Abortion Drugs Are Now Contraception Drugs and Vice Versa
Every once in a while, an argument proves too much.
That’s exactly what happens in this article in Dame Magazine by Lux Alptraum highlighting fuzzy distinctions between products that prevent pregnancy and those that end it.
Background:
- RU-486 (Mifepristone) is a progesterone receptor blocker which causes abortion and is banned in some countries, has near-total bans in some US states, and is highly regulated.
- Ulipristal Acetate (UPA, available in Ella) is a selective progesterone receptor modulator, is increasingly acknowledged in research articles and popular articles (the article of discussion in this post!) as an abortifacient, but is marketed as emergency contraception and is prescription-only in the US.
- Levonorgestrel (LNG) disrupts the hypothalamic-pituitary-gonadal axis to alter progesterone levels, most likely can act as an abortifacient during a narrow window between ovulation and fertilization, is marketed as both a contraceptive and as an emergency contraceptive, and is now available over-the-counter in Plan-B One Step.
Research has shown that all three of these drugs may act as an abortifacient at least some of the time.
In the Dame article, Laptraum points out that UPA–used in Ella as emergency contraception–“very likely is” an abortifacient1 (Alptraum, 2025). Additionally, UPA is now being looked at for use in smaller doses as a contraceptive. In her words, this is one drug that bridges the “supposedly uncrossable birth control-abortion divide” (Alptraum, 2025). In her eyes, this is a good thing–a super-drug that works as both contraception and abortion depending on the timing and dose.
She writes:
“Plan B may not be an abortifacient. But other forms of emergency contraception can be. That’s not something to shy away from or apologize for. That’s a liberatory revelation that we should be shouting from the rooftops” (Alptraum, 2025).
For abortionists, emergency “contraception” has never been about contraception. It’s always been about preventing birth. It might be nice if a contraceptive mechanism of action was at play; but for them, it’s not necessary. And as she correctly points out in her article, it’s very likely not reality.
She continues:
“…the line between ‘contraception’ and ‘abortion’ is far fuzzier than many of us think; more a spectrum of possibilities than two discrete and separate buckets” (Alptraum 2025).
The fuzzy line is not between the definition of contraception and abortion. That is clear and they are morally at odds with each other. The relevant fuzziness is in our knowledge of what’s actually happening in the body to prevent a baby. Those with honest moral questions about our place interfering should want to know what’s actually going on before, during, and after conception. Was a baby prevented from being conceived? Or is a baby potentially being aborted?
Laptraum seems almost excited to tell you that the emergency contraception drug UPA used in Ella can probably also be considered an abortion drug. And in reverse order, an abortion drug (Mifepristone) can probably also be used as a contraceptive. She doesn’t want there to be a “cruel moral binary” between abortion and contraception. She’s tolerant of both.
But in arguing that these drugs can have different effects based on timing and dose, she spilled the can of worms that I’ve been spotlighting with posts about hormonal contraception.
There’s another drug that women have been hooked on for decades that can be used as a contraceptive or to attempt an abortion: birth control pills.
Specifically, progestins. Levonorgestrel is one progestin used in the combination birth control pill or the mini-pill as a contraceptive. Women have known about the Yuzpe method to attempt abortions–where they megadose the progestin component of their birth control over a short period of time–since its inception in the 1970s. As the article implies, timing and dosage can mean the difference between contraception and abortion.
There are other reasons to believe hormonal contraception is abortifacient including its contribution to impaired tubal motility, endometrial atrophy, and luteal phase defect, all of which disrupt the embryo-endometrial synchrony required for a normal healthy birth.
While a moral binary between contraception and abortion is good, a binary distinguishing drugs as either contraceptive or abortifacient is less useful. Hormonal contraceptive opponents have been fighting for the recognition that a drug can be two things: sometimes a contraceptive, and sometimes an abortifacient. They have historically lost that cultural war. But in this battle, the enemy is becoming an ally.
Laptraum’s article is one of several that are slowly acknowledging the dual-mechanisms of these kinds of drugs. Abortionists praise this revelation because it means less births and more potential ways to circumvent pro-life legislation. If in-person abortion is illegal in your state, use an abortion drug at home. If Mifepristone is too highly regulated, just use UPA for the same effect. All you need is a prescription. Can’t get a prescription? Just use Plan-B over-the-counter. But while we’re here, why not just market Mifepristone as a contraceptive, lower the dose, and loosen the restrictions?
I should trademark Yuzpe+ in advance.
The group that will have the most trouble with this revelation are the hedged contraceptionists–the ones that don’t know, or don’t want to know, if a drugs like birth control pills or other forms of hormonal contraception might also be working as an abortifacient. The fence they’re sitting on is getting sharp.
This article is also a wink and a nod about Plan-B. Laptraum disagrees with moralists who say it can work as an abortifacient. She believes it can’t, and her disappointment leaps off the page. The “fuzzy distinctions” angle of this article seems like a veil covering an alternative motive to show women which drugs they should be pursuing to “get the job done.” You can try Plan B, but why not go ugly early with Ella?
Laptraum’s surface-level understanding of how these drugs affect the process of menstruation and pregnancy leads her to make overgeneralized statements like this:
“Once a pregnancy has begun developing, progestin has no effect on it. Indeed, it would be odd if it did, as progestin is a synthetic version of progesterone, a hormone that is crucial for maintaining a healthy pregnancy” (Laptraum, 2025).
We should be concerned with the effect of progestins throughout the entire cycle of menstruation and pregnancy, not just just “once a pregnancy has begun,” regardless of when you believe a pregnancy begins.
Progesterone is crucial for maintaining a healthy pregnancy. But the proper cycling of progesterone levels are crucial throughout the entire cycle of menstruation. When progestins are used in contraception and emergency contraception, it manipulates the HPG axis and shuts down normal progesterone cycling.
In the case of contraception, prolonged use of progestins–used in virtually every form of hormonal contraception–continuously downregulates the production of progesterone. In a normal cycle of menstruation, progesterone cycles between 0.1-0.7 ng/mL in the follicular stage and peaks around 18 ng/mL on day 20. A study about sugammadex interaction with hormonal contraception in 2022 showed that 83 out of 122 women on “any form” or hormonal contraception had progesterone levels that were below 0.06 ng/mL.2
Doses of progestins are just small enough to mitigate fear of side-effects or disease, and just big enough to trick the body into thinking it doesn’t need to make progesterone. For hormonal contraception, the effect on the body is not more progesterone, it’s way less.
This chronically low progesterone during hormonal contraception likely leads to luteal phase defect in the event of ovulation and conception. Luteal phase defect can lead to poor pregnancy outcomes. Some methods of contraception such as progestin-only pills have high ovulation rates (40-60%).
In the case of Plan-B, research by Peck et al. has shown that:
“LNG-EC, when given in the pre-ovulatory period, has been demonstrated to have 100 percent efficacy in preventing clinical pregnancy and no effectiveness when given at or after ovulation (Novikova et al. 2007; Noé et al. 2011). From this it has been concluded that the drug has no post-fertilization effect. However, if LNG is given in the late follicular phase of the fertile window (before ovulation), it could alter LH secretion, decrease progesterone levels, shorten the luteal phase, and lead to aberrant vaginal bleeding (Soules et al. 1989). All of these findings would impair the embryo’s ability to survive. Thus, pre-ovulatory drug administration could lead to post-fertilization effects” (Peck, et al., 2016)3
“When LNG-EC is given in the late follicular phase of the fertile window (before ovulation), it can disrupt normal pituitary-ovarian feedback mechanisms, alter LH secretion, and hinder luteinization of the follicle and its supporting network of cells (the corpus luteum), leaving the embryo unsupported and resulting in its early death” (Peck, Velez, 2013)4
Emergency contraception is a dangerous moral game, and research has shown that it might not be as useful as once thought. A study by Jensen et al. in 2024 concluded that “only 53% of our enrolled participants in the oral EC study might have benefitted from both oral EC pills provided in the study”5 (Jensen, et al., 2024). Those women took the EC prior to the LH surge and had a chance for it to work. But 37% of the participants taking the pills were already in the luteal phase (and either were never pregnant or would remain pregnant). And “4-6% presented too late for UPA or LNG to affect ovulation” (Jensen, et al. 2024).
This 4-6% are exactly who Peck describes. These women may be attempting emergency contraception too late to stop ovulation, but just early enough cause luteal phase defect potentially leading to early death in the event of conception.
It’s a misunderstanding to suggest that if progesterone is helpful during a normal pregnancy, then progestins must be incapable of having abortifacient properties (Yuzpe!). It’s also a point unnecessarily made considering Laptraum’s point is that you shouldn’t care whether it’s a contraceptive or an abortifacient as long as it “gets the job done.” She carefully points out meaningful distinctions–mifepristone blocks progesterone receptors whereas progestins act differently–only to convince you not to care about the distinctions and celebrate the “liberatory revelation” that as long as you’re not buying a carseat, you’ve won.
Abortionists will agree with her. They have reluctantly tolerated a clear line between abortion and contraception out of political necessity. But facing strong headwinds, they appear willing to continue their pursuit of abortion underground and to embrace whatever blurry lines lead away from a child.
But these blurry lines are a problem for Christians with moral questions about contraception and abortion, and they should listen carefully to these quiet parts that are increasingly spoken out loud.
- Alptraum, L. (2025). Does It Matter Whether Plan B Is Contraception or an Abortifacient? Dame Magazine. https://www.damemagazine.com/2025/07/01/does-it-matter-whether-plan-b-is-contraception-or-an-abortifacient/ ↩︎
- Devoy, T., Hunter, M., & Smith, N. A. (2023). A prospective observational study of the effects of sugammadex on peri-operative oestrogen and progesterone levels in women who take hormonal contraception. Anaesthesia, 78(2), 180–187. https://doi.org/10.1111/anae.15902 ↩︎
- Peck, R., Rella, W., Tudela, J., Aznar, J., & Mozzanega, B. (2016). Does levonorgestrel emergency contraceptive have a post-fertilization effect? A review of its mechanism of action. The Linacre quarterly, 83(1), 35–51. https://doi.org/10.1179/2050854915Y.0000000011 ↩︎
- Peck, R., Velez, J. (2013). The Postovulatory Mechanism of Action of Plan B: A Review of the Scientific Literature. The National Catholic Bioethics Quarterly, Winter 2013. https://liberty4life.org/wp-content/uploads/2019/03/peck-velez-post-ovulatory-mechanism-of-action-plan-b-ncbq.pdf ↩︎
- Jensen, J. T., Edelman, A., Westhoff, C. L., Schreiber, C. A., Archer, D. F., Teal, S., Thomas, M., Brown, J., & Blithe, D. L. (2024). Use of serum evaluation of contraceptive and ovarian hormones to assess reduced risk of pregnancy among women presenting for emergency contraception in a multicenter clinical trial. Contraception, 137, 110475. https://doi.org/10.1016/j.contraception.2024.110475 ↩︎