AUSTIN, Texas — A federal appeals court preserved access to the abortion pill mifepristone for now but reduced the period of pregnancy when the drug can be used and said it could not be dispensed by mail.

The ruling late Wednesday temporarily narrowed a decision by a lower court judge in Texas that had completely blocked the Food and Drug Administration’s approval of the nation’s most commonly used method of abortion. 

The Texas order unsettled abortion providers less than a year after the reversal of Roe v. Wade curtailed abortion access in some states.

The case may now be headed to the U.S. Supreme Court.

Mifepristone was approved for use by the FDA more than two decades ago and is used in combination with a second drug, misoprostol.

In a far-reaching ruling last week, a federal judge blocked the FDA’s approval of the pill following a lawsuit by the drug’s opponents. There is little precedent for a lone judge overturning the regulator’s medical recommendations.

The ruling was put on pause to allow an appeal.

Just before midnight Wednesday, the Fifth Circuit of the United States Court of Appeals at New Orleans ruled that the FDA’s initial approval of mifepristone in 2000 could remain in effect.

But in the 2-1 vote, the panel of circuit court riders put on hold changes made by the regulator since 2016 that relaxed the rules for prescribing and dispensing mifepristone. 

Those included extending the period of pregnancy when the drug can be used to 10 weeks from seven weeks, and also allowing it to be dispensed by mail, without any need to visit a doctor’s office.

The two judges who voted to tighten restrictions, Kurt Engelhardt and Andrew Oldham, are both appointees of President Trump. The third judge, Catharina Haynes, is an appointee of President George W. Bush. She said she would have put the lower court ruling on hold entirely for now to allow oral arguments in the case.

Either side, or both, could take the case to the Supreme Court. Opponents of the drug could seek to keep the full lower court ruling in effect. The Biden administration, meanwhile, could ask the high court to allow all the FDA changes to remain in place while the case continues to play out.

The appeals court judges in the majority noted that the Biden administration and mifepristone’s manufacturer “warn us of significant public consequences” that would result if mifepristone were withdrawn entirely from the market under the lower court ruling.

But the judges suggested changes the FDA made making mifepristone easier to obtain since 2016 were less consequential than its initial approval of the drug in 2000. It would be “difficult” to argue the changes were “so critical to the public given that the nation operated — and mifepristone was administered to millions of women — without them for sixteen years” the judges wrote.

When the drug was initially approved in 2000, the FDA limited its use to up to seven weeks of pregnancy. It also required three in-person office visits: the first to administer mifepristone, the next to administer the second drug misoprostol, and the third to address any complications. 

It also required a doctor’s supervision and a reporting system for any serious consequences associated with the drug.

If the appeals court’s action stands, those would again be the terms under which mifepristone could be dispensed for now.

Democratic leaders in states where abortion remains legal since the Supreme Court overturned Roe v. Wade last year say they are preparing in case mifepristone becomes restricted.

Governor Hochul said Tuesday that New York would stockpile 150,000 doses of misoprostol.

Pharmaceutical executives this week also signed a letter that condemned the Texas ruling and warned that FDA approval of other drugs could be at risk if the decision by a federal district judge, Matthew Kacsmaryk, stands.

The lawsuit challenging mifepristone’s approval was brought by the Alliance Defending Freedom, which was also involved in the Mississippi case that led to Roe v. Wade being overturned. 

At the core of the lawsuit is the allegation that the FDA’s initial approval of mifepristone was flawed because the agency did not adequately review safety risks.

Mifepristone has been used by millions of women over the past 23 years, and complications from mifepristone occur at a lower rate than problems in wisdom teeth removal, colonoscopies and other routine procedures, medical groups have recently noted.

As for dispensing Mifepristone by mail, Judge Kacsmaryk cited the 1873 Comstock Act, which barred sending abortion materials through the mails, in his ruling barring the shipment of the pills in the postal system. The circuit court riders let that ban stand for now, but noted that “the speed of our review does not permit conclusive exploration of this topic.”