The Supreme Court justices who overturned Roe v. Wade justified their decision in part by asserting that abortion rights did not exist in the 1860’s when the 14th Amendment was passed. We disagree with the Justices’ legal reasoning. For centuries, women took concoctions or drugs to induce bleeding when their periods were late, “regulating” their menses and restoring what was seen as a healthy, normal flow of blood, while also ensuring an end to any possible early pregnancy.
Long before the term “abortion” entered our history, Anglo-American legal traditions protected this practice of menstrual regulation. Under common law, from at least the early 1600s onward, the practice of bringing on a late period was both legal and culturally acceptable in the British colonies and early United States. Anytime before the “quickening”—the time in pregnancy around 16-18 weeks when women can feel the fetus moving within them— women could ingest herbs or teas to try to get their menses to restart. A late period might mean the woman had a “blockage” or “obstruction” to her natural flow in addition to indicating a possible pregnancy. Both could be addressed by bringing on menstrual bleeding.
In the 1860s, an American suspecting a possible pregnancy may have used plants like tansy, black or blue cohosh, rue, angelica or pennyroyal to bring on bleeding. Today we have period pills: life-saving medicines that have been used safely around the world for over thirty years.
We spend our days working to expand access to this form of fertility control. Anyone who can bear children should have access to medicines that can bring down their menses—they should have access to period pills.
Yes, the purpose of these historical remedies —and now, of period pills—is to ensure that women do not have to carry an unwanted pregnancy if they suspect one might be developing. But unlike abortion, period pills embrace the ambiguity that can come at the beginning of a possible pregnancy. Though period pills will end a pregnancy that has begun to develop, patients do not have to confirm if they are pregnant to take these medicines. And after using period pills to bring on bleeding, they will never know whether they were pregnant in the first place.
These medications—misoprostol, either alone or with mifepristone—can be used as early as three or four days after a period is missed, and possibly even earlier than that. Though they are best known for their use in abortions (for which they are prescribed after a confirmed pregnancy test), they have also been safely used for menstrual regulation in other settings for years. In fact, they have a variety of uses in gynecological healthcare, as they cause the uterus to contract and expel whatever is inside it.
We know there is substantial interest in period pills. In a recent study, people seeking pregnancy tests at clinics in two US states were asked if they would prefer period pills instead of a test. Of those who did not want to be pregnant, more than 70 percent indicated they would prefer to use period pills. We also know from reporting in popular media and results from unpublished research (a study that one of us led) that some people in the US are currently practicing menstrual regulation without a prescription or advice from a doctor, in many cases using medications or other substances that are less effective than mifepristone and misoprostol.
Currently period pills are available via telemedicine in six states and the District of Columbia (all are states where abortion is still legal because for now we are assuming states may regulate them as they do abortion pills). We anticipate access and use will increase as more providers develop interest in this traditional option for fertility control, one that has undeniably deep historical roots in the US, and which also has cultural resonance in many US communities today.
To expand access, we collaborate with a number of reproductive health and justice organizations that are charting a path forward for period pills, with the goal of making them accessible for people across the country. Partner organizations conduct research looking at patients’ interest in and experience of taking period pills in the US; conduct communications and outreach with clinicians interested in this method of fertility control; and help educate the public about the option to bring down a period when one is late.
Period pills do not provide a full solution to the demise of abortion rights under Roe. They will not replace providers, clinics or hospitals that formerly offered a full spectrum of care, particularly in later pregnancy when fetal anomalies and health issues in pregnant people often become apparent. (They also have side effects, which can include cramping, nausea, fever and chills.) But they are one way for Americans to continue to exercise control over their fertility.
Justice Alito and his conservative colleagues have concluded that abortion rights are not deeply rooted in American legal history, and therefore cannot be constitutionally protected under an interest in “liberty.” We disagree with them. But if the Justices insist we must go back to the way things were in 1860, then at the very least, let’s make sure we use all the options available to Americans at that time—including the option to bring down our periods when we do not want to be pregnant.