MS-2 Step approved for missed miscarriage for the first time

A decision by the Therapeutic Goods Administration (TGA) provides Australian women more time to access early medical abortion and a new approved option for managing missed miscarriage.

The TGA extended the approved use of MS-2 Step (mifepristone and misoprostol) as of October 21.

MS-2 Step is now approved for early medical abortion up to 70 days (10 weeks) of pregnancy, up from 63 days.

It is also approved, for the first time, for the medical management of missed miscarriage up to 70 days.

About one in four confirmed pregnancies ends in miscarriage. A missed miscarriage occurs when a pregnancy has stopped developing but the pregnancy tissue has not passed.

Perth GP Dr Jana Combrinck, who has a special interest in women's health, said small changes in women's healthcare like these could have a big impact.

She said it gave women more choice at a difficult time.

“When someone experiences a missed miscarriage, they've usually just received devastating news. Some women will choose surgery, others will prefer expectant management, but many tell me they simply want to avoid an operation if they safely can,” she told Medical Forum.

“Expanding access to medical management means we can offer another evidence-based option that can often be managed in the comfort of their own home, with support from their GP.”

Dr Combrinck said women value having continuity with a doctor they know and trust, rather than feeling rushed into hospital-based care simply because of gestational limits.

"Anything that allows us to individualise care and respect a woman's preferences is a positive step forward," she said.

On the expanded use of MS-2 Step for medical abortion, Dr Combrinck said the extra week meant women would be less likely to miss out on the medical option they may have preferred simply because they couldn't get through the system quick enough.

“Women are incredibly busy. They're balancing work, looking after children, caring for family members, trying to organise an ultrasound, find time off work, arrange childcare and navigate appointments, all while making a very personal and often difficult decision.

“I see women who present just beyond the previous 63-day cut-off, not because they've delayed intentionally, but because life gets in the way or access to healthcare isn't always immediate.”

Dr Combrinck said it was a doctor's responsibility to always to provide safe, evidence-based care within current regulations.

"I think we should always be looking for ways to make healthcare more accessible, compassionate and centred around the needs of our patients," she said.

She said the current WA clinical abortion guidelines – last updated in 2025 – were developed before the TGA expanded the approval to 70 days, so would need updating to reflect these changes.

Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) President Dr Nisha Khot said the decision brought the approved use of the medicine into line with the College’s guidance.

“This decision aligns the approved use with RANZCOG’s Clinical Guideline for Abortion Care, and with practice in comparable countries including the United Kingdom, the United States and Aotearoa New Zealand,” she said.

A recent study highlighted that a lack of access to medical abortion had forced many women to seek out a new provider to receive care.

A requirement for GPs to complete mandatory training and registration specific to MS-2 was removed in 2023.

While detailed data since this period is not yet available, it is hoped access may have improved as a result of this change.

Another barrier to access can be cost, however the Pharmaceutical Benefits Advisory Committee (PBAC) has recommended listing MS-2 Step for medical abortion up to 70 days and will consider the miscarriage indication at its November 2026 meeting.