Medical abortion is a safe and effective option for ending an early pregnancy, but not all pregnancies develop normally. One serious condition that must be considered before taking abortion medication is ectopic pregnancy, which occurs when a fertilised egg implants outside the uterus—most commonly in the fallopian tube. Because medical abortion medications (mifepristone and misoprostol) only work for pregnancies inside the uterus, they do not treat ectopic pregnancies and could delay life-saving care.
Why Abdominal Pain Before a Medical Abortion Matters
Mild to severe persistent cramping or abdominal pain before a medical abortion is not normal and requires investigation. Up to 70-80% of people with an ectopic pregnancy experience symptoms in early pregnancy, sometimes before they even know they are pregnant. If left untreated, an ectopic pregnancy can rupture, causing life-threatening internal bleeding.
Signs That Require Immediate Medical Attention
If you are on the no-scan pathway and develop any of the following symptoms before taking abortion medication, you must go to the hospital immediately:
- Severe or persistent one-sided abdominal pain – This may feel sharp, stabbing, or cramp-like.
- Heavy or unusual vaginal bleeding – Lighter or heavier than a period, sometimes dark brown.
- Dizziness, fainting, or weakness – These can be signs of internal bleeding.
- Shoulder tip pain – A warning sign of internal bleeding affecting the diaphragm.
Why It’s Important to Get Checked
Because the no-scan pathway relies on clinical history rather than ultrasound, it is especially important to listen to your body. If you experience abdominal pain before taking abortion medication, it could indicate an ectopic pregnancy, miscarriage, or another complication that requires immediate medical care. Do not proceed with the medication until ectopic pregnancy has been ruled out in hospital.
What to Do If You Have Symptoms
If you have any of the symptoms above, go to the nearest hospital emergency department immediately. Do not take abortion pills until an ectopic pregnancy has been ruled out. Seeking care early can prevent serious complications and ensure you receive the safest treatment.
Your safety comes first. If you’re unsure, get checked.
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- American College of Obstetricians and Gynecologists. (2018). Ectopic pregnancy: FAQ 155. https://www.acog.org/womens-health/faqs/ectopic-pregnancy
- Barnhart, K. T. (2009). Clinical practice: Ectopic pregnancy. New England Journal of Medicine, 361(4), 379-387. https://doi.org/10.1056/NEJMcp0810384
- Centers for Disease Control and Prevention. (2021). Ectopic pregnancy. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/ectopic-pregnancy.htm
- Jurkovic, D., & Wilkinson, H. (2011). Diagnosis and management of ectopic pregnancy. BMJ, 342, d3397. https://doi.org/10.1136/bmj.d3397
- Shaw, J. L., Dey, S. K., Critchley, H. O., & Horne, A. W. (2010). Current knowledge of the aetiology of human tubal ectopic pregnancy. Human Reproduction Update, 16(4), 432-444. https://doi.org/10.1093/humupd/dmq002
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