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Episode 139 -- Mifepristone (Patreon)

Published:
2026-06-15 13:24:29
Imported:
2026-09

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Content

In this episode, Moira walks Adrian through the history of Mifepristone. Developed in France in the 1980s, this medication (which, together with Misoprostol, is used to end pregnancies) has been a flashpoint in Europe and the United States pretty much since it was first created. Today, it is the only way for millions of Americans living in states where abortion is illegal or impossible to get to safely terminate their pregnancies safely. This episode dives into the attack on Mifepristone, the history of medical abortion and what the future might look like.

Comments

OuijaFBabysMama

MY FAVORITE POD & MY SECOND FAVORITE DRUG WOO HOO 🪩🕺❤️‍🔥

Tobias Heal

I can confirm Adrian, you did pronounce the French correctly, and I'll add an anecdote from my French schooling: I had the "women didn't get the vote until 1944" explained to me as a positive thing because France was actually the first country to truly give women the right to vote, the previous countries didn't count because they weren't French.

abortland

GOD BLESS ABORTIFACIENTS 🗣️🗣️🗣️

Sandra

Even though I find this topic triggering as hell (i had to have two abortions for medical reasons, the first was a D&C, the last happened only a few months ago), I am so grateful for this sober, educational and detailed description of what Miffie is, how it works and what its's advantages are. I would like to add one more: D&Cs come with the risk of chronic scarring and inflammation called Asherman syndrom, which causes infertility. The risk rises disproportionately with repeat procedures and can be high for certain types of pregnancy complications. Medical abortion does not carry this risk. So, ironically, if you are very much trying to have a child, medical abortion can help prevent additional risks to your fertility. I live in Germany, where abortion care is a prohibitively bureaucratic, humiliating clusterf**k, so while Miffie is technically available, it can be incredibly hard to actually obtain, even for terminating a non-viable pregnancy. I had *beg* my doctor for the pills for over a month, before they would let me end a clearly non-viable pregnancy my body just would not resolve on its own and Miso alone did nothing. Miffie should be standard care. And these "pro-life" ghouls need to be confronted over and over again with the full consequences of legislating things they do not know nearly enough about.

OuijaFBabysMama

I love that you bring up the topic of scarring or other pathological sequelae of uterine evacuation. One of my research interests are the associations and sequelae for late preterm birth and it is quite interesting that this field is also finding that uterine damage may contribute (along w much stronger other associations) to incidence of preterm birth. To be clear however, an abortion of any type or a live birth delivery with use of tools, or any other intrauterine cause of damage that causes scarring increases the risk for infertility and other negative outcomes like preterm birth. It is the scarring, not the abortion, that caused the damage. When we talk about a procedure (I am an ICU RN in pediatric unit and an MPH maternal child health researcher lmao sorry about this) as a nurse, we educate on what to expect and the negative possibilities. There are known side effects to any drug or procedure and these are to be expected and transient in nature, acceptable, but that does not include true damage, an injury, this is a negative outcome that is not expected but may be a known possibility and this is why we sign informed consent documents. But it is not like Oh okay cool that is fine and expected when someone has a known negative outcome from a procedure, it is still a tragedy. It is still terrible even if we signed a consent document. But it is still the scarring that is the pathological cause, and not how the damage got there. We can prevent this damage with the ability to uphold rigorous standard of care and dogged research always attempting to prove the null hypothesis.

OuijaFBabysMama

This is not me disagreeing, this is just me excitedly nerding out in the only space available to me to talk overlap in abortion, research, uteri, moira, aidrian, it is like worlds colliding when you do these ones

OuijaFBabysMama

Omg the next research question should be— what are the drivers of uterine scar-associated infertility and start with huge observational studies. And then… wow this is surely already being investigated. Can’t wait to look up and hopefully not report back but this is the most fun I have had on my phone since I was long distance w my man xx fam

Gwen

Abortion pills and the freedom they bring even where laws ban abortion are great! Still I think we need to fight for surgical abortion access as well. When I had an abortion I was able to choose between both and was advised that since I had very heavy periods, medical abortion might have been more uncomfortable than surgical. I chose surgical under anaesthesia and it was great, over quickly and had me feeling like myself again only two hours later.

Rachael Rothrock

Thank you for pointing out about the increased risk for uterine scarring with D&Cs. I went through years of fertility treatments and multiple losses, the first of which my body also would not fully evacuate. I had to persistently ask for medication over the procedure because I knew about this but everytime I asked either the nurse or doctor, they acted like there were no risks involved. I dont recall the medication now, but the doctor admitted she initially only prescribed half the regular dose, had to prescribe it a second time, and then I ended up going in for a methotrexate injection. What a fucking unnecessary run around and misinformation.

Lauren Weinberg

Thanks so much for this informative episode. Miffy + Miso 4ever!

Kat

Question for y’all! Have miffie and miso been proven affective for fat folks?? I ask bc I found out recently that plan b isn’t as effective for us which is so scary I didn’t know that sooner and disheartening to hear.

JanaKat

Good lord, I hadn't known about the enforced transvaginal ultrasounds. That is appalling.

Cara

This was so good. I came in bracing a bit because of the political reality and did not expect to be so moved and inspired. Thank you! Now to go research online options for some miffie for under my bed…

Astraea

Virginia: paving the way for the very worst decisions since 1607.

Astraea

Afaik they are effective for fat folks, but you may need a higher dose of miso at higher weights. I don't *think* a higher dose of mife is required, but don't take my word for it. (I am not a medical professional, I just read a lot on the internet.) You might try checking Dr. Jen Gunter's website/newsletter. She's very evidence-focused as a counterpoint to whatever grifty bullshit the wellness spaces are currently spewing. She does a lot of lay-friendly synopses of medical studies. Lately she's been talking more about menopause science, but she has some very good articles on birth control, including birth control/Plan B and weight, in her archives.

Astraea

I'm so sorry to hear about the necessary abortions (for what sound like wanted pregnancies). Thank you so much for the information about scarring - I had never heard of this and it is so very important. And once again... Nothing about the anti-choice movement has anything to do with health, safety, or benefits to women of any kind.

Astraea

OuijaFBabysMama - look up infertility associated with endometriosis, if you want a nerdy rabbit hole. Endo has about a 10% prevalence rate among people who menstruate, and it is associated with both infertility/delayed fertility and also pre-term births. (It might also come with a higher rate of spontaneous abortion, but I'm not sure. I wouldn't be surprised, anyway.) Endo runs in my family. I'm an only child and was born early after my mother had a very difficult pregnancy. She always felt, based on the literal sensations in her body, that the endo scarring was a significant contributing factor in both her ability to get pregnant and her difficulty in carrying me successfully. (Literally: she felt like the scarring was making it difficult for her uterus to expand as needed as her pregnancy progressed.) It would not surprise me AT ALL to learn that scarring is the main or a major contributing factor in fertility issues and pregnancy outcomes for people with endometriosis.

Astraea

Also Plan B *at the regular dose* isn't as effective, but iirc the treatment protocol for larger folks is to just take a double dose. So it *can* still be used, but has a slightly different protocol.

Astraea

In addition to all the great information in this episode, I just wanted to add a few things: 1. You can get Plan B online for SO MUCH CHEAPER than at a pharmacy! There are both brand-name options and generics that are the exact same drug. Most are $20 or less. You can buy multiple doses (they are shelf-stable for at least two years) for the same cost as a single dose at CVS, plus you don't have to deal with the intentional shaming of the locked case/locked-up meds. 2. The website plancpills.org is great! I also recommend ineedana.com (possibly .org, the Internet will know). They don't provide medications but they maintain an up-to-date list of state laws governing abortion access, restriction, and criminalization. If you want to know the current state of abortion access in your state, ineedana.com is a good resource. 3. Mife and miso are shelf-stable for several years. Don't use expired pills, obviously, but if you can get pregnant or care about someone who can, then I think getting the meds for a self-managed abortion ahead of time is a very good idea. Frankly, I think anyone who can get pregnant should have them on hand - even if you are trying for children, something could go wrong, and there are plenty of states where doctors are basically required to watch you die rather than give you anything to "end" your pregnancy (even if you've had an incomplete miscarriage). Get yourself some medication in self-defense. If you don't need it, someone you love might. 4. VPNs are your friend, especially if you live in a hostile state. As are single-use, throwaway email addresses. 5. The "I might have to prescribe mife and that makes me sad" case lost at SCOTUS, but only for now and, critically, it was NOT on the merits. IIRC it wasn't even on standing; I think maybe SCOTUSv said it wasn't ripe yet? In any case, this absolute insult of a clusterfuck is still alive, waiting to come back like a zombie. Elect pro-choice, pro-abortion politicians everywhere, folks, because someone's life literally depends on it!

Candice Jade

I fall further in love with you both each episode! Bless you Moira for clinic escorting. I will always remember how humiliating and horrible it was walking past those protesters for my abortion. My appointment was at 6:30am and there was a HUGE group of protesters screaming at me before the escort could get to me… all I could think of was was “how early did these psychos get up to harass people already having such a shit day?!” Thanks again for all the amazing knowledge and immaculate vibes xx

Moira Donegan

Candice, I’m so sorry they did that!! What a bunch of losers. Thanks for listening.

A Felt

The part of this episode where Moira describes Lader smuggling mife into the US felt like I was listening to a thriller audiobook. Really excellent storytelling and I learned so much!

Jenny

This episode has *everything* - science, law, brave women, and corporate espionage. Thank you Moira for taking us on a clearly structured journey through the history and dimensions of a single topic; I always learn so much and find so many entry points to learn more.

Lauren Steward

I’m a scientist and I just went to go grab a chemical from our room temperature cabinet and noticed it was neighbors with a vial of mifepristone. I’ve never noticed it before.

Cynthia Brosnan-Rackin

Im wondering if the Miffe compound was prevented from American labs to prevent compounding pharmacies from creating it for “off label use” which in the case would be “on label use” just written differently.

Maud McInerney

It’s funny about France… yes, it’s historically a Catholic country but “laïcité” (secularism) is the 4th pillar of French democracy after liberté fraternité égalité. I know far fewer Catholics here than in the US. Also, when it comes to women’s suffrage it happened over 20 years later than in the US, UK or Germany— but damn, check out Switzerland ! Great episode as always.

hellsbells

I am sure this wasn’t the intent but I have to say, I don’t think it’s helpful to pit medication abortion with mife against procedural abortion as if one is better than the other. Mifepristone is revolutionary, amazing, safe, game-changing and we should absolutely fight like hell to protect it. But I feel like Moira leaned a little too hard on the “clinics are unpleasant,” “who would choose to have a procedure when they could just take a pill?” The reality is that lots of people choose procedural abortion for lots of reasons! Mife is very safe but there are people with certain medical conditions for whom it is contraindicated. And its safety and efficacy decreases at later gestational ages. Stigmatizing procedural care means increasing stigma on folks who have abortion later in pregnancy. Also, it feels a little naive to say, “who wouldn’t want to be at home on their couch watching Netflix with their cat?” For many people, home isn’t private or safe, not to mention folks who don’t have a home to go to. Let’s not position any of the current methods of abortion as inherently better!! Everyone’s circumstance and preference and medical history is different. And the vast majority of abortion providers work really hard to make in-clinic abortion as safe, comfortable, trauma-informed as possible!

hellsbells

I’m so sorry that you had difficulty accessing mife! It should absolutely be more accessible. But it is worth pointing out that the risk of intrauterine scarring is relatively rare, especially when aspiration (suction) is used as opposed to sharp curettage, which is the method that was common in the US in the 1970s and is still common in some other parts of the world. (Not sure what type technique is used most commonly in Germany.) Intrauterine scarring, when it does occur, is generally mild and most often does not result in future infertility. Pregnancy and miscarriage themselves can lead to intrauterine scarring. Not a zero risk but overwhelming, abortion with vacuum aspiration is safe!

Sandra

Thanks for the addition. And yes, I am aware that it is generally a rare complication. However, the risk increases for repeat procedures. And there are other factors that amplify it further, some of which meant that I didn't want to chance it. There are very few practices that perform surgical abortions in the first place over here, and they don't advertise, certainly not what procedures they perform exactly (sharp curretage is still performed), so you kinda have to take what you can get. So, as I said: It's a clusterf**k, all around. Miffie should be the easiest, safest option, it certainly was for my specific case, and fully independent of having to find one of those rare and elusive abortion-performing practices, but it is so highly regulated that doctors are hesitant to prescribe it. Also, you still have to take it in the doctor's practice.

Astraea

These are all really important points; thank you for saying this. In defense of Moira (and based on nothing at all but a complete guess) I wonder if part of where she was coming from is the "abortions are always surgical" fallacy and its implications for self-managed abortions today as compared to 50 years ago. I remember that when the Dobbs decision was leaked, there was a wave of folks talking about the horrors of DIY abortions and how to accomplish them, and then a second wave of activists saying "Please for the love of God don't tell people they need to use coathangers or rue or pennyroyal to induce abortion nowadays! They can get pills online, and they're far less likely to kill you!!" (It was an interesting little sequence on my particular corners of the internet.) To me - again, based on *nothing* but a guess - it felt a bit like Moira was reacting to the real danger that comes with people wanting abortions but not knowing that there are non-surgical options. All that having been said: not everyone is safe at home, surgery is indeed a better option for some people for various reasons, and you're absolutely right that we should not be making value judgements about one (safe and effective) method over another.

wibbelkind

Coincidentally this week you're not the only one of my podcasts talking about birth control and abortions... For Adrian and anyone else proficient in German, I highly recommend this episode to round off the week: I'm listening to Zwischen Fortschritt und Frevel | Das dunkle Geheimnis der Anti-Baby-Pille on Podbean, check it out! https://www.podbean.com/ea/dir-x4ubv-2edbaaa1

hellsbells

That’s a very valid point. Self-managed abortion has changed so much and is now vastly safer than ever before because of mife! I just don’t want people to forget that every day there are hundreds of people traveling many hours from abortion ban states to states where abortion is legal. Facing all the barriers to doing that that you would imagine. Many of those folks prefer procedural abortion or need procedural abortion. And some even travel for pills because that feels like a preferable option for whatever reason. So while pills by mail is amazing and should be protected, it can’t be the only option.

Z F

Great episode overall, and I have to add, I love that you both love Valencia! Back in like 2007, I was on a date, and my ex took me to Lambda Rising and showed me that book. I went home and read it cover to cover like 5 times in a row. It has everything, but most of all it has incredible descriptions of the kind of love that destroys your life and forces you to decide who you are... All the same, I tried recommending it to my queer book club in my new city last year, and found that some of the language hadn't aged well. We used the r slur a little too freely in the 90's, and the young folks are right to be offended. I'm not sure how to balance that with the urgent, confessional quality of those beautiful vignettes. It's such a time capsule.

OuijaFBabysMama

I am an RN in critical care but my background before nursing was birth postpartum and abortion doula and frontline worker at abortion clinic and abortion fund. I am not able to give medical advice and everything is complicated but body mass has less to do with medication dosing for abortion than gestational age of the fetus. Different drugs work depending on properties of the drug thenselves abd how we take the drug and what it is for. Excellent point about the Plan B dosing, oral progesterone-affiliated hormone. But Mifi is different kibd of drug and then when we give miso, it is based on how much fetus we are tryibg to expel and honestly just provider preference and experience. Miso orally will have more systemic bad effects and less of what we want anyway so we try to go buccally or vaginally hut it depends. Everything here has caveats and gets even more interesting the more you dig in! @kat @astraea

OuijaFBabysMama

This also brings up very important topic of the importance of Follow up and education about pregnancy for people at baseline. All pregnancies should be followed up with care to make sure the pregnancy and placenta are fully OUT afterwards no matter how the pregnancy exits uterus (abortion, live birth, etc)

OuijaFBabysMama

I used to work at clinic and one of the guys that screamed whore at me everyday once commented on my hair like “oh you did your hair different you can’t hide from me” and I was just beaming like omg a guy noticed my hair hell yeah I am beautiful and then realized I was being harrassed again/still. I even waved! Said thanks… what a bunch of fucking freaks. We had a lot of catholic ladies walking around praying. Menacing packs of teen boys would come seasonally to protest and it would like like a nazi rally in front of clinic.