Don’t Take Advice from TikTok on Herbal Abortifacients

There are no safe and effective herbal methods for abortion

In the wake of the disastrous decision to overturn Roe v. Wade in the United States, videos, blogs, Instagram posts and tweets are surfacing about so-called herbal abortifacients. While some of these people may be well-intentioned, there are no safe, effective methods of inducing abortion with botanicals. If there were, I’d be the first to tell you. I’ve looked up a lot of methods trying to find one that made medical sense and is safe.

The myth of the safe, herbal abortion is pervasive. It is a combination of two fallacies, appealing to the belief in the magical power of ancient remedies and that of course, natural is best.

Pre-1850 ish medicine was based on humorism, a belief system base on four humors–black bile, yellow bile, blood, and phlegm–bring in balance. Many proponents of herbal abortifacients still look to the writings of this time, even as far back as Ancient Egypt and Hippocrates, as proof of the power of natural remedies. But if you believe that the ancient Greeks were right about herbal abortifacients, why don’t you also believe that disemboweling a puppy, stuffing it with herbs, and burning it for smoke to fumigate the uterus is good therapy? Because they also recommended that. Or believe that the uterus wanders the body? Or that menstruation and breast milk are the same fluids. Because those are also ancient medical beliefs attributed to the time of Hippocrates.

Since I don’t believe the uterus gets lost like a naughty sheep or that breast milk and menstrual blood are the same fluid, we’re not going to accept claims of ancient abortifacients at face value.

To cause an abortion a substance must do at least one or more of the following:

• Block progesterone

• Induce contractions

• Be toxic to fetal/placenta tissue

• Cause an infection in the uterus (which then triggers fetal demise and/or contractions)

If there were effective herbs that could do these things, that is what we would be using. Why would anyone have stopped? No one would have ever had to suffer with the shame of having child out of wedlock and we wouldn’t now have 25 million women a year having unsafe abortions if there were safe herbal abortifacients. Unless you buy into a global conspiracy in every country to suppress that knowledge? Or, perhaps consider the alternative is these methods were not effective or they were believed to be unsafe . In fact the are contributing now to unsafe abortions. Safety falls by the wayside in the face of desperation.

I think it’s important to note that therapies that work seem to stay with us. A great example is even found within OB/GYN. A fungus that grows on rye produces mycotoxins called ergot alkaloids, which are poisonous to humans producing ergotism. When it became clear that pregnant women who were suffering from ergotism suffered abortions or went into labor, using grains of rye contaminated with the fungus were used in the 1800s to trigger labor and stop postpartum hemorrhage. Eventually, the ergot alkaloids were identified and used to develop the drug ergonovine (ergometrine), which can be used to stop postpartum hemorrhage. We have a clear example of an effective, albeit dangerous, abortifacient staying with us as the danger could be relatively controlled. Or, with a post partum hemorrhage in the face of bleeding to death the risk was worth it.

Many herbal abortifacients are quite literally poisons, so abortion may be a by-product of the poisoning . Either the fetus or placenta are affected and fetal death occurs, eventually triggering either labor or an infection that then hopefully triggers labor. Or the pregnant person becomes so ill, for with example liver failure, that abortion results, either because of fetal demise due to insufficient oxygen or perhaps because the blood loses its ability to clot and bleeding begins behind the placenta.

Placing herbs vaginally is also sometimes recommended, but for a product to work vaginally it almost certainly needs to be manipulated in a lab so there are sufficient levels of any compound available to make it into the uterus. If vaginal products ever worked, it is likely because leaving a bouquet garni in the vagina for several days caused a profuse inflammatory response or an infection, and this process triggered contractions. Intrauterine infections can be deadly, so causing an infection is not a recommended method for abortion.

There are no plants that I could find that can block progesterone and purposefully cause an abortion.

Let’s look at the most common so-called herbal abortifacients. A big thanks to Dr. Josh Trebach and Dr. Ryan Marino who are both toxicologists and who have been very generous in answering my questions.

Pennyroyal or Mentha pulegium

Pennyroyal was traditionally used as a flea repellent and as an abortifacient. It contains pulegone, which is highly toxic to the liver and the central nervous system, causing seizures and coma. There is no evidence it is actually an effective abortifacient, any effect is likely a by-product of being catastrophically ill. Deaths due to pennyroyal ingestion to induce abortion are well reported. Anyone who recommends pennyroyal is putting your life at risk. Block them and move along.

Rue, also known as herb grass, herb of grace or ruda.

This is the plant Ruta graveolens. It is harmful and contains several toxic compounds. Side effects include vomiting, hemorrhage, abdominal pain, multisystem organ failure and death. There are some older animal studies that suggest a possible abortifacient effect in rats, but this is with a pharmaceutical extract, so how applicable this is to humans ingesting homemade remedies is unknown. In a series of cases of 26 women who reported to a poison control center after ingesting rue for abortion, 9 had abortions and many, including those who did not have abortions, were quite ill. Four women died. It isn’t clear if the abortions were the result of the poisoning (meaning the sickness caused by rue) or a direct effect of the rue itself. This is not a safe nor a particularly effective method of abortion.

Parsley

The scientific name is Petroselinum crispum. We all think of parsley as a lovely garnish, so how can that be dangerous? Parsley contains myristicin and apiol. Myristicin is toxic to cells in general and specifically neurons, and apiol is toxic to the kidneys. Remember, when we eat parsley leaves we are not consuming a pharmacological dose. Parsley is suggested as an abortifacient either by putting springs in the vagina, by boiling and drinking water, or using an extracted oleoresin called apiol.

Parsley is associated with abortion in that same review of women reporting to a poison control center after attempting self-abortions, 13 took parsley and it was successful for 7 women, but it was also associated with hemorrhage, liver damage, and death (when combined with other herbs). There are also reports of death from apiol.

Leaving parsley in the vagina for several days could cause an infection that could trigger contractions, but that could also cause sepsis.

Parsley and apiol are not recommended.

Lycopodium saururus or clobmoss.

The chemicals of concern are lycopodium alkaloids, including sauroxine, lycodine, lycopodine, and clavolonine. Depending on concentration, extracts can cause vomiting, diarrhea, convulsions and even death. In the same series of women presenting to the poison control center just mentioned, 20 had taken lycopodium, 16 had severe vomiting, and none aborted.

Again, pass.

Savin oil

Oil of savin is typically distilled from leaves and twigs of Juniperus sabina, but all parts of the plant are toxic due to terpenes and podophyllotoxin. Even the pollen is dangerous! Podophyllotoxin is well known as a cytotoxin (damages cells) and neurotoxin (damages neurons). It is cytotoxic enough that it is used to make some chemotherapy drugs. The cytotoxic properties might make oil of savin toxic to a fetus or placenta, and hence trigger an abortion.

Another issue is that the roots of Juniperus sabina can be confused with other roots while harvesting, so people might also be ingesting extracts of other plants that further increase the toxicity when taken together. This highlights a major concern with botanicals– they may not contain what they claim, either accidentally or on purpose.

Oil of savin can cause vomiting, stomach pain, coma, liver damage, kidney failure, and death. It is well known as an abortifacient, but whether that is distinct from its overall toxicity isn’t known. At least one death in pregnancy has been reported and while I can’t find the reference, numerous sites claim 5-6 drops of the oil can be fatal.

Pass

Blue cohosh

Blue cohosh is the dried root or extract of dried root of Caulophyllum thalictroides and contains N-methylcytosine, which has nicotine-like effects and is toxic. It also contains a variety of other chemicals, including anagyrine (although this isn’t consistently identified). Blue cohosh can cause blood vessels in the heart to constrict (not a good thing), and can cause nausea and vomiting and tremors. It may also stimulate the uterus to contract and be toxic to the embryo. In one survey, about two-thirds of midwives recommended blue cohosh to induce labor. There are reports of severe maternal harm from taking blue cohosh to induce labor and one report of nicotinic toxicity when blue cohosh was used to induce an abortion. The safety and effectiveness is really unknown.

Mugwort

This is Artemisia vulgaris and is related to ragweed. It’s been used for centuries in a variety of medicinals and there are reports that it has estrogen-like properties, which some claim could inhibit implantation. However, lots of people get pregnant taking the pill which has very high levels of estrogen, so it’s hard to see how this mechanism could produce any effect. Some amounts are relatively benign, as long as you aren’t allergic to ragweed. However, mugwort has thujone, which is neurotoxic, and an oil extract or essential oil could be harmful because it may have high levels of thujone. Again, not proof of efficacy and anyone taking the oil is definitely risking toxicity.

Summary

I absolutely appreciate the desperation of not to be pregnant, but many plants that are often suggested are extremely toxic and others likely have no effect. When oils are recommended, this often provides very concentrated doses of dangerous compounds. Many herbal abortifacients can be fatal or cause serious illness, and are only likely to be abortifacients because they are so toxic that it is no different than recommending any poison. In addition, botanicals may not contain what they claim, and they could even be adulterated.

Putting faith in historical documents which were almost certainly written by men (basically what the men thought women were doing) as sources of valid medical information about abortifacients is simply not warranted.

It’s true we have no studies with these drugs, but we also have no proof they are safe and effective, in fact, we have a lot of evidence to suggest otherwise. Once you know what a plant contains and the concentration of the active substance in an oil or extract, it’s often possible to predict if something is unsafe and if it has a hope of working.

At best these products might not work, but they could lead to delays in getting access to care, which is problematic and harmful. At worst they can cause serious harm and death. And it is highly likely that people who take them might be hesitant to seek care afterwards for fear of repercussions, further increasing the risk of death.

Instead of promoting unsafe methods that have no proof of efficacy, advocates should be focusing on finding ways for people to access mifepristone and misoprostol, or even misoprostol alone. In fact, misoprostol by itself is far safer than any botanical and also more effective. You can read more about medication abortion and how to use it safely here. And no, the medical team can’t tell if you took these drugs, read more about that here.

Many things are awful right now, but suggesting poisons isn’t the answer.

References

King, H. Hippocrates’ Woman. Routledge, 1998. Chapters 6 and 7.

Ciganda C, Laborde A. Herbal Infusions Used for Induced Abortion. Journal of Toxicology 2003,41: 235–239.

Letheby H. On the poisonous effects of savin (JUNIPERUS SABINA). Lancet 1845.

Li J, Sun A, Jin L, et al. Alleviation of Podophyllotoxin Toxicity Using Coexisting Flavonoids from Dysosma versipellis. PLOS One. 2013, August.

Juniperus sabina oil toxicity https://www.botanical-online.com/en/medicinal-plants/juniperus-sabina-toxicity

Rader JI, Pawar RS. Primary constituents of blue cohosh: quantification in dietary supplements and potential for toxicity. Anal Bioanal Chem 2013 May;405(13):4409-17.

European Food Safety Authority; Compendium of botanicals reported to contain naturally occurring substances of possible concern for human health when used in food and food supplements. EFSA Journal 2012;10(5):2663.