There’s a Pill Between Plan B and Abortion That ‘Treats’ a Missed Period

Menstrual regulation with period pills could let us think of ourselves as "a little bit pregnant," as a new episode of the podcast Invisibilia explores.

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There’s a Pill Between Plan B and Abortion That ‘Treats’ a Missed Period
Illustration:AP News (AP)

A late period ratchets up the anxiety. You could be pregnant. You need to hunt down a pregnancy test. You might have to consider ending a pregnancy. But as Invisibilia producer Abby Wendle suggests in the NPR podcast’s latest episode “A Little Bit Pregnant,” this doesn’t have to be the case, especially for those who don’t want to be pregnant. The episode’s “thought experiment” asks: What if, when you miss your period, you can be prescribed a pill to bring it back without having to cross your fingers and pee on a stick?

Falling somewhere between emergency contraception like Plan B and abortion as most people think about it, the period pill—also called “missed period pill” or “late period pill”—is a way for individuals to treat the symptom of a missed period without necessarily having to grapple with the question of whether a pregnancy caused it. As the podcast makes clear, it’s an abortion pill (typically misoprostol alone, or with mifepristone) but rebranded; you don’t need a positive pregnancy test to feel justified in taking it.

For the episode, Wendle spoke to a number of experts seeking to reframe how we think about pregnancy and abortion. They included Dr. Wendy Sheldon and Cari Sietstra, who are part of the National Working Group on Period Pills—a group of nearly two dozen collaborators trying to introduce period pills into our fertility control options, Sheldon said. This type of menstrual regulation (MR) is regularly used across the world, in places like Bangladesh, Indonesia, Myanmar, India, Cuba, and Brazil (some of which have restrictive abortion laws), Wendle reported. MR was historically practiced in the U.S. by midwives using herbs and tinctures. But the group’s attempt to reintroduce it via pills has prompted skepticism from many—including from those who work in reproductive health.

“If you are in a situation where you want to value your reproductive freedom over knowing for certain…then that ambiguity is very valuable.”

Especially in a post-Roe America, there is the sense that period pills could further exacerbate the stigma surrounding abortion, allowing people to skirt the issue of abortion entirely instead of actively fighting to protect access to it. Sietstra said that at a conference where Sheldon was presenting, an influential abortion rights funder shut her proposition down by saying, “Period pills? Good luck with that!” before walking away.

But Wendle chooses to look at it differently: “The goal of period pills really is…harm reduction. It is about communicating with people in need of healthcare, on their terms,” she told Jezebel. “And if they’re not ready to use the word ‘abortion,’ where if they don’t want to test to see if they’re pregnant before taking a pill to get their period back, then this is an option that…allows them to access that healthcare.”

Wendle believes that it’s key to deconstruct pregnancy as a binary—pregnant or not pregnant, as confirmed by the ubiquitous drugstore pregnancy test—and get comfortable with the idea of being a “little bit pregnant.” More than that, when we stop thinking that a missed period automatically means possible pregnancy, a missed period can be just that: a physical ailment like any other that can be treated with medicine.

So far, the medical field has not welcomed the idea of a period pill. But a survey Sheldon conducted comprised of nearly 700 people who were in clinics to receive pregnancy tests suggests that, if it were available, this medication would actually be very popular among some. Over 40 percent of respondents said they’d take the pill if it were available to them. Of those respondents, those who said they would be “unhappy” if they were pregnant were the most likely to want the pill. Survey participants also told Sheldon that it would improve their mental health to not have to decide whether or not to have an abortion.

“It opens up an opportunity to reclaim [and] redefine pregnancy,” Wendle told Jezebel. “It really centers agency, decision making, [and the] desire of the person who would be responsible for carrying a certain pregnancy to term to locate the definition of pregnancy not in, you know, some hCG in in your blood or in your urine, but in your want.”

She emphasized that the grey area in which these period pills exist is exactly the point. “For the person who is holding that ambiguity inside of themselves, they’re avoiding having their freedom of decision making taken away from them,” she said. “If you are in a situation where you want to value your reproductive freedom over knowing for certain…then that ambiguity is very valuable.”

Right now, period pills are only available via clinical trials and in some clinics in a handful of progressive states, including California, Colorado, Massachusetts, Oregon, New Mexico, Washington, and Washington, D.C. But the potential for period pills to crack open a wide range of possibilities for people—ones that relieve someone of making a choice whether or not to get an abortion—can push us towards a more nuanced way of thinking about reproductive autonomy. With them, we could think differently about missed periods.

This piece initially stated the wrong number of members of the National Working Group on Period Pills.

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