Do you need ultrasounds and bloodwork to get an abortion?

Blood tests, ultrasounds, and other lab tests can come up for a range of medical needs. While these tests may be necessary in some situations, they are often not required for medication abortions. Because procedural abortions use different sizes of equipment based on how far along you are, it may be required. In this article, we’ll discuss when abortion seekers might need these tests, when they’re not necessary, and why some telehealth abortion clinics like Hey Jane typically don’t require them. 

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If you’re seeking an at-home abortion, Hey Jane offers FDA-approved abortion pills and everything else needed for a safe, private abortion at home. To see if you’re eligible, complete our quick intake form. 

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What tests may be required before an abortion?

Aside from an at-home urine test to confirm pregnancy, most people don’t need additional testing before getting abortion care. If you and your provider aren’t able to confirm the estimated gestational age of the pregnancy, or if you have a history of ectopic pregnancy or bleeding disorders, the most common tests that a clinic or medical provider may request before an abortion are an ultrasound and/or hCG blood test.

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Ultrasounds 

An ultrasound (also known as ultrasonography or sonography) is an imaging test that uses sound waves to create pictures of your organs, tissues, and other structures in your body. 

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hCG blood test

The human chorionic gonadotropin (hCG) blood test—more commonly known as the pregnancy test—measures the amount of the hormone hCG in your blood to confirm a pregnancy. However, the estimated gestational age determined by an hCG is not very accurate for dating your pregnancy because they cover a much larger range of hCG levels than needed.

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Why tests are sometimes needed before an abortion

Ultrasounds and blood tests aren’t required for medication abortion care unless the pregnant person has a history of irregular periods, ectopic pregnancies, certain blood conditions, or the pregnancy cannot be dated confidently. Most medical institutions, including the American College of Gynecologists and Obstetricians and UCSF, have proven that medication abortions are safe regardless of whether they are done in a clinic or via a telehealth provider. Most people can figure out the estimated gestational age of the pregnancy based on their last menstrual period, and have access to at-home urine tests that will conclusively confirm the pregnancy.

At Hey Jane, we don’t require additional testing unless medically necessary. They can be expensive, delay abortion care, and require additional travel or time off from work. Some states require all patients to get an ultrasound before they can have an abortion, which ultimately prevents people from getting timely and safe care and doesn’t increase the safety of the procedure in most cases.

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1. Confirm pregnancy and gestational age

If your at-home pregnancy test results are not conclusive, or if you’re having trouble dating the pregnancy, a health care provider may request that you get additional lab testing done before an abortion. The estimated gestational age (EGA) describes how far along the pregnancy is and is measured in weeks from the first day of your last menstrual period to the current date. Depending on how far along the pregnancy is, there may be different abortion methods (medication vs. procedural) or state requirements for care. 

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2. Detect ectopic pregnancies

Ectopic or tubal pregnancies can be life threatening, and occur when a fertilized egg grows outside of the uterus, usually in the fallopian tubes. This can cause the fallopian tube to rupture and cause severe internal bleeding, and can be fatal if not treated as soon as possible with an injection or surgery. An ultrasound after a certain number of weeks can confirm whether the pregnancy is ectopic or not, and allows your provider to recommend the safest course of action to end the pregnancy. If it is too early to see your pregnancy on ultrasound, labs can be done to ensure the pregnancy is inside of the uterus.

While only 1-2% of pregnancies are ectopic in general, 10% of people with a history of ectopic pregnancy will experience it again. Other risk factors include fallopian tube damage, pelvic inflammatory disease (PID), fertility treatments, and a history of smoking. 

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3. History of severe anemia

Anemia is a condition where the body doesn’t have enough healthy red blood cells or hemoglobin (what carries oxygen throughout the body), and can cause fatigue, weakness, dizziness, and shortness of breath. It’s safe to have an abortion if you’re a little anemic, but if you have severe anemia, your provider may recommend a procedural abortion so they can observe and monitor your bleeding in person.

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4. State requirements

As of August 2024, Twenty-seven states have laws and policies requiring an ultrasound before an abortion. These ultrasound requirements are not medically necessary for abortions earlier in pregnancy and exist to restrict abortion access for people who need it.

Is it safe to take abortion pills without testing?

Yes, medication abortion without an ultrasound is safe—including those done via telehealth. The only time when a medical professional should recommend additional testing before abortion care is if the patient has a history of irregular periods, certain blood conditions, or a history of ectopic pregnancy according to ACOG, the American College of Gynecologists and Obstetricians.

A recent UCSF study also reinforced that telehealth abortions were as safe as receiving care in a physical clinic. In 99.8% of patients, no serious complications occurred and 98% of patients did not require follow up care.

As Hey Jane, we take safety seriously—and our record proves it. In our 2023, our Clinical team published that 99.84% of our patients had no serious complications (better than the national average). Our thorough intake form and provider consultation are designed to identify patients who may need additional testing or in-person abortion care, and we continue to put the health of our patients first by referring them to in-person services or coordinating testing depending on the situation.

If we do determine that additional testing is needed, our team can help connect you to a local clinic to get blood work or an ultrasound quickly and discreetly. We typically refer patients to the closest Quest Diagnostics location for bloodwork. For ultrasounds, we recommend that patients contact their insurance provider to see what imaging centers are covered nearby. Then, we’ll send lab orders to wherever you need them.

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