Program Highlights

Participant enrolment began in Fall for a study to identify an ulipristal acetate-misoprostol medication abortion regimen that balances efficacy, safety, and cost-effectiveness. By the end of the year, the double-blind, placebo-controlled randomized trial had enrolled 60 out of a total of 426 participants desiring abortion with medications at two clinical sites in Mexico. We anticipate reaching the 100-participant mark in early 2026, at which point we will temporarily halt the study to review the accumulated data; enrolment will then resume until completion.

Ulipristal acetate, like mifepristone, is a selective progesterone receptor modulator and is rapidly absorbed when taken orally. This latest study follows on from our proof-of-concept study, also conducted in Mexico, which established the potential of combining ulipristal acetate with misoprostol for early pregnancy termination (Winikoff 2025). Outcomes from this clinical research will help determine the design of future studies.

To find out more about this work so far—the result of a research project initiated in response to the gap in number and type of safe abortion products—you can access a set of Frequently Asked Questions, available in English and Spanish, and listen to The FMUS podcast episode featuring an interview with Gynuity’s president.

In May, Gynuity took part in a webinar hosted by the Latin American Consortium Against Unsafe Abortion (Consorcio latinoamericano contra el aborto inseguro, Clacai) to present the early-stage evidence on ulipristal acetate for this new purpose.

Despite evidence that medication abortion without in-person screening tests is safe and effective, ultrasound and pelvic examination before medication abortion provision remain common when care is provided in person. These tests can incur unnecessary costs and delay care.

In a retrospective cohort study, data were analyzed for patients who during the height of the COVID-19 pandemic obtained medication abortion care from three U.S. clinics with and without in-person screening tests (Koenig 2025). Although loss to follow up was high, the results are consistent with previous studies and indicate that medication abortion provided without screening ultrasound or pelvic examination is comparably effective and safe to medication abortion with those tests.

Based on the findings and the weight of the evidence from other studies, the authors of the study—researchers affiliated to the universities of California, Washington and Hawaii, Planned Parenthood, and Gynuity—recommend that clinicians can safely offer the option of no-test medication abortion to all eligible patients, including those screened in person.

Gynuity has a long history of assessing medication abortion eligibility without prior ultrasound. Our more recent engagement in this area in the United States has included leading the development of a sample protocol for providing medication abortion without any routine facility-based tests either before or after treatment (Raymond 2020); undertaking studies to compare outcomes among patients who did or did not have screening ultrasound or pelvic examination when medication abortion was offered via direct-to-patient telemedicine and mail (Anger 2021; Anger 2024); and, collaborating on a study which showed that screening for medication abortion based on medical history alone is highly effective and low risk, with medications dispensed either in-person or by mail (Upadhyay 2022).

Gynuity participated in a regional conference in Moldova and delivered a presentation to share evidence from our research in Eastern European and Central Asian countries and elsewhere related to de-medicalized medication abortion and self-care approaches. The presentation included insights from, among others, a published study conducted with partners in Ukraine, Uzbekistan and Azerbaijan to evaluate a telemedicine medication abortion service using medical history alone to screen for eligibility (Tsereteli 2024).

The two-day hybrid conference in May was organized by the Reproductive Health Training Centre (Centrul de Instruire în Domeniul Sănătăţii Reproductive, CIDSR). It focused on gaps, barriers and emerging opportunities in the region regarding self-care strategies for abortion and family planning. Around 60 experts participated, all committed to aligning national policies with recent World Health Organization recommendations on self-care interventions for reproductive health.  

Guidelines released in October by global health agencies* now also recommend diagnosing and triggering treatment for PPH, the leading cause of maternal deaths, when measured blood loss reaches 300 mL and any abnormal signs in pulse rate, blood pressure and shock index have been observed. 

The new recommendation is particularly useful for low-resource settings, where delays are more likely to result in deaths, and is supported by the findings from the largest study on this topic to date (Gallos 2025). Published in The Lancet, the meta-analysis by WHO and colleagues suggests that measured blood loss below the conventional threshold of 500 mL (i.e. 300 mL or more), when combined with abnormal hemodynamic signs, accurately predicts women at risk of death or severe complications from excessive bleeding after childbirth. 

To assess the prognostic accuracy of clinical markers of postpartum bleeding in predicting maternal mortality or severe morbidity, researchers analyzed individual participant data of over 300,000 women from 12 datasets, including datasets associated with two studies contributed by Gynuity. The first, a community-based study implemented in rural Pakistan, assessed misoprostol administration by trained traditional birth attendants for PPH prevention in home births (Mobeen 2011). The second, a study in Argentina that systematically collected data on blood pressure and pulse rate along with measured blood loss, evaluated the impact of routes of oxytocin administration on postpartum blood loss and rates of PPH (Durocher 2019).

*World Health Organization, International Federation of Gynecology and Obstetrics, and International Confederation of Midwives.