hCG
/ ˌeɪtʃ siː ˈdʒiː / · Human Chorionic Gonadotropin
hCG is the hormone your body produces when you're pregnant — and the same hormone that a pregnancy test detects. After a medication abortion, hCG levels drop as the pregnancy ends. Checking hCG is one of the key ways to confirm that the process worked.
What is hCG?
hCG stands for Human Chorionic Gonadotropin. It's produced by cells that will eventually form the placenta, starting shortly after a fertilized egg implants in the uterus. In a viable intrauterine pregnancy, hCG typically rises rapidly in early pregnancy — in many cases increasing by at least 50–66% every 48–72 hours during the first weeks, though the rate varies and slows as pregnancy progresses.
When a pregnancy ends — whether through medication abortion, a natural miscarriage, or a surgical procedure — hCG levels begin to fall. This is why hCG testing is used to confirm that a medication abortion was complete.
How does hCG relate to medication abortion?
hCG plays two important roles when you take the abortion pill:
Why a home pregnancy test may be used for follow-up
Some telehealth providers may ask you to take a urine pregnancy test several weeks after the abortion as part of follow-up. Interpretation of the result depends on timing and your provider's guidance — a faint line is not automatically a confirmation of completion. Always follow your provider's specific instructions on what result to look for and when.
hCG levels — what's normal?
hCG levels vary widely between people and are measured in mIU/mL (milli-international units per milliliter). What matters more than the exact number is the trend — is it rising, stable, or falling? Importantly, how a trend is interpreted depends on clinical context: the same pattern of rising hCG means something different before an intrauterine pregnancy is confirmed on ultrasound versus after one is confirmed. Always let your provider interpret your results.
| Timing | Typical hCG range | What it means | Status |
|---|---|---|---|
| 3–4 weeks pregnant | 5 – 426 mIU/mL | Very early pregnancy; home test may just turn positive | Normal |
| 5–6 weeks pregnant | 1,080 – 56,500 mIU/mL | Rapid rise; gestational sac visible on ultrasound | Normal |
| 1–2 weeks after abortion pills | Falling from pre-abortion level | Level dropping — process is working | Expected |
| Weeks after abortion pills | Declining toward undetectable | Trajectory of decline is reassuring; completion confirmed by provider assessment, not a single hCG threshold | Trending well |
| 4 weeks after — still elevated | Remains significantly high | May indicate incomplete abortion or ongoing pregnancy | Follow up |
| Not rising as expected — before abortion | Rise <50% over 48–72 hrs (in context) | May indicate ectopic or non-viable pregnancy — requires provider evaluation; do not self-interpret | Seek care |
Important: hCG levels alone don't tell the whole story
A single hCG number is less useful than two readings taken 48–72 hours apart. Rising hCG confirms a pregnancy exists — but it cannot distinguish an intrauterine pregnancy from an ectopic one. An ultrasound is required to confirm location. Levels that aren't rising as expected, alongside symptoms, may raise concern for ectopic pregnancy, which is a medical emergency requiring immediate care — not medication abortion.
Types of hCG tests
- Sensitivity varies by brand — typically 10–25 mIU/mL; check your test's packaging
- Most home pregnancy tests use this method
- Fast and private — result in minutes
- Used for post-abortion follow-up at 4 weeks
- Cannot give an exact number — just positive or negative
- Gives an exact hCG level in mIU/mL
- Can detect hCG as low as 1–2 mIU/mL
- Used to track rising or falling levels over time
- Used when clinical picture is unclear, ectopic is suspected, or urine test result is inconclusive
- Done at a clinic or lab — not a home option
Telehealth follow-up
Some telehealth abortion providers incorporate urine hCG testing as part of follow-up — but protocols vary. Not all providers require it, and timing depends on your clinical situation. Your provider will give you specific instructions on whether testing is needed, when to do it, and what result to look for. Never self-interpret a result without provider guidance.
When to seek medical care
Most people don't need to track their hCG levels in detail — your provider handles the follow-up. But there are situations where checking hCG sooner matters:
- Pregnancy test negative at 4 weeks
- Heavy bleeding followed by lighter flow, then stopping
- Pregnancy symptoms (nausea, breast tenderness) fading
- Provider confirms via telehealth check-in
- Pregnancy test still strongly positive at 4+ weeks
- No bleeding at all within 24 hrs of misoprostol
- Severe one-sided pelvic pain (possible ectopic)
- Shoulder tip pain (possible ectopic complication)
- Feeling faint, very weak, or collapsing
Common myths — cleared up
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Sources & further reading
- WHOMedical management of abortion, 2nd edition, 2025 — follow-up protocols and hCG testing guidance. who.int
- ACOGMedication Abortion Up to 70 Days of Gestation — Practice Bulletin No. 225, follow-up and confirmation. acog.org
- FDAMifepristone (Mifeprex) — approved labeling including post-treatment assessment. fda.gov
- Plan CState-by-state guide to accessing abortion pills and telehealth follow-up options. plancpills.org
- ACOG FAQhCG levels in early pregnancy — patient education resource. acog.org
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