaged in the practice of medicine, nursing, or the provision of any health care service.

MSF hereby disclaims any and all liability to any party for any direct, indirect, implied, punitive, special, incidental or other consequential damages arising directly or indirectly from any use of the materials shared, which is provided as is, and without warranties.

Video transcript:
Lesson 3: How does an abortion with pills work?
An abortion with pills, also known as a medical or medication abortion, is a safe and common method of abortion. Millions of women all over the world safely and successfully use pills to end pregnancies every year. Many people prefer an abortion with pills because it can be done privately within the comfort of their home, is non-invasive, can feel more natural, and is similar to a spontaneous miscarriage.

There are two types of medications used for abortion: mifepristone and misoprostol. An abortion with pills works better if both of these medications are taken together. However, if mifepristone is not available, misoprostol alone will also work to end a pregnancy and is still safe. We will review both options in this video series.

Mifepristone and misoprostol cause the opening of the uterus to relax and the walls of the uterus to contract. This results in bleeding and cramping, which pushes the pregnancy out of the body, just like a miscarriage. Most women experience bleeding and cramping that’s similar to a heavy menstrual period and lasts several hours.

Some women go to see a medical provider, like a doctor or midwife, to get information about an abortion with pills and obtain the necessary medications. Then they go home to take the pills and manage the process themselves. Some women may decide to get information and pills in other ways. So long as the proper instructions are followed and quality medications are used, an abortion with pills will work to end a pregnancy almost every time.

Severe complications are extremely rare. An abortion with pills is so safe that most women successfully manage the process at home without any problems.

Almost everyone can have an abortion with pills – including young women, older women, women with and without children, women who have had an abortion before, women who are pregnant with twins, women who have had Caesarean deliveries, and women who are breastfeeding. Regardless of your age or weight, the dose stays the same and the pills will work equally well.

There are very few contraindications and they are very rare. If you know you have an ectopic pregnancy, which is a rare condition where the pregnancy is outside the uterus, abortion pills will not work to end the pregnancy, so you need to see a health care worker. If you have been told you have a medical condition called porphyria or problems with your adrenal glands, which are both very rare conditions, you should not do an abortion with pills. If you have an IUD in place, it should be removed before using abortion pills.

Many countries have laws surrounding the availability of abortion and the use of abortion pills. To learn more about the abortion laws in your setting, see HowToUseAbortionPill.Org.

In our 2 next videos, we will explain how to take both mifepristone and misoprostol or misoprostol alone to have an abortion before 13 weeks. Abortions 13 weeks and beyond require a different approach.

Doctors Without Borders/Médecins Sans Frontières helps people worldwide where the need is greatest, delivering emergency medical aid to people affected by conflict, epidemics, disasters, or exclusion from health care. Learn more at https://www.doctorswithoutborders.org

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A short video on how ‘the pill’ works to prevent pregnancy
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How do abortion pills work? Mifepristone and Misoprostol work together to end and expel a pregnancy. They work by effecting the hormones that are necessary for a pregnancy. You can acquire them via telemedicine or at a medical clinic. There is some pain or discomfort involved similar to strong cramps or a miscarriage. Speak with a medical professional before making any decisions regarding abortion, Mifepristone, or Misoprostol.

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How do birth control pills work? Birth control pills, sometimes called ‘the pill’, are medicines a person takes daily to prevent pregnancy.
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Over a person’s lifetime they are likely to be prescribed more than 14,000 pills. Antibiotics, cholesterol lowering tablets, anti-depressants, painkillers, even tablets to extend youth and improve performance in bed. These drugs perform minor miracles day after day, but how much is really known about them?

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Drugs expert Jon Ramsey explains the huge variation in the content of commonly available ecstasy tablets. Tests he conducted on pills confiscated at the 2009 Glastonbury Festival showed that just 8% of all tablets studied contained any of the substance MDMA – the drug most users would expect to find in an ‘ecstasy’ tablet.

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If you’re thinking about going on the pill, you may have questions. What do birth control pills do? Are birth control pills safe? Here’s all the info on how to use birth control pills.

Check out our other Birth Control videos:
The Birth Control Ring – https://www.youtube.com/watch?v=mkSakVCq9tg
The Birth Control Shot – https://www.youtube.com/watch?v=z2pAQytp-Cc
The Birth Control Implant – https://www.youtube.com/watch?v=IJgGrltWMCs
IUD – https://www.youtube.com/watch?v=BfNqNNLmHE4

To learn more about the Birth Control Pill, visit https://www.plannedparenthood.org/learn/birth-control/birth-control-pill

Transcript:

The birth control pill is safe and super simple: you swallow one tiny pill every day and that’s it — you’re protected from pregnancy. But you have to take it every day, so use an alarm or app to help you remember. And the pill doesn’t prevent the spread of STDs, so use condoms along with the pill to help protect yourself from both pregnancy and STDs.

Like other medications, the pill has possible side effects, but they usually go away in the first few months. It has lots of benefits too. The pill can clear up acne, ease cramps, and make your periods lighter and more regular. Want to get on the pill? Your nearest Planned Parenthood health center can hook you up.

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You may have heard of “abortion pills” – here’s what these medications are and what they do (and don’t do).

RESOURCES:
**************

More Information:
WHO Guidelines:
https://apps.who.int/iris/bitstream/handle/10665/332334/WHO-SRH-20.11-eng.pdf
Kaiser Family Foundation Factsheet:

The Availability and Use of Medication Abortion

Doctors Without Borders Video Series:
https://www.doctorswithoutborders.org/latest/how-ensure-safe-abortion-pills
Planned Parenthood Factsheet:
https://www.plannedparenthood.org/learn/abortion/the-abortion-pill
Abortion Pill Info from SASS:
https://abortionpillinfo.org/en/using-abortion-pills-for-safe-abortion-usa

Legality:
Abortion Laws by Country:
https://reproductiverights.org/maps/worlds-abortion-laws/
Abortion Laws by US State:
https://reproductiverights.org/maps/abortion-laws-by-state/
Abortion Pill Laws By US State:
https://www.guttmacher.org/state-policy/explore/medication-abortion
Legal Helpline:
https://www.reprolegalhelpline.org/

LEARN MORE
**************
To learn more about this topic, start your googling with these keywords:
– Medication abortion/pill-based abortion: an abortion that uses pills, rather than surgical intervention
– Self-managed abortion: a pill-based abortion done by an individual without medical guidance
– Progesterone: a hormone made by the body that plays a role in the menstrual cycle and pregnancy
– Cervix: the narrow passage forming the lower end of the uterus
– Contraction: a shortening of the uterine muscles

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REFERENCES
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Abubeker FA, Lavelanet A, Rodriguez MI, Kim C. (2020). Medical termination for pregnancy in early first trimester (≤ 63 days) using combination of mifepristone and misoprostol or misoprostol alone: a systematic review. BMC Womens Health 20(1):142. https://pubmed.ncbi.nlm.nih.gov/32635921/

Allen R & O’Brien BM. (2009) Uses of misoprostol in obstetrics and gynecology. Reviews in Obstetrics and Gynecology 2(3):159-68. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760893/

American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology, Society of Family Planning. (2020). Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225. Obstetrics and Gynecology 136(4):e31-e47.https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation

Cadepond F, Ulmann A, Baulieu EE. (1997). RU486 (mifepristone): mechanisms of action and clinical uses. Annu Rev Med. 48:129-56. https://pubmed.ncbi.nlm.nih.gov/9046951/

Garris R & Kirkwood, C (1989). Misoprostol: A prostaglandin E1 analogue. American Journal of Hospital Pharmacy 46 (10): 2162–2170. https://academic.oup.com/ajhp/article-abstract/46/10/2162/5174740

Papp C, Schatz F, Krikun G, Hausknecht V, Lockwood CJ. (2000) Biological mechanisms underlying the clinical effects of mifepristone (RU 486) on the endometrium. Early Pregnancy 4(4):230-9. https://pubmed.ncbi.nlm.nih.gov/11742418/

Pierce S, Bakker R, Myers DA, Edwards RK. (2018) Clinical Insights for Cervical Ripening and Labor Induction Using Prostaglandins. AJP Rep. 8(4):e307-e314. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205862/

Schreiber CA, Creinin MD, Atrio J, Sonalkar S, Ratcliffe SJ, Barnhart KT. (2018) Mifepristone Pretreatment for the Medical Management of Early Pregnancy Loss. N Engl J Med 378(23):2161-2170. https://www.nejm.org/doi/full/10.1056/nejmoa1715726

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Emergency Contraception is a way to prevent pregnancy AFTER unprotected sex. Lots of people have questions about it: How does the morning after pill work? What does the morning after pill do? How does emergency contraception prevent pregnancy? What are the different types of emergency contraception? This video answers these questions and more.

To learn more about the morning after pill/emergency contraception, visit https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception

Transcript:

Accidents happen — maybe you mess up your birth control, or forget to use a condom. But since it can take several days for pregnancy to happen after sex, there’s still something you can do.

Emergency contraception is a safe way to prevent pregnancy up to 5 days after unprotected sex. It mainly works by stopping sperm from meeting with an egg.

There are 2 options for emergency contraception: the copper IUD, or morning­ after pill.

Getting a copper IUD inserted within 5 days of unprotected sex is the most effective type of emergency contraception. It works as well if you get it inserted on day 5 as it does on day 1.

And — bonus! — it keeps giving you super effective pregnancy protection for up to 12 years, or until you have it removed.

But sometimes it’s hard to get an appointment for an IUD on such short notice, so call your local Planned Parenthood health center or doctor as soon as possible.

The morning­-after pill is not the same thing as the abortion pill — it won’t end an existing pregnancy.

There are 2 kinds of morning­-after pills. ella is the most effective kind of morning-­after pill. You can take ella up to 5 days after unprotected sex, and it works as well on day 5 as it does on day

1. You need a prescription from a Planned Parenthood health center or your doctor or to get ella.

Plan­B and other generic pills like it are the next best option for emergency contraception.

They’re available without a prescription from most drug stores and pharmacies. You can be any gender, any age, and walk in and buy it without ID.

You can take Plan B up to 5 days after unprotected sex, but the sooner you take it, the better it works. It’s most effective when taken within 3 days after unprotected sex.

Morning-­after pills really lower your chances of getting pregnant, but they don’t work as well as using regular birth control. So it’s best to find a regular method of birth control, and save the morning-­after pill for emergencies.

Sometimes insurance covers emergency contraception. If you’re worried about cost, Planned Parenthood can help.
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View full lesson: http://ed.ted.com/lessons/how-do-contraceptives-work-nwhunter

Contraceptives are designed to prevent pregnancy in three basic ways: they either block sperm, disable sperm before they reach the uterus, or suppress ovulation. But is one strategy better than the other? And how does each one work? NWHunter describes the mechanics behind different kinds of contraceptives.

Lesson by NWHunter, animation by Draško Ivezić.

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How morning after pill works? – 3D animation
Mode of action of emergency contraception www.escapelle.com www.postinorpill.com
REFERENCES:

Croxatto HB, et al. Pituitary-ovarian function following the standard levonorgestrel emergency contraceptive dose or a single 0.75 mg dose given on the days preceding ovulation. Contraception 2004; 70(6):442–450.
De Santis M, et al. Failure of the emergency contraceptive levonorgestrel and the risk of adverse effects in pregnancy and on fetal development: an observational cohort study. Fertil Steril 2005; 84:296 –299.
Durand M, et al. On the mechanisms of action of short-term levonorgestrel administration in emergency contraception. Contraception 2001; 64(4):227–234.
Hapangama D, et al. The effects of peri-ovulatory administration of levonorgestrel on the menstrual cycle. Contraception 2001; 63:123-129.
ICEC: Emergency contraception and medical abortion. February 2013
http://www.cecinfo.org/custom-content/uploads/2014/01/ICEC_Medical-Abortion-Fact-Sheet_Feb-2013.pdf (accessed in August 2017)
ICEC and FIGO. How do levonorgestrel-only emergency contraceptive pills (LNG ECPs) prevent pregnancy? (Statement on Mechanism of Action). March 2012
http://www.cecinfo.org/custom-content/uploads/2014/01/ICEC_MoA_Statement_3-28-12.pdf (accessed in August 2017)
Lalitkumar PGL, et al. Mifepristone, but not levonorgestrel, inhibits human blastocyst attachment to an in vitro endometrial three-dimensional cell culture model. Human Reproduction 2007; 1-7.
Marions L, et al. Emergency contraception with mifepristone and levonorgestrel: mechanism of action. Obstet Gynecol 2002; 100:65–71.
Marions L, et al. Effect of emergency contraception with levonorgestrel or mifepristone on ovarian function. Contraception 2004; 69(5):373-377.
Meng CX, et al. Effect of levonorgestrel and mifepristone on endometrial receptivity markers in a three-dimensional human endometrial cell culture model. Fertility and Sterility 2009; 91(1):256-264.
Meng CX, et al. Effects of oral and vaginal administration of levonorgestrel emergency contraception on markers of endometrial receptivity. Hum Reprod 2010; 25(4):874-883.
Müller LA, et al. Postcoital treatment with levonorgestrel does not disrupt postfertilization events in the rat. Contraception 2003; 67:415–419.
Novikova N, et al. Effectiveness of levonorgestrel emergency contraception given before or after ovulation-a pilot study. Contraception 2007; 75(2):112-118.
Okewole IA, et al. Effect of single administration of levonorgestrel on the menstrual cycle Contraception 2007; 75(5):372-377.
Ortiz ME, et al. Post-coital administration of levonorgestrel does not interfere with post-fertilization events in the new world monkey Cebus apella. Hum Reprod 2004; 19(6):1352–1356.
Palomino WA, et al. A single midcycle dose of levonorgestrel similar to emergency contraceptive does not alter the expression of the L-selectin ligand or molecular markers of endometrial receptivity Fertil Steril 2010; 94(5):n1589-94.
Pitkin J, et al. Obstetrics and Gynaecology. 2003, Elsevier Science Limited.
Planned Parenthood Federation of America (PPFA). The difference between the Morning-After Pill and the Abortion Pill
https://www.plannedparenthood.org/files/3914/6012/8466/Difference_Between_the_Morning-After_Pill_and_the_Abortion_Pill.pdf?_ga=1.136880304.1649696582.1475150110 (accessed in August 2017)
Senanayake P, et al. Atlas of Contraception. Second Edition, 2008, Informa UK Ltd.
Tirelli A, et al. Levonorgestrel administration in emergency contraception: bleeding pattern and pituitary-ovarian function Contraception 2008; 77(5):328-332.
Vargas MF, et al. Effect of single post-ovulatory administration of levonorgestrel on gene expression profile during the receptive period of the human endometrium. J Mol Endocrinol 2012; 48(1):25-36.
Wilcox AJ, et al. The timing of the “fertile window” in the menstrual cycle: day specific estimates from a prospective study. BMJ 2000; 321: 1259–1262.
Wilcox AJ, et al. Timing of sexual intercourse in relation to ovulation N Engl J Med 1995; 333:1517–1521.
WHO: Fact Sheet on Emergency contraception, June 2017
http://www.who.int/mediacentre/factsheets/fs244/en/ (accessed in August 2017)
Zhang L, et al. Pregnancy outcome after levonorgestrel-only emergency contraception failure: a prospective cohort study. Human Reproduction 2009; 24(7):1605-1611.
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Birth control pills are medications used to prevent pregnancy. They contain hormones that suppress ovulation. The most effective type is the combination pill which contains both estrogen and progestin – a synthetic form of progesterone. These 2 hormones interfere with the normal menstrual cycle to prevent ovulation.
The menstrual cycle refers to the monthly events that occur within a woman’s body in preparation for the possibility of pregnancy. Each month, an egg is released from an ovary in a process called ovulation. At the same time, the lining of the uterus thickens, ready for pregnancy. If fertilization does not take place, the lining of the uterus is shed in menstrual bleeding and the cycle starts over. The menstrual cycle is under control of multiple hormones secreted by the hypothalamus, pituitary gland, and ovaries. Basically, the hypothalamus produces gonadotropin-releasing hormone, GnRH; the pituitary secretes follicle-stimulating hormone, FSH, and luteinizing hormone, LH; while the ovaries produce estrogen and progesterone. These hormones are involved in a REGULATORY network that results in monthly cyclic changes responsible for ovulation and preparation for pregnancy.
The 2 hormones that are required for ovulation are: FSH, which starts the cycle by stimulating immature follicles to grow and produce a mature egg; and LH, which is responsible for the release of the egg from the ovary – the ovulation event itself. Two other hormones, estrogen and progesterone, are at high levels after ovulation, in the second half of the cycle. They suppress FSH and LH during this time, preventing the ovaries from releasing more eggs. If fertilization occurs, estrogen and progesterone levels REMAIN HIGH throughout pregnancy, providing a continuous suppression of ovulation. On the other hand, in the absence of pregnancy, their levels FALL, causing menstrual bleeding.
The levels of estrogen and progesterone in the combination pills mimic the hormonal state after ovulation, tricking the ovaries into thinking that ovulation has already occurred; FSH and LH are constantly suppressed, no egg is matured or released.
The pills are taken every day for three weeks, followed by one week of placebo pills containing no hormones. During the week of placebos, estrogen and progesterone levels fall, triggering a so-called withdrawal bleeding, or fake periods. The bleeding serves as a convenient indication that fertilization did not happen, but it is not required for birth control. In fact, there exist continuous-use contraceptive pills with less or no placebos, resulting in less or no menstrual periods. These pills are particularly beneficial for women who suffer from menstrual disorders such as excessive menstrual bleeding, painful menstruation and endometriosis.
For lactating women, or those who cannot tolerate estrogen, there are mini-pills that contain only progestin. These are not as effective as combination pills at preventing ovulation. Their effect relies more on the ability of progestin to promote secretion of a thick cervical mucus to obstruct sperm entry.

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