When do i need an in person visit for a medication abortion?
For most patients, it is perfectly safe to have a telemedicine medication abortion without ever having to step foot in a doctor’s office. What are some exceptions? Who needs to be seen in person?
Uncertain dates
Generally, for people with a regular period, the first day of the last menstrual period provides a reliable estimate of gestational age. Some people, for example those with polycystic ovarian syndrome (PCOS), have irregular periods. In these cases, it may not be clear when the first day of the last period occurred, and we’ll recommend an ultrasound to confirm that the pregnancy is within a safe window to take the abortion pills. This is also important because the gestational age determines the dosage of one of the abortion pills, misoprostol.
risk factors or symptoms concerning for ectopic pregnancy
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. Ectopic pregnancy accounts for an estimated 1-2% of pregnancies - it’s rare! However, if someone has strong risk factors or symptoms for ectopic pregnancy, we want to check an ultrasound before prescribing the abortion pills. This is because the pills will not end an ectopic pregnancy - a different treatment is necessary. If we check the ultrasound and do not see a pregnancy within the uterus, we’ll check the blood level of the pregnancy hormone beta human chronionic gonadotropin (bHCG). If the bHCG is higher than a certain level (around 2000) and there’s no intrauterine pregnancy, that is very concerning for possible ectopic.
risk factors for ectopic pregnancy
Previous ectopic pregnancy
History of pelvic inflammatory disease
History tubal surgery or disease
History of infertility
Cigarette smoking
Current intrauterine device (IUD) in place
Symptoms of ectopic pregnancy
Vaginal bleeding
Severe pain only on one side of the pelvis that then becomes more generalized to the lower belly
Dizziness, fainting, vomiting
Complications after taking the pills
Typically, patients who have had a medication abortion do not need to be examined after they’ve taken the pills. Most patients will notice their pregnancy symptoms like nausea or breast tenderness go away within about one week. Many people describe a sense that they “just don’t feel pregnant anymore.” We recommend folks take a home pregnancy test about 4 weeks after taking misoprostol. This delay is because it takes time for the pregnancy hormone bHCG to come down. Taking a test too early can lead to false positives - a positive test when someone is no longer pregnant.
Abortion pills are very safe and effective. That being said, no medication or treatment is perfect. If there are concerns that someone is having a complication, we’ll recommend they be seen in person for physical exam, to check blood levels of bHCG, and in some cases to check an ultrasound. Some examples of complications include:
Ongoing pregnancy
Pregnancy tissue still inside the uterus
Infection
Heavy or prolonged bleeding
We want to emphasize that complications are rare! Always ask your provider for signs and symptoms of complications to look out for, so that they can support you ASAP.
