Vaginal Bleeding or Spotting Before a Medical Abortion: What Does It Mean? – Aunty Jane

Experiencing vaginal bleeding or spotting before taking abortion medication can be unexpected and concerning. While some light spotting can be normal in early pregnancy, bleeding before a medical abortion may indicate an underlying issue, such as:

Ectopic pregnancy – A life-threatening condition where the pregnancy develops outside the uterus.
Miscarriage – A spontaneous loss of pregnancy, which occurs in 10-20% of all pregnancies.
Other complications – Such as subchorionic hematomas or cervical changes.

Understanding what your symptoms might mean and when to seek medical attention is crucial for your safety.

Could It Be an Ectopic Pregnancy?

An ectopic pregnancy occurs when a fertilised egg implants outside the uterus, usually in the fallopian tube. This type of pregnancy cannot continue and is a medical emergency if it ruptures. Since medical abortion medications only work for pregnancies inside the uterus, an undiagnosed ectopic pregnancy could be life-threatening.

Signs and Symptoms of Ectopic Pregnancy

If you experience vaginal bleeding before a medical abortion, watch for these warning signs of an ectopic pregnancy:

Sharp or one-sided abdominal pain – Often located in the lower abdomen or pelvis.
Persistent or worsening cramping – More severe than normal early pregnancy discomfort.
Dizziness, fainting, or weakness – Signs of internal bleeding.
Shoulder tip pain – A red flag for internal bleeding affecting the diaphragm.
Heavy bleeding or clots – May be mistaken for a miscarriage but requires urgent assessment.

Regardless of whether you are on the Scan Pathway or the No Scan Pathway, all vaginal bleeding or spotting in early pregnancy is treated as a suspected ectopic pregnancy until ruled out by an ultrasound.

What to Do If You Experience Vaginal Bleeding

Scan Pathway: If you have completed Consult 1 and are awaiting your formal ultrasound, but develop moderate vaginal bleeding before your scheduled scan, go to your local emergency department (ED) for an urgent ultrasound.
No Scan Pathway: If you have completed Consult 1 and been assessed as safe to proceed without an ultrasound, but then develop vaginal bleeding, this could be a sign of an ectopic pregnancy. Present to your local ED for an urgent ultrasound to rule out complications.
If you develop vaginal bleeding, DO NOT TAKE abortion pills until ectopic pregnancy is ruled out – Misoprostol will not work for an ectopic pregnancy and could delay critical care.

If you are unsure or concerned, seek urgent medical care. Early assessment can help prevent serious complications.

Could It Be a Miscarriage?

Miscarriage occurs in 10-20% of known pregnancies, and in some cases, vaginal bleeding before a medical abortion may indicate that the pregnancy is already ending naturally.

Signs of Miscarriage

Light spotting or heavier bleeding – Can range from brown discharge to bright red blood.
Cramping – Similar to period pain, sometimes with passing of clots.
Pregnancy symptoms decreasing – Breast tenderness, nausea, or fatigue may reduce.

If you suspect a miscarriage:

Let Aunty Jane know- We can arrange ultrasounds, blood tests and referrals if needed.
See a GP or EPAS provider – They may order an ultrasound or blood tests to confirm if the pregnancy is ongoing.
Wait for further guidance – Some people may pass the pregnancy naturally, while others may need medical or surgical management.

What Should You Do Next?

Seek urgent medical attention if needed – If you have severe pain, dizziness, or moderate- heavy bleeding, go to a hospital emergency department immediately.
Consider an EPAS referral – Depending on where you live in Australia, you may need to visit an Early Pregnancy Assessment Service (EPAS) for an ultrasound and further assessment.
Do not take abortion medication until you know the cause of bleeding – It is important to confirm that the pregnancy is intrauterine before proceeding.
Follow up with a healthcare provider – If you are unsure, a GP or abortion provider can help guide your next steps.
Seek emotional support – Experiencing unexpected bleeding before a medical abortion can be distressing. Free, confidential support services are available:

Emergency Counselling Services by State

National – 1800 RESPECT (1800 737 732) – 24/7 crisis support
New South Wales – NSW Mental Health Line: 1800 011 511
Victoria – Safe Steps Family Violence Response Centre: 1800 015 188
Queensland – 1300 MH CALL (1300 642 255) – 24/7 mental health support
Western Australia – Women’s Domestic Violence Helpline: 1800 007 339
South Australia – Mental Health Triage Service: 13 14 65
Tasmania – Mental Health Helpline: 1800 332 388
Northern Territory – NT Mental Health Line: 1800 682 288
Australian Capital Territory – Access Mental Health: 1800 629 354

Final Thoughts

Vaginal bleeding before taking abortion medication can be a sign of an underlying issue. Whether it is an ectopic pregnancy, miscarriage, or another complication, it is essential to seek medical care before proceeding with abortion pills. If you are unsure, get checked—it could save your life.

The information provided on this website by Aunty Jane in any format or medium, are for general information purposes only and are not intended as medical advice or as a substitute for consultation with a qualified healthcare professional. The information made available by Aunty Jane do not provide personalised medical advice, diagnosis, or treatment. To the extent permitted by law, Aunty Jane disclaims all liability for any outcomes resulting from reliance on the information provided. For specific medical concerns, please consult a qualified healthcare professional.

American College of Obstetricians and Gynecologists. (2018). ACOG practice bulletin no. 193: Tubal ectopic pregnancy. Obstetrics & Gynecology, 131(3), e91-e103. https://doi.org/10.1097/AOG.0000000000002560
Centers for Disease Control and Prevention. (2022). Ectopic pregnancy: Symptoms, diagnosis, and treatment. https://www.cdc.gov/reproductivehealth/maternalinfanthealth/ectopic-pregnancy.htm
National Institute for Health and Care Excellence. (2019). Ectopic pregnancy and miscarriage: Diagnosis and initial management. NICE Clinical Guidelines, No. 126. https://www.nice.org.uk/guidance/ng126
Royal Australian and New Zealand College of Obstetricians and Gynaecologists. (2023). Early pregnancy loss and ectopic pregnancy: Clinical practice guidelines. RANZCOG. https://www.ranzcog.edu.au
van Mello, N. M., Mol, F., Opmeer, B. C., Ankum, W. M., Barnhart, K., Coomarasamy, A., … & Mol, B. W. (2009). Diagnostic value of serum hCG measurements in suspected ectopic pregnancy: A meta-analysis. BMJ, 339, b3367. https://doi.org/10.1136/bmj.b3367