SELF-MANAGED MEDICATION ABORTION
(SMMA), MENSTRUAL REGULATION,
& ADVANCE PROVISION

SMMA

• Self-managed abortion incorporates all forms of self-managed care outside of the formal medical setting. See Ch 2 for means other than medications, and legal considerations.
• SMMA is safe and effective in a variety of settings (WHO 2022, Moseson 2022 / 2023)
• Access to information and medications is available at: Plan C, Safe 2 Choose, Women Help Women, and Women on Web. People may source medications for SMMA through online pharmacies, veterinarian supply shops, or other means.
• Clinicians may offer person-centered support, advice, and early pregnancy evaluation for people self-managing their abortion care. Help assess completion as needed with UPT, serum hCG, or US. Manage bleeding and Rh as needed. For people seeking aftercare support, provide the same resources as if you were prescribing and/or if they were seeking care for miscarriage management, including return precautions, and reassurance to return for concerns, including desired contraception.
• Clinicians and healthcare teams have a responsibility to uphold ethical standards by refusing to contribute to the growing criminalization of people seeking and/or providing reproductive health care, ensuring patient safety, confidentiality, and upholding the individual’s right to make their own informed decisions. Providers also have a responsibility to inform people of the risk of criminalization and refer them to appropriate legal resources if they have additional questions. The greatest risk for people utilizing SMMA comes from the threat of criminalization. Clinicians can be proactive by teaching their peers to focus on management, while excluding unnecessary questions and documentation about abortion plans, use of medications or other means. For example, symptoms can be appropriately treated without documenting medications in the chart, as chart records are permanent (and may not be secure) which can cause future harm.

Menstrual Regulation (aka Period Pills)

• Menstrual regulation (MR) includes various methods to “establish non-pregnancy” after a missed period, without pregnancy testing or confirmation.
• Historically, MR was widely accepted , and was utilized primarily by midwives. MR is still used through state-funded programs in countries where abortion is legal and illegal (ASAP 2016, Samuels 2020).
• MR services are typically provided through the use of mifepristone and/or misoprostol (called “missed period pills”) or uterine aspiration.
• While the use of medications to trigger a bleed may sound synonymous with MAB, MR exists within this space of pregnancy uncertainty, creating a medical and legal grey zone as period pills are neither contraception or abortion (Chisausky 2024). This approach may be less stigmatizing, as menses may be missed for a variety of reasons other than pregnancy (such as thyroid conditions, stress, or contraceptives).
• A National Working Group (periodpills.org) is working to increase access for this purpose, and additional information is available at RHAP.

Advance Provision

• Advance provision involves prescribing MAB medications for future use with immediate availability, before pregnancy occurs.
• Providers can prescribe and dispense abortion medications for people 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”) (NAF 2024).
• There is considerable interest in advance provision in the U.S., especially among people in states with abortion bans (Aiken 2024b). Clinicians should check their local/state laws to ensure legal practice.
• Several telehealth platforms offer advance MAB provision in the US, with information at Plan C.