Physicians Could Prescribe Period Pills to Patients Who Are Late But Not Tested
October 1, 2025 6 minutes read
By Melinda Young
Period pills could become a more popular contraceptive option in the future as clinicians and women explore new ways to maintain reproductive autonomy. The actual pills used are the same as the pills used for medication abortion: mifepristone and misoprostol.
“The concept of period pills comes from menstrual regulation, which has been used internationally,” says Ushma Upadhyay, PhD, MPH, professor in the department of obstetrics, gynecology, and reproductive sciences, and public health scientist at the University of California, San Francisco. For example, Bangladesh and Cuba promote menstrual regulation as a fertility control option, according to research.1
“It’s a way to keep periods regular, and if a period is late, in Bangladesh, it’s a procedure of menstrual extraction,” Upadhyay says. “Period pills are for people whose periods are late.” If someone is pregnant, the pills will end their pregnancy. They will not have to take a pregnancy test, so for some people, there is not the moral dilemma of what to do if they have a positive pregnancy test and do not want to be pregnant, she explains.
“In the U.S., it is relatively new,” she adds. “There are a few telehealth providers that are regularly offering it.” One example is The Massachusetts Medication Abortion Access Project (MAP), which uses a telemedicine platform to provide medication abortion pills to people throughout the United States. The MAP offers medication abortion pills for future use and for use as period pills, as well as for ending a pregnancy. The project provides pills in a pay-what-you-can-afford-to-pay model, asking for a minimum payment of $5.2 (Using the medications for period regulation is an offlabel use.)
Aid Access will send abortion medication to people for advanced provision, which patients could use as period pills. Aid Access has an abortion pill consultation form for advanced provision. Applicants select the box stating they are not pregnant but would like to get pills for the future.3
A new study found that most people are interested in period pills or are in favor of the concept.1 From December 2021 to January 2022, researchers asked women about their interest in exploring period pills as a method to induce bleeding when a menstrual period is late and pregnancy is suspected but not confirmed. About one-quarter of the people ages 15 to 49 years said they would consider personally using period pills, and half of the participants said they were in favor of period pills being available. A quarter of respondents were uncertain.1
Period pills are not widespread since the concept has not yet been accepted and adopted by mainstream reproductive healthcare providers, Upadhyay notes. “It’s a brand new concept,” she explains. “I’ve talked to some providers, and I think they struggle with not doing all the tests and not getting all the knowledge [they believe is] necessary before prescribing pills.”
When more research shows the safety and acceptance of period pills, providers may become more interested in the idea, she adds. “We need more research before it becomes adopted,” Upadhyay says. “This study [on acceptance by pregnancy-capable people] is one step towards that goal.”
Investigators used a nationally representative survey that had more than about 7,000 survey respondents across the country. They used weights to make sure they were representative of the national population, and they found that 24% would consider using period pills if they were available.1
“It is something people can take along the continuum of emergency contraception and medication abortion,” Upadhyay says. “It’s most effective when people are already at least five days late after their period or one to two weeks of their period being late.” Prescribing period pills would give patients another reproductive option, and it could be a benefit to people who live in highly restrictive states or who have ambivalent feelings about abortion. They do not have to see a doctor in person or take a pregnancy test before using period pills, for instance.
“Not having proof of pregnancy may be helpful for some people,” she says. “Many people would prefer not to have the results of a pregnancy test in a state that is highly restrictive.”
For clinicians who are able to prescribe mifepristone and misoprostol, determining eligibility criteria for period pills may include the following questions:
- Does the person have a regular menstrual cycle?
- Has the patient had vaginal bleeding or spotting recently?
- Has the patient had a prior ectopic pregnancy?
- Does the patient have an intrauterine device in the uterus currently?
“Some will offer period pills right away, as soon as the period is a day late,” Upadhyay says. “Others will encourage patients to wait one more week because it’s more effective.”
The benefits to period pills include that they produce bleeding similar to a person’s period and could be kept on hand in case someone needs them, she says. Since mifepristone and misoprostol are safe medications, patients can take them whether or not they need to end a pregnancy. Providers might request patients call them for advice before taking the pills, and they also may request a follow-up call at four weeks to make certain the patient has resumed menstruation, she adds.
“Remote follow-up is standard for medication abortion to ensure menstrual bleeding has resumed. If it hasn’t resumed, then the pills could have not worked, or there could be an ectopic pregnancy,” Upadhyay says. “Often times, we advise providers to have patient materials that discuss period pills, talking about a late period and bleeding returning instead of language that is abortion specific,” she says. “We recommend they have specific material available for period pills.”
Prescribing period pills offers patients another option, particularly if they are not interested in the most effective contraceptive methods.
The chief drawback is cost. Abortion medication is expensive, so many people would not be able to afford the cost of period pills or advanced provision pills, she notes. “It’s hard to pay this much for a medication that you may not even need,” she adds.
“It’s a patient-centered approach that is meeting patients where they are,” Upadhyay says. “Many patients would not consider having an abortion, but if they have an option of not testing for pregnancy and could take period pills, they might consider that.”
Period pills could be available in some states that have six-week abortion bans unless they also require pregnancy tests and ultrasounds, she notes. “We’re in the planning phase of implementing this service in Virginia,” Upadhyay says. “I’m seeking donor funding for a trial offering these medications at a clinic where people regularly come in for a pregnancy test and a reproductive health clinic.”
The goal is to pilot actual use of period pills and monitor people’s interest in them and to collect more specific information on why people were interested, she adds. “We thought Virginia would be an ideal state because it’s restrictive and near other states with more restrictions,” Upadhyay explains. “It would be too challenging to test period pills in a state with a six-week ban because those states [often] require ultrasounds and pregnancy tests, which Virginia does not require.” The project has a clinician on board and is ready to start when funding is set, she adds.
Some reproductive rights advocates may be uncomfortable with the concept of period pills because they may believe it perpetuates abortion stigma, she notes. “My feeling is we need to meet patients wherever they are in achieving their reproductive autonomy,” Upadhyay says.
“If this allows them to not test and not know if they are pregnant, then we should give them that option,” she explains. “It’s hard because it’s still controversial, but the more we talk about it the more people are familiar with the concept and the more acceptance there will be.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Upadhyay UD, Sietstra C, Koenig LR, et al. Interest in period pills in the United States: A nationally representative survey, 2021-2022. Contraception. 2025;149:110980.
2. The MAP. Cambridge Reproductive Health Consultants. https://www.cambridgereproductivehealthconsultants.org/map
3. Aid Access. Abortion pills for future use. https://aidaccess.org/en/page/2880027/advance-provision
Period pills could become a more popular contraceptive option in the future as clinicians and women explore new ways to maintain reproductive autonomy.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content