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Abortion

What to expect in the days after an (induced) abortion

If you have access to a legal abortion, here is what to expect.

Abortion is common, safe, effective, and lifesaving (9). As a Board Certified Obstetrician Gynecologist (OB/GYN) who cares for all pregnant people, no matter their pregnancy outcomes, this is the most important thing I can say to anyone after their abortion. 

Although local laws across the world might require a clinic visit for an abortion, many people don’t need in-person visits to receive an abortion. Even more people don’t require in-person follow-up care after an abortion. This article will review what to expect after an induced abortion from the perspective and opinion of an OB/GYN who provides abortion care in diverse areas of the United States. This is not meant to be taken as individual medical advice or replace individual medical advice you may have received from your healthcare provider. 

Dr. Moayedi says: Contact your healthcare provider or seek help if at any point after your abortion you are soaking more than 4 pads in 2 hours, you are having pain that your medications cannot control, you have a fever over 100.4F/ 38 C, or you faint/ lose consciousness. 

Knowing what to expect right after an abortion can help you know what’s common, or when you might need follow-up care. I will explain what you can expect immediately after an abortion, from pain to bleeding. Most people want to know when to return to work, resume exercise, have sex, and return to other daily activities after an abortion, so I’ll provide answers to these common questions, too. 

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What to expect after a medication abortion

A medication abortion in the USA most commonly involves taking two types of pills: mifepristone and misoprostol. Immediately after taking mifepristone, most people do not notice  significant side-effects. Some spotting or bleeding can be expected (1, 2). The misoprostol should still be taken as instructed (1, 2). Other symptoms, like headache, have been reported (2), but are not common. 

If the mifepristone is vomited immediately after ingestion, contact your healthcare provider to decide if another dose is necessary, because you may have vomited up the medication. Before or immediately after taking the mifepristone, you should have a plan for where you will take the next medication, misoprostol. Try to be in a comfortable space with access to a bathroom where you can manage your bleeding. Bleeding can start as soon as an hour after taking the misoprostol (3), so I recommend taking the medication wherever you plan on going through the process and staying there. Avoid driving or being driven to places after taking misoprostol while your body is expelling tissue from the pregnancy. 

What to expect after a procedural abortion

A procedural abortion, also called a surgical abortion, removes the contents of the uterus, usually with suction. Most people are monitored for 5 minutes to an hour after a procedural abortion, depending on pregnancy gestation (how many weeks pregnant they are), sedation medications, local laws, or facility policies. Most people can drive themselves home after a first-trimester procedural abortion without sedation medications. If you get sedation, you will need a ride. Many people are hungry after a procedural abortion —there are usually no restrictions on eating after discharge.

Rhogam after an abortion

If you have a negative blood type, your healthcare provider may advise you to get a shot called Rhogam within 72 hours of your abortion. This shot protects you from a blood protein that could be in the fetus's blood and might mix with yours. Your abortion provider can tell you whether or not you need the shot based on their specific practice guidelines.

Bleeding after abortion varies

How much and how long you bleed can vary after an abortion depending on the type of abortion, how many weeks pregnant you were and your medical and pregnancy history (2, 4). Most people report bleeding on-and-off for anywhere from a few days to six weeks after an abortion. Bleeding can stop and restart after an abortion and does not always follow the typical pattern of a period (heavy to light). People can ovulate as soon as 2 weeks after an abortion, so period bleeding is typically expected around 4-6 weeks after an abortion (4). Typically, you can expect more bleeding after a medication abortion than a procedural abortion (2). 

Aftercare instructions from your clinic might discuss “pelvic rest” or not using tampons for 2-4 weeks after abortion, however, there is no medical evidence to support this. I generally advise patients not to use a tampon while the pregnancy is expelling during medication abortion (after taking misoprostol) because the tissue needs to exit the body. Once the pregnancy tissue has passed and the medication abortion process is complete, you can use a tampon again. 

 Unlike tampons, menstrual cups are likely safe to use throughout the medication abortion process. Menstrual cups each hold a specific volume, so keeping track of how many times you have emptied the cup during the medication abortion can help your provider decide if your bleeding is within the expected range. As mentioned earlier, if you soak through 4 pads within 2 hours after an abortion, you should contact your healthcare provider or seek medical attention. 

So, how does that translate to a menstrual cup? A soaked heavy flow, super, or ultra pad holds around 15-18 ml of blood, so 4 soaked pads would be 60-72 ml of blood in 2 hours. Menstrual cups can vary in volume capacity, from 20-70 ml each. You should check with your individual menstrual product to know how much volume it holds to determine how many times your cup would need to be full to equal about 70 ml in 2 hours.   

Pain after an abortion might feel like cramping or pressure

It is typical to have some cramping, a feeling of pressure, or soreness during or immediately after either type of abortion (2, 5). The cramping afterwards could feel like   heavy menstrual cramps or diarrhea cramps (6). Pain and cramping after an abortion typically only lasts a few days (6).  

Most people can manage the pain after an induced abortion with higher doses of ibuprofen (800 mg every 8 hours) coupled with a heating pad. Those with allergies or contraindications to ibuprofen and people with complex pain conditions might require a few tablets of narcotic medications for pain control. Some providers routinely prescribe a few narcotic tablets for pain management with medication abortion or second-trimester procedural abortion, while some do not. If your pain is not controlled with high-dose ibuprofen or the narcotic medications you were prescribed, contact your healthcare provider.

Time off work and exercise after an abortion depends on you

In a just and equitable world, every person would have access to paid time-off from work for physical and emotional recovery after any pregnancy outcome — abortion, miscarriage, ectopic pregnancy, and birth.  

When you can return to work is unique to you and your recovery. Physical and emotional recovery can vary for each person and each pregnancy. Some people want a procedure in the morning and want to return to work in the evening. Some people want a month to recover emotionally before returning to work. Both are totally fine. 

If your work involves heavy labor, consider at least one or two days off after your abortion for physical recovery. If your job is work-from-home or you can get accommodations to sit for most of your day, then you can likely return to work the day after an abortion. Don’t return to work the same day after a procedural abortion with sedation medications. With medication abortion, you can return to work after taking mifepristone and before taking misoprostol. 

You can exercise when you feel ready (8). Immediately after an induced abortion is not the time to start a new exercise program or do heavy weightlifting or high-intensity workouts. If you usually do a workout every day and you feel like doing it after your abortion, listen to your body. Start slow and work back up to your regular pace over the next few days or weeks. If you notice increased bleeding or pain after a particular exercise, back down a little and go slower. Allow your body the unique time you need to recover.  

You can have sex after an abortion when you feel ready

You can have vaginal sex after an abortion when you feel ready to have sex (7, 8). Although your aftercare paperwork from your abortion provider may say to wait 2-4 weeks after an abortion before having vaginal sex, this is not an evidence-based recommendation (4). Do not have vaginal sex on the day you take the misoprostol or while you are passing the pregnancy. Do not have vaginal sex if you have overnight cervical dilators in place prior to a second-trimester procedural abortion. 

There’s a lot more to abortion

Your experience following an abortion depends on the procedure, how many weeks pregnant you were, and your medical history. It’s good to know how much you might bleed, or how much pain you might feel so that you can plan accordingly. You might want to carry on with some normal activities immediately after an abortion, while others might need to wait a few days.

In our second article, Dr. Moayedi talks about what to expect in the days and weeks after an abortion, and how to approach topics like birth control, talking about your abortion, common abortion myths, and mental health after an abortion. 

Download Clue to track bleeding, pain, sex, and exercise after your abortion so you can keep track of how you’re feeling. 

Terminology Index

Induced abortion: Induced abortion is medical term used to distinguish an abortion from a miscarriage. A miscarriage is called a spontaneous abortion and what we commonly think of as an “abortion” is called an induced abortion (2, 9). 

Medication abortion: Medication abortion can refer to any single medication or medication combination that can induce an abortion (2). Medication abortion protocols can also be used to assist in a spontaneous abortion, or miscarriage. Prior to the invention of mifepristone, medication abortion was typically completed with a combination of methotrexate and misoprostol (2). Currently, most medication abortion in the USA is completed with a combination of mifepristone and misoprostol. Globally, the mifepristone/misoprostol combination is used or misoprostol is used as a single agent, sometimes over multiple doses to achieve higher efficacy. Second-trimester induced abortion with oxytocin is also a type of medication abortion, along with other induction methods with pharmaceuticals. Other common terminology for medication abortion is medical abortion, the abortion pill, or RU-486. Medication abortion is not the same thing as emergency contraception or the “morning-after-pill”. 

Procedural abortion: Procedural abortion is also known as surgical abortion, aspiration abortion, dilation and curettage (D and C), or dilation and evacuation (D&E) (2,9).

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