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What to expect before, during, and after abortion

Abortion is a common experience. It’s estimated that about 1 in every 4 pregnancies worldwide end in abortion (1). In the U.S., it’s about 1 in 5 (2). Of U.S. pregnancies that are unplanned, about 2 in 5 ends in abortion (2).

About 1 in 4 U.S. women will have an abortion by age 45 (2).

Most abortions happen in the first 8 weeks of pregnancy, and nearly all abortions (9 in 10) happen in the first trimester (the first 12 weeks of pregnancy) (3). Legal abortion is a safe and effective way to end a pregnancy (4,5).

It’s helpful to know what to expect before, during, and after an abortion. Tracking can help you keep a record for yourself and for your healthcare provider, and can give you a sense of control during what may be an unfamiliar, but common experience.

When researching abortion, it’s important to have trustworthy sources of information. A 2010 study found that even among sexual health websites, 35% contained inaccurate information, most commonly for first-trimester abortion info. Some sources may try and mislead you on purpose (6).

You may also have heard abortion referred to as induced abortion. This differentiates it from miscarriage, which is sometimes called spontaneous abortion.

Access to abortion is limited or threatened in many parts of the world. Globally, highly restrictive abortion laws are not associated with lower abortion rates. Countries with more restrictions have more unregulated, illegal and unsafe abortions (and the associated consequences of those). This article describes the abortion process in areas with access to abortion as a right to comprehensive healthcare services.

Before an abortion

Missing a period and pregnancy tests

If your periods tend to be quite regular, you may suspect a pregnancy as soon your period doesn’t arrive at the expected time. Pregnancy tests work by detecting a hormone produced in the uterus after pregnancy begins (called hCG). It can take a few days after a “missed” period for an at-home test to detect a pregnancy, mainly depending on when you ovulated. For most people, a test will show up as positive within one week of the first day of a missed period (7).

If your periods are often irregular (or if you ovulated a few days later than usual), it may take longer for a pregnancy test to show up as positive. This is because it can take about 2-3 weeks from the time of ovulation for enough hCG to be in your body to register on tests (7,8).

Early pregnancy symptoms

Hormonal changes cause early symptoms of pregnancy. About 6 in 10 people will notice new symptoms within a week or two after a “missed” period, and 9 in 10 will have noticed symptoms within a month after a “missed” period (9). Some of the most common symptoms of early pregnancy include nausea, fatigue, sore breasts, changes in appetite, and increased urination (peeing more often) (10).

Spotting: Light spotting can also happen early in pregnancy. About 1 in 10 people experience spotting within the first 8 weeks of pregnancy (11). That means it’s possible to mistake pregnancy spotting for a menstrual period. In many cases, this spotting is light enough that someone might only notice it when wiping with toilet paper. For just under 2 in 10 people, the spotting may be heavier, but still not as heavy as a typical period (11).

If you’ve had your period for a while, and your period is about the same each cycle, you’d likely notice the difference between pregnancy spotting and a period. Heavier bleeding can happen too, but often indicates a miscarriage — it’s not uncommon for a very early miscarriage to seem like a heavy, late period and/or otherwise unusual period (11,12).

Options: What are the types of abortion?

Some clinics will give you the option to choose between a medication abortion (also known as an abortion pill) and an aspiration abortion (also known as a surgical abortion, a D&C procedure, or an in-clinic abortion). Your choice may depend on how far along a pregnancy is, the time each method takes, and whether you prefer to be mainly at home or in the clinic. Recommendations and procedures can also vary country-to-country.

Medication abortion (the “abortion pill”)

medication abortion is an abortion using pills that you swallow, or that are put through the vagina, in the cervix. This type of abortion can be done as soon as pregnancy begins, and is usually available until week 10-12 of pregnancy, and sometimes later, depending on where you live.

It typically involves taking one pill at the clinic and then going home and taking another pill. In some areas, you may have the choice (or requirement) to take the second pill in the clinic as well, although most people report a preference for being at home (13). After taking the second pill, the uterus will cramp, bleed, and empty over the course of a few hours—similar to a miscarriage.

The level of cramping, pain, and bleeding can be intense and may depend on the timing in the pregnancy (14). A follow-up appointment usually happens a week or two later.

First-trimester medication abortions are safe and very effective. More than 95 in 100 people who have a medication abortion need no further treatment (15,16). In the small number of cases where the pills don’t work completely, another pill or an aspiration procedure is used as a follow-up. More serious complications are very rare, occurring in less than 0.4 per 100 cases (4,16,17).

Some countries currently require that the second pill is in the clinic as well. The UK recently changed its protocol and will allow people to take the second pill at home by the end of 2018.

Upsides: A medication abortion is available as soon as you know you are pregnant. No shots or anesthesia are involved, and you will likely have some control over when to take the second pill. Abortion may feel more natural, like a miscarriage. There may be the option to be at home (or wherever is most comfortable), and shape the space in a way that best meets your needs. You can choose to have someone with you, or you can be alone. There are more time and space for awareness of the abortion process (for others, this can be a downside).

Downsides: It takes one to two days to complete the abortion. Bleeding and cramps can be quite heavy/painful and last longer than with an aspiration abortion. People may question if their symptoms are normal when they are at home, which can be stressful. Medication abortions are typically not available as late into a pregnancy as other methods.

Aspiration abortion (also known as surgical abortion, D&C, or in-clinic abortion)

Aspiration abortion is a procedure to remove the contents of the uterus. This happens in a clinic or hospital. Aspiration abortion is usually available until about week 16 of pregnancy (some clinics don’t offer it after week 12, though, so it’s important to check). After that amount of time, the procedure and availability can differ. In some clinics, aspiration abortions can be performed as soon as someone finds out they are pregnant. Other clinics only offer this type of abortion after week 5 or 6 from the first day of the last period.

Medication is usually given an hour or two before the procedure. A type of anesthetic is then offered to block pain, and/or making you feel sleepy or be completely asleep. A healthcare provider then inserts an instrument into the vagina, and through the cervix, to reach the uterus. The contents of the uterus are suctioned out. The procedure usually takes about 5 to 10 minutes (18,19). After the procedure, half an hour or so is spent resting in the clinic before heading home.

First trimester aspiration abortions are safe and extremely effective: 99 times out of 100, everything works well the first time (4). In rare cases, a follow-up procedure may be required. More serious complications are very rare, occurring in less than 0.2 per 100 cases in the US (4,20).

Upsides: The procedure is over in a few minutes. The discomfort lasts for a short amount of time and is helped by the anesthetic. There is less bleeding than with medication abortion. Medical staff members are with you, and you may only need one appointment at the clinic. It can be done later in a pregnancy than a medication abortion. Slightly more effective than medication abortions.

Downsides: It is more invasive; instruments are inserted through the vagina to open the cervix to reach the uterus. Anesthetics and pain medication may cause side effects. You have less control over the procedure, the tone of the room, what position your body is in, and perhaps over who can accompany you into the room. The aspirator tool can be noisy. Some clinics may not offer it as early in pregnancy as medication abortion.

During an abortion: What to expect

When you go in for an abortion appointment, the clinic may ask that you chat with a counselor or healthcare staff member about your decision. This person should answer any questions you may have, and let you know about your options for birth control. They will also want to make sure that your decision is your own, and that you aren’t being pressured by anyone.

A healthcare provider will do a physical exam and some tests, sometimes including blood tests. They may do an ultrasound to confirm how far along your pregnancy is and what your options are. They should provide written instructions about medication, who to contact if you have any questions after you’ve gone home, and what to expect during or after the abortion.

You might also want to prepare for an abortion by having some comforting things around you, like a hot water bottle, menstrual pads, or a friend with massage skills. If you’re having an in-clinic abortion, you’ll also need to arrange for someone to drive you home.

What happens during a medication abortion

If you’ve chosen to have a medication abortion, you’ll probably be given one pill to take at the clinic, and another pill to take at home. Some clinics will ask that you come back for a second visit to take the pills.

The first pill you’ll take is a medication called mifepristone. An embryo needs progesterone to stay attached to the uterine lining and develop, and mifepristone blocks the progesterone your body is producing. You’ll then get another medication to take home with you, and, in some places, schedule a follow-up appointment a week or two after your abortion.

At home (or a second visit to your clinic), you’ll take a medication called misoprostol. Most guidelines strongly recommended that you wait 1-2 days before taking the second pill (22). The timing of when you take it may depend on factors that your healthcare provider will discuss with you (21,22).

Misoprostol causes your uterus to cramp and shed its inner lining and contents. The drug is a type of prostaglandin, similar to what causes regular period cramps (and related symptoms). You’ll also likely take pain medication (acetaminophen or ibuprofen) and an anti-nausea medication half an hour or so before taking the misoprostol. Don’t take Aspirin or any pain medication that might increase bleeding (19,23).

Symptoms: the first few days

  • Bleeding and cramping after taking the first pill, mifepristone, but this is uncommon
  • Bleeding that starts 1-4 hours after taking the second pill, misoprostol. Some people report that it’s stressful waiting for bleeding to begin, and they fear the pills aren’t working.
  • Heavy bleeding with blood clots and tissue for several hours—usually about 4-5 hours, but it can vary. Clots can be quite large, and heavy bleeding can be surprising.
  • Heavy cramping for several hours. These can feel very intense and can vary between mild and strong.
  • Low fever and chills lasting less than a day after taking the second pill, misoprostol (about 1 in 3 people experience this), as well as nausea, vomiting, dizziness, diarrhea, and tiredness (13,14,23-26).

Symptoms: the next few weeks

  • Less-heavy bleeding that continues for 1-2 days, becoming lighter over the next 2-3 weeks. Mild cramping may also continue for 2-3 weeks.
  • Spotting can continue until the around next menstrual period. One study based on people’s bleeding diaries for that light bleeding/spotting continued for about 24 days on average. For 1 in 5 people, it lasted more than 35 days.
  • Changes in things like energy level, mood, appetite, and other pregnancy symptoms, like hormones, come back into balance. In most people, pregnancy symptoms go away within a 1-2 of weeks but may linger for up to a month. (13,14,23-26)

Worried?

Heavy bleeding can be surprising, but it’s usually normal. If you’re soaking less than 2 thick pads per hour, for two hours in a row, it’s typically okay. If you’re bleeding that amount or more, it’s a good idea to check-in with your healthcare provider (19,24).

At your follow-up appointment, your healthcare provider will then give you a blood test or ultrasound to make sure the abortion was completed.

What happens during an aspiration abortion

Some clinics will do everything in a single appointment. Others will ask that you come first for a check-up and some medication to help the cervix open and then come back for the procedure a few hours to a day later. Before the procedure, you’ll likely be given some painkillers and antibiotics (14,20).

You may have the choice of being fully awake, sleepy, or asleep during the procedure. A local anesthetic is an injection given in the cervix to block pain and lets you be awake and aware during the procedure. It can be combined with sedation that makes you very sleepy but conscious. A general anesthetic puts you completely asleep. Talk to your clinic about this beforehand so you know what your choices are and what to expect.

During the procedure, your healthcare provider will examine your abdomen. If you’re having sedation, you’ll be given that medication through a small tube (IV) in your arm or on the back of your hand. Next, a speculum is inserted into the vagina, to open it slightly so the cervix can be easily reached (just like in a pap test). A numbing medication is then injected into the cervix. If you haven’t received any pre-treatment for your cervix, your provider will do it at this time, inserting some small tools of different sizes to help the cervix open. They’ll then insert a long, thin tool through the cervix into the uterus and use a hand-held suction device, or suction machine, to suction out the inner lining of the uterus, like what is shed when you have your period, as well as the embryo. You’ll then go to a different room to rest for about half an hour or so before heading home (23,24,27,28).

Symptoms:

  • Discomfort, pain, pinching, and pressure during the procedure
  • Drowsiness, if sedation is used
  • Light bleeding with small amounts of tissue that begins immediately or within days of the procedure and lasts days to weeks (usually about 2 weeks), becoming lighter over time
  • Mild cramping for 2-4 days (19,23,26,28)

After an abortion: What’s important

If you can, plan to take it easy in a day or two following an abortion. Your hormones are coming back into balance, and you may feel sore, tired, and want to rest.

It’s important to avoid inserting anything into the vagina for 2-3 weeks after an abortion, including tamponspenisessex toys, etc. This is to avoid any possible infection while the cervix may still be slightly open (28).

After a medical abortion

A follow-up appointment is sometimes recommended to make sure the abortion is complete. At this appointment, your healthcare provider might perform a quick examination, a blood test, and/or an ultrasound. Your healthcare provider will also ask you some questions about your experience. In the unlikely event that you are still pregnant, your healthcare provider will offer you an additional treatment or procedure.

After an aspiration abortion

No follow-up appointment is typically needed after an aspiration abortion unless you experience complications.

Abortion and your period

It usually takes between 4-6 weeks for normal menstruation to return after an early abortion (29,30).

Ovulation can return in the first cycle following an abortion, so becoming pregnant again right away is possible, even before the return of menstruation (30).

It’s normal for your first couple of periods and cycles to be slightly irregular after an abortion (29-31). Tracking can be a helpful way to keep a record of your abortion bleeding and symptoms like sore breasts, cramps, and nausea. If you do track your post-abortion bleeding in Clue, you can exclude that cycle in your Analysis history so it won’t affect your predictions.

Is everything okay? Possible complications

It’s common to wonder if everything is okay while or after experiencing an abortion (13). In most cases, there is nothing serious to worry about. Here are the things to look out for after your abortion:

Symptoms that signal a possible complication:

  • A fever of lasting more than 24 hours
  • Heavy bleeding that doesn’t stop, or soaking more than 2 sanitary pads per hour, two hours (or more) in a row
  • Worsening pelvic pain in the days following the abortion
  • Continued symptoms of pregnancy after 2-4 weeks
  • You don’t get your period after 8 weeks
  • Bad-smelling vaginal discharge
  • Minimal or no bleeding in medication abortion, paired with continued pregnancy symptoms (23,29,32,33)

If you experience any of these things, contact your healthcare provider. They may be a sign of an incomplete abortion requiring more treatment, or of an infection. Infections can happen when not all tissue is expelled during the abortion.

Severe pain with or without bleeding may be a sign of an ectopic pregnancy (a pregnancy that is developing outside of the uterus, usually in the fallopian tube). Abortion procedures are not treatments for ectopic pregnancies, as the pregnancy will continue to grow. An ectopic pregnancy should be treated as a medical emergency (23).

Emotions and abortion

The decision to have an abortion can be an easy or difficult one. For some people, it is a very stressful time, for others it’s straightforward. Each person and situation is different. Abortions occur for pregnancies that are both desired and undesired, for a multitude of reasons. Talking to friends, family, or a partner about your decision or experience may be helpful for some people. For others, it can lead to added stress.

A large study in the United States found that 3 in 4 people felt positive emotions, such as relief, in the week after an abortion, while 1 in 4 felt predominantly difficult emotions during that time(34). People living in communities with more stigma around abortion, as well as people with less social support, were more likely to feel negative emotions. Both positive and negative emotions declined with time. Overall, about 99 in 100 people felt they had made the right decision when asked about it at various points over the three years following the abortion (34).

Whatever your choices and experiences are when having an abortion, know that you’re not alone.

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