Cari Siestra first learned about menstrual regulation when they were working on the Myanmar-Thailand border. At the time, abortion was broadly criminalized in both countries. But if a person’s period was late, it was relatively easy to get access to pills that would induce menstruation in just a few days. In Bangladesh, where abortion is largely illegal, menstrual regulation is available up to 10 weeks after a missed period, and public health advocates routinely talk about it as a promising way to reduce maternal mortality and rates of unsafe abortion.
Menstrual regulation isn’t completely unknown in the United States. Melissa Grant, chief operations officer and cofounder of Carafem, recalls friends who would have their periods brought back through manual vacuum aspiration in the 1980s, when early pregnancy tests weren’t as common. But in recent years, it hasn’t been a widespread option, and for a while, Siestra wasn’t sure if there was a place for menstrual regulation in the US.
But as abortion has become increasingly stigmatized and criminalized throughout the US, they’ve joined with other advocates to raise awareness of this novel form of fertility management that exists somewhere between emergency contraception and abortion. As director of The Period Pills Project, Siestra has worked to make menstrual regulation—or, as they call the practice, missed period pills—available in all 50 states. Here’s a guide to everything you need to know about this under-discussed method of contraception.
What are Missed Period Pills?
The pills are mifepristone and misoprostol, the same FDA-approved medications that are used for abortion. The first pill, mifepristone, blocks progesterone and stops any potential pregnancy from developing further. Misoprostol is taken 24 hours later and kick-starts uterine contractions that empty the contents of the uterus. Whether or not you’re pregnant, misoprostol will induce bleeding, bringing your period back.
Who Are They For?
Anyone who has missed a period and just wants to bring their period back without the hassle of a pregnancy test or ultrasound. In some cases, that includes people who feel more comfortable with missed period pills than abortion. But there are also people who know they don’t want to be pregnant and don’t want to have to jump through hoops or wait several weeks to get an abortion. According to family medicine physician Michele Gomez, who’s been providing period pills out of Family Care Associates in Burlingame, California, since May 2022, period pill patients tend to be on the younger side, in part because “they are so on top of their periods. I didn’t have period-tracking apps when I was growing up, but this generation does. They know when they are late, and they just don’t want to wait around,” she says.
There’s also reason to believe that missed period pills would be a very popular option if they were widely available. A study conducted by Gynuity Health Projects found that 42 percent of people who’d arrived at a health clinic seeking a pregnancy test would be interested in missed period pills. Among people who said they’d be unhappy if they were pregnant, the rate of interest was a whopping 70 percent.
Do You Need an Ultrasound and Positive Pregnancy Test?
Nope! Although many abortion providers require these procedures before dispensing abortion pills, research has shown that people can safely take the pills without an ultrasound or positive pregnancy test.
Are There Any Risks?
If someone has an ectopic pregnancy—a pregnancy where the egg implants in the fallopian tube rather than the uterus—missed period pills won’t work. Though they’re very rare, ectopic pregnancies are incredibly dangerous and need to be addressed as soon as possible to prevent potential complications. Raegan McDonald-Mosley, the CEO of Power to Decide and a practicing gynecologist, says that if you don’t have bleeding two days after taking the pills, that could mean you have an ectopic pregnancy. Another sign is pain in the pelvic area. (Your provider can help you figure out the difference between normal cramping and pain that might be an ectopic pregnancy.)
There’s also the possibility that the pills won’t work. Siestra recommends waiting four or five days after a missed period to increase their effectiveness. If you’re not sure whether the pills worked, or if you still feel pregnant even after taking them, you can always seek follow-up care. Gomez also recommends taking a home pregnancy test four to five weeks after taking the pills to confirm you don’t have an ongoing pregnancy.
What About Legal Risks?
If you live in a state where abortion is legal, then there’s no problem. Your doctor has the right to prescribe medications as they deem appropriate, and menstrual regulation is a perfectly appropriate use of mifepristone and misoprostol.
If you live in a state where abortion is illegal, it’s more complicated. In a number of states, legislation known as “shield laws” protect providers who want to serve patients in places where abortion is criminalized—and in Colorado, Massachusetts, New York, Vermont, and Washington, there are specific protections in place for telemedicine providers who ship abortion pills to anti-abortion states. Because of that, it’s possible to get missed period pills in all 50 states.
But there still could be legal complications. Right now, missed period pills exist in a legal gray area, and it’s unclear whether anti-abortion states will attempt to come after them. If you have legal questions or face criminalization for taking missed period pills, If When How can always help.
Isn’t This Just an Abortion?
Yes and no. Because missed period pills are taken without any confirmation of a pregnancy—and, potentially, before it’s even possible to know if you’re pregnant—there’s no way to say whether they’re actually terminating a pregnancy. It’s possible that they’re terminating an early pregnancy; it’s also possible that they’re simply kick-starting a period that’s been delayed for other reasons.
In some ways, missed period pills are a return to an earlier way of thinking about pregnancy. Siestra points out that in many cultures, early pregnancies are seen as tenuous and unconfirmed—a belief that makes sense given the substantial number of pregnancies that turn out not to be viable. Embracing the gray area of missed period pills can give us a more nuanced understanding of the complexities of pregnancy while also providing a method of fertility management that may feel more comfortable to people who’ve grown up seeing abortion as stigmatized.
How Much Does This Cost?
It varies from provider to provider, but the general range is about $150 to $250—the same as an abortion with pills. Depending on your insurance, you may not have to pay the full cost out of pocket, and funding is available for people who need financial assistance. Plan C is also working with an Indian pharmacy to provide a more affordable option: a kit that includes mifepristone, misoprostol, and ibuprofen, all for just $25.
Where Do I Get Missed Period Pills?
The Period Pills Project has a list of providers in all 50 states. In some cases, providers will even do advance provision, sending you the pills before you’ve missed your period, so you have them just in case you need them.