How Early Is Too Early for the Abortion Pill? What You Need to Know Before Your Appointment

A Message from Dr. Brian Park, Medical Director

One of the most common situations Dr. Roston and I see at Dr. Emily Women's Health Center is patients arriving too early in their pregnancy to receive the abortion pill. We want to help you avoid an unnecessary trip and make sure your appointment is as effective as possible — so we're being very direct about what you need to know before you call us.

Why Timing Matters for the Abortion Pill

The abortion pill — also known as medication abortion, RU-486, or mifepristone — works by blocking the hormone progesterone, which the pregnancy needs to continue. But for the medication to work, the pregnancy must be far enough along to be visible on an ultrasound. If we cannot see a gestational sac on ultrasound, we cannot safely prescribe mifepristone.

This is not a policy decision — it is a medical safety requirement.

When Should You Come In?

The right time to come in is when you are at least one full week late for your period and you have a positive home pregnancy test.

At that point there is a reasonable chance that the gestational sac will be visible on ultrasound, allowing us to confirm the pregnancy, date it accurately, and determine whether the abortion pill is the right option for you.

When Is It Too Early?

Do not come to our office if you are only 3 to 4 days late for your period — even if you have a positive home pregnancy test. At that stage, there is a high probability that the gestational sac will not yet be visible on a pelvic ultrasound. If we cannot see the gestational sac, we cannot provide the abortion pill, and your visit will not be productive.

Similarly, do not come in based on a quantitative beta HCG blood test result alone. If your beta HCG level is below 1,500, it is almost certainly too early for us to see the pregnancy on ultrasound and prescribe mifepristone. A beta HCG of 49 or 100 — levels we see patients come in with — is far too low. The mifepristone and misoprostol will not work at this stage, and we will not be able to prescribe them.

The only exception is if you are having vaginal bleeding at any stage, which could be a sign of a possible miscarriage — in that case, please call us regardless of your beta HCG level.

Why a Home Pregnancy Test Alone Is Not Enough

Home pregnancy tests are sensitive and can detect pregnancy hormones very early — sometimes before the pregnancy is far enough along to be seen on ultrasound. A positive home test tells you that you are pregnant, but it does not tell us enough to safely prescribe the abortion pill. The ultrasound is what gives us the precise information we need.

Many patients are also surprised to discover they are further along than they thought based on their last period. Periods can be irregular, ovulation timing varies, and date calculations based on your last menstrual period are estimates, not certainties. The ultrasound gives us the accurate gestational age we need to recommend the right option for you.

When Is It a Medical Emergency?

If you are one to two weeks late for your period, have a positive home pregnancy test, and are experiencing severe lower abdominal pain, do not wait for an office appointment. Go to your nearest hospital emergency room immediately — day or night.

Severe abdominal pain in early pregnancy can be a warning sign of an ectopic pregnancy, where the fertilized egg has implanted outside the uterus, most commonly in the fallopian tube. An ectopic pregnancy cannot be treated with the abortion pill, and if left untreated it can rupture, which is a life-threatening emergency. Please do not delay.

What Happens at Your First Visit

When you come in at the right time — at least one week late for your period with a positive home pregnancy test — here is what to expect at your first appointment:

Pregnancy test to confirm you are pregnant. Pelvic ultrasound to confirm the gestational age and location of the pregnancy. This is included in your fee and takes only a few minutes. Medical history review and blood pressure check. Discussion of your options — if you are within 9 weeks and eligible for the abortion pill, we will explain the full process. If you are further along, we will discuss surgical abortion options. If eligible, you will take the first medication (mifepristone) in our office the same day.