Making the decision to have an abortion can bring up many questions, especially regarding care before and after the procedure. One of the most common doubts is whether it’s necessary to get an ultrasound at any point during the abortion process. In this blog, we’ll explore when and why an ultrasound might be helpful, its benefits and limitations, and whether it’s essential for having a safe abortion. Remember, evidence-based information is key to making informed decisions about your reproductive health.
What Is an Ultrasound and How Does It Work?
An ultrasound, also known as a sonogram, is a medical imaging technique that uses high-frequency sound waves to create images of the inside of the body. There are different types of ultrasounds designed for various parts of the body and medical purposes, but in the context of pregnancy, the two most common are abdominal and transvaginal ultrasounds. These allow visualization of the uterus, the gestational sac, and in some cases, can help detect issues such as ectopic pregnancies.
The main difference between an abdominal and a transvaginal ultrasound for pregnancy detection lies in the method of access and the quality of the image produced. An abdominal ultrasound uses an external transducer on the abdomen, while a transvaginal ultrasound involves inserting the transducer into the vagina. Transvaginal ultrasounds provide clearer images, especially in the early stages of pregnancy, and are useful for evaluating pelvic structures in greater detail.
Ultrasound is a common, safe, and non-invasive medical tool that can offer helpful information at certain points in the abortion process. However, in many contexts, access to ultrasound is not always easy. The cost can be high, and in rural or low-resource areas, it may be difficult to find a healthcare facility that offers this service. That’s why it’s important to understand that not having access to an ultrasound does not mean you can’t have a safe abortion, as long as you have the correct information and follow proper guidelines.
Is an Ultrasound Necessary Before an Abortion?
Although having an ultrasound before an abortion is not mandatory, it can be helpful for the following reasons:
- To confirm that the pregnancy is located inside the uterus and is not an ectopic pregnancy (when the pregnancy grows outside the uterus, usually in the fallopian tubes).
- To estimate the gestational age.
- To ensure that the abortion was complete.
In clinical abortion services, some providers may require a pre-abortion ultrasound. However, in the context of self-managed abortion, this is not always necessary.
Medical abortion is safe and effective even without this exam, as long as you have reliable basic information, such as the date of your last menstrual period, and there are no warning signs (such as severe pain or heavy bleeding). If you’re unsure about your gestational age, you can use our pregnancy calculator. Remember that even if the abortion with pills has worked, there may still be some blood and tissue visible on the ultrasound for at least 2 weeks.
If the ultrasound is performed too early, it could result in an “incomplete abortion” diagnosis, leading to unnecessary surgical procedures. If you have an ultrasound, it is recommended that you wait at least 2 weeks, unless you have symptoms of complications.
How early can an ultrasound detect an ectopic pregnancy?
A transvaginal ultrasound involves inserting a thin probe into the vagina to obtain clearer images of the uterus, ovaries, and other internal parts of the reproductive system. It can detect an ectopic pregnancy as early as 5 to 6 weeks of gestation.
However, symptoms such as severe abdominal pain or abnormal bleeding are warning signs that should be evaluated, even if immediate access to an ultrasound is not available.
What to Expect During a Pre-Abortion Ultrasound
During a pre-abortion ultrasound, healthcare providers may perform either an abdominal or a transvaginal ultrasound, depending on the gestational age and the resources available.
As mentioned earlier, a transvaginal ultrasound involves inserting a thin probe into the vagina, which allows for clearer images of the uterus in very early pregnancies. In contrast, an abdominal ultrasound is performed externally: a special gel is applied to the lower abdomen, and the transducer is moved over the skin. This device emits sound waves that create images of the inside of the body, such as the uterus and the pregnancy, if present.
Both types of ultrasound are safe and painless, although the transvaginal method may feel slightly uncomfortable for some people. During the exam, the healthcare provider will check the location of the pregnancy, measure the gestational sac, and estimate the gestational age. This information can be helpful in deciding which abortion method is most appropriate for each individual case.
Why Is an Ultrasound Done After an Abortion?
An ultrasound after an abortion can be helpful to confirm that the procedure was successful and that the uterus is empty, meaning no pregnancy tissue remains. This can provide peace of mind and help detect potential complications, such as retained tissue or infections.
However, it is not always necessary. If the person does not experience any warning signs, it is very likely that the abortion was complete and no follow-up ultrasound is needed.
When is the follow-up ultrasound performed?
The follow-up ultrasound, also known as the post-abortion ultrasound, is typically done one to two weeks after the procedure, although this may vary depending on the context and the method of abortion used. In the case of a medication abortion, this ultrasound can be helpful to confirm that the uterus is empty and that no pregnancy remains.
Is a follow-up ultrasound always necessary?
Getting an ultrasound after an abortion is not always necessary—especially if everything goes smoothly. If there are no warning signs such as fever, severe abdominal pain, foul-smelling discharge, or heavy and persistent bleeding, the abortion was likely complete.
In many cases, a simple and effective way to confirm this is by taking a home pregnancy test 3 to 4 weeks after the abortion. If the result is negative or shows low levels of the pregnancy hormone (hCG), it means the abortion was successful. This option is safe, accessible, and recommended when there is no immediate access to an ultrasound or a healthcare facility.
In contexts where access to ultrasounds is limited or where abortion has legal restrictions, requiring this test can become an unnecessary barrier. That’s why international reproductive health organizations like Women on Web and Aid Access explain that an ultrasound is not essential if there are no signs of complications.
Differences in Ultrasound Use for Abortion with Pills vs Surgical Abortion
When it comes to safely terminating a pregnancy, there are two main methods: medical abortion and surgical abortion. Both are safe and effective, but the use of ultrasound can vary significantly between the two.
Abortion with pills —whether using misoprostol alone or the combination of mifepristone and misoprostol—can be done at home, in a self-managed way, especially in pregnancies up to 13 weeks. This method doesn’t always require an ultrasound, either before or after, because if you know the date of your last menstrual period, you can estimate with good accuracy how many weeks pregnant you are. And if, after taking the pills, you experience the expected symptoms, that is usually enough to know that the abortion has worked. However, if there are warning signs or uncertainties, an ultrasound can be a useful tool to confirm everything is fine or detect complications, such as retained tissue or an ectopic pregnancy (pregnancy outside the uterus).
Surgical abortion, on the other hand, is performed in clinics or medical centers by trained professionals. In this context, ultrasound use is much more common and is part of the protocol in many hospitals or health centers.
- Before the procedure: An ultrasound is usually performed to confirm that the pregnancy is intrauterine (meaning the pregnancy is located in the uterus and not outside of it) and to accurately estimate how many weeks along the pregnancy is. This helps medical professionals decide which surgical technique to use and ensures the procedure is carried out safely.
- After the procedure: Many clinics also perform an ultrasound to check that the uterus is empty and the abortion is complete. This follow-up ultrasound is not always essential, but in clinical settings, it is commonly used as a routine measure to ensure everything went well.
Benefits and Limitations of Using Ultrasound for Abortion Care
Ultrasound is a valuable tool in abortion care, offering key benefits such as diagnosing ectopic pregnancies, confirming pregnancy and estimating gestational age, as well as verifying that the abortion was complete. However, it also has some limitations.
Ultrasound is not always accessible, especially in rural areas or in places where abortion is restricted. It can also cause unnecessary anxiety if not interpreted correctly, and its absence does not necessarily prevent someone from having a safe abortion.
Frequently Asked Questions
If you still have questions about the use of ultrasounds in the context of abortion with pills, here are some of the most frequently asked questions from people who want to learn more about ultrasounds and safe abortion:
When can an ultrasound detect an ectopic pregnancy?
From around 5 to 6 weeks of pregnancy, with a transvaginal ultrasound.
Do I need an ultrasound before taking abortion pills?
Not necessarily. Many people safely take abortion pills without an ultrasound, especially if they are confident about the date of their last menstrual period.
Can I have an abortion without an ultrasound?
Yes. Although ultrasound is useful for confirming the number of weeks, many people have safe abortions without access to ultrasounds, especially in self-managed abortion contexts.
What if I skip the post-abortion ultrasound?
If you don’t have any warning signs—such as severe pain, fever, or heavy bleeding— and have no symptoms of pregnancy, an ultrasound may not be necessary. You can take a pregnancy test 3 to 4 weeks after the abortion to confirm that you are no longer pregnant.
Will the ultrasound show if the abortion is complete?
Yes, it can show if the uterus is empty. But it’s not the only way to confirm that the abortion was complete. You can take a pregnancy test 3 to 4 weeks after the abortion to confirm that you are no longer pregnant.
Is ultrasound painful or harmful?
No. Ultrasounds are safe and generally do not cause pain. A transvaginal ultrasound may feel uncomfortable, but it is not dangerous.
Final Thoughts: Safe Abortion Involves Accurate Information
Making decisions about your reproductive health is a deeply personal act, and as such, it deserves to be supported by clear, accurate, and judgment-free information. In a world filled with myths, misinformation, and barriers to access, understanding your options—and knowing what is necessary and what isn’t—can make a big difference in your experience.
Ultrasound, for example, can be a helpful tool in some cases, but it is not essential for everyone or in every situation. In many cases, an abortion with pills can be safely carried out without an ultrasound, as long as the right protocols are followed and you pay attention to your body’s signals. Still, to feel confident in making that choice, it’s crucial to rely on trustworthy, evidence-based sources of information.
Websites like safe2choose.org and howtouseabortionpill.org offer clear, up-to-date, and reliable information on how to use abortion pills, how to know if they worked, what to do if you have questions, and where to find support. These platforms are designed to support you without judgment, with respect, and with a strong focus on your rights and autonomy.
Need Help?
If you have questions or concerns about using abortion pills or need guidance before, during, or after the process, you can start a chat with Ally, our chatbot, directly on our website. You can also message on Instagram, Facebook, or WhatsApp—Ally is here to help you too!