Abortion is a common experience. It’s estimated that about 1 in every 4 pregnancies worldwide end in abortion (1). In the USA, it’s about 1 in 5 (2). Of pregnancies in the USA that are unplanned, about 2 in 5 end 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 both before and during 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 of comprehensive healthcare services.
Before an abortion, you will miss a period and may have symptoms of pregnancy
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 human Chorionic Gonadotropin or 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 unpredictable (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 pregnancy tests (7, 8).
Early pregnancy symptoms before an abortion
Hormonal changes cause the 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 been getting your period for a number of years, and it's similar every cycle, then you'll 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).
What are the types of abortion? Your abortion options
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 procedural abortion, a dilation and curretage (D&C) procedure, or an in-clinic abortion). Your choice may depend on gestation, or 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 involves taking pills
A medication abortion is an abortion using pills that you take orally (in your mouth), or that are put through the vagina, into the cervix. This type of abortion can be done as soon as a 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 might happen a week or two later, or no follow up may be needed.
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 a procedural abortion is used as a follow up. More serious complications are very rare, occurring in less than 0.4 per 100 cases (4, 16, 17).
Benefits of medication abortion:
A medication abortion is available as soon as you know that you are pregnant
No shots or anesthesia are involved, and you will likely have some control over when to take the second pill
The 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 is more time and space for awareness of the abortion process (for others, this can be a downside)
Risks of medication abortion:
It takes 1-2 days to complete the abortion
Bleeding and cramps can be quite heavy/painful and last longer than with a procedural abortion
People may wonder whether their symptoms are typical once they are at home, which can be stressful
Medication abortions are typically not available as late into a pregnancy as other methods
Procedural abortion is an in-clinic procedure (it’s also known as surgical abortion, procedural abortion, D&C, or in-clinic abortion)
A procedural abortion is a procedure to remove the contents of the uterus. This happens in a clinic or hospital. A procedural 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 procedural 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 make you feel sleepy or be completely asleep. A healthcare provider then inserts an instrument into the vagina, through the cervix, to reach the uterus. Then 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 procedural abortions are safe and 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).
Benefits of procedural abortion:
The procedure is over in a few minutes and the discomfort lasts for a short amount of time, helped by the anesthetic.
There is also less bleeding than with a medication abortion.
Medical staff members will be with you, and you may only need one appointment at the clinic.
A procedural abortion can be done later in a pregnancy than a medication abortion. They’re also slightly more effective than medication abortions.
Risks of procedural abortion:
It is a more invasive option than medication abortion; instruments are inserted through the vagina to open the cervix to reach the uterus.
Often, the anesthetics and pain medication can cause side effects.
You have less control over the procedure, the tone of the room, what position your body is in, and potentially also over who can accompany you into the room.
The aspirator tool used for the procedure can be noisy, which is good to be aware of in advance.
Some clinics might not offer procedural abortion as early in pregnancy as medication abortion.
What to expect during an abortion
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 have, and let you know about your options for birth control after the abortion, although you don’t have to start birth control if you don’t want to. 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 the pregnancy gestation and your abortion options. They should provide written instructions about medication, who to contact if you have questions once you're home, plus what to expect during and 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 second pill.
Most of the time, 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 at the second visit to your clinic), you’ll take a medication called misoprostol. Most guidelines 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 . You’ll also likely take a pain medication (acetaminophen or ibuprofen) and an anti-nausea medication half an hour or so before taking the misoprostol. Do not take Aspirin or any pain medication that might increase bleeding (19, 23).
What happens during a procedural abortion
Some clinics will do everything in a single appointment. Others will ask you to 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 allows you to 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, (similar to 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).
Feelings during 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 of America 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(29). 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 (29).
Whatever your choices and experiences are when having an abortion, know that you're not alone.
Tracking your period can help you determine if you might be pregnant or not. Download Clue to track your period.