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Abortion

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

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

Abortion is common, safe, effective, and lifesaving (12). 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 visiting a clinic for an abortion, many people don’t actually 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. 

We covered what to expect immediately after an abortion in my previous article, so now we are going to look forward to the days and weeks after an abortion.

When can I start birth control after an abortion?

After an abortion, some people prefer to start birth control right away, while others may delay starting birth control or prefer not to use birth control at all. No person should feel compelled to start contraception at the time of abortion and evidence shows that for many people, an abortion might not be the right time to discuss contraception options (10, 12). Your abortion is not a “lesson” to learn — abortion is a normal and routine part of our reproductive lives. You do not need to feel compelled to immediately choose contraception after abortion to “prevent” another abortion. It’s ok to have one abortion. It’s ok to have more than one abortion. For those wishing to start birth control after abortion, the timing depends on the method of abortion you choose. 

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You have birth control options after a medication abortion

Mifepristone, the first drug in the medication abortion regimen (you can read about it here), is a progesterone antagonist — that means it blocks the actions of progesterone (the hormone that maintains a pregnancy) for a short amount of time in the body (1, 2). There is a concern that birth control with progesterone or progestin (the synthetic form of progesterone) could impact the efficacy of the mifepristone. Since pregnancy is not possible immediately after abortion (4), the impact of mifepristone on the efficacy of progesterone or progestin contraception is not a concern. Research has shown that birth control pills and the implant can be started at the same time as taking mifepristone without any decrease in efficacy for the medication abortion (2). 

The birth control shot was found to slightly decrease the efficacy of medication abortion (6). This does not mean that starting the shot at the same time of medication abortion is not ok. Some people may choose to accept the slightly increased risk of incomplete medication abortion for the convenience of not having to return for a shot (11). I generally tell people about the  risk of doing both at the same time and offer either immediate injection, or injection at their follow-up visit. An IUD cannot be inserted at the same time of a medication abortion — but evidence shows an IUD can be placed soon after the misoprostol has been taken and the pregnancy has passed (9). There is no evidence to support waiting 4-6 weeks for IUD insertion after medication abortion and I generally insert them at the follow-up visit in 1-2 weeks.   

You can start any birth control after a procedural abortion

There are no restrictions or concerns with starting birth control at the time of procedural abortion. Pills, the patch, the ring, the implant, the injection, the IUD, and surgical sterilization can all be offered at the same time as procedural abortion (2, 10). Pills, the patch, and the ring can be prescribed and started immediately after or right before a procedural abortion. The shot can be administered right before or right after a procedural abortion (10). An IUD can be placed right after a procedural abortion before the speculum has been removed  (10). For people living in areas where abortion can be performed in hospital settings, a procedural abortion can be completed and then a laparoscopic tubal ligation (having your fallopian tubes tied) or salpingectomy (removal of one or both of the fallopian tubes) can be completed immediately after the abortion before the patient wakes up (10). There is no medical or physiologic reason to wait to initiate contraception after most procedural abortions, although some people may prefer to wait for other reasons.  

Talking about your abortion (if you want to)

Although induced abortion is common, no one must know you had an abortion. You can tell whoever you are comfortable telling — you might be surprised at the support you receive from others. Your physician or healthcare provider will not be able to “tell” that you had an abortion. There are no lab tests to detect the medication abortion drugs in your blood stream. If you take the misoprostol in your mouth (buccal or sublingual) or rectally (in the rectum), there will be no evidence of the pills. If you place the pills vaginally, there could be some residual pill material left in your vagina, especially if you do not experience any bleeding. 

Procedural abortion involves stretching your cervix and gentle suction — there are no “scars” after and there is no physical evidence of a procedure. If your healthcare provider knows you were pregnant, or tests you for pregnancy immediately after an abortion, you can say you had a miscarriage. You do not have to disclose that you had an induced abortion if you do not feel safe or comfortable. 

If you do not want to share with your family, friends, or employer that you had an induced abortion, you can tell them you had a miscarriage. The treatment and recovery are the same. If you do not feel safe discussing pregnancy at all (for example, you are not “allowed” to be having sex), you can say you had a very heavy period or are having a very heavy period. If you are undergoing a self-managed abortion, be very careful who you tell and who you trust with that information. Although you have the human right to manage your own pregnancy outcomes in whatever way is right for you, having the legal right to self-manage abortion varies globally. It is often safer to say you are having a miscarriage in this situation and both are medically managed the same ways in an emergency.   

Breaking down some common abortion myths

You may have heard the different ways abortion can negatively affect your health and future fertility. These are myths usually spread by anti-abortion extremists. Pregnancy, not induced abortion, is a risk factor for infertility. Any pregnancy, whether it ends with birth, miscarriage, or abortion, can be complicated by infection or hemorrhage (13). When severe, both infection and hemorrhage can necessitate a hysterectomy to save a person’s life (14). A hysterectomy is when the uterus is removed, therefore preventing future pregnancies.

Hysterectomy because of induced abortion complication is rare. Hysterectomy because of vaginal birth or cesarean section complications is more common (13). Neither of the medication abortion drugs (mifepristone or misoprostol) are toxic or harmful to the reproductive organs or impact ovulation in future cycles (13, 14). The modern technique for procedural abortion without the use of sharp curettage does not result in uterine scarring (15). Most people can become pregnant again about three weeks after an induced abortion, procedural or medication (4). The leading causes of female infertility in the United States are ovulation dysfunction from conditions like polycystic ovary disease (PCOS) and fallopian tube blockage from chlamydia and gonorrhea infections which are sexually transmitted. 

Abortion does not cause breast cancer and it does not increase your risk of developing breast cancer. There is no credible scientific link to breast cancer from induced abortion or spontaneous abortion (miscarriage) (13). Evidence-based information on risk factors for breast cancer can be found through the World Health Organization or in the United States through the Centers for Disease Control and Prevention

Managing your mental health after an abortion 

Emotions are complex after an abortion and many people report feeling relief and grief at the same time. It’s ok to feel both resolve, contentment, or comfort in your abortion and to feel sadness or grief for the pregnancy you could not keep. It’s also ok not to feel any sadness, or to feel a lot. Although the range of emotions can vary greatly immediately after an abortion, there is no credible scientific evidence that abortion negatively impacts mental health, or causes depression, anxiety, or PTSD (13). But key findings from The Turnaway Study found that having a wanted abortion does NOT negatively impact mental health and that being denied a wanted abortion DOES negatively impact mental health (16). 

You may or may not need a follow-up after an abortion

Abortion is safe and most people do not require an in-person follow-up visit. After a procedural abortion, your provider will make sure the procedure is complete through several different methods before you leave the facility (2). Although most people “know” that their medication abortion was successful, it is important to have some method of ensuring a medication abortion is complete. This can be done with an ultrasound or pregnancy test in-person, or through a variety of home questionnaires and a home pregnancy test a few weeks after your medication abortion. Whether or not you have an in-person follow-up required, it is important to seek medical care if you are experiencing heavy bleeding, uncontrolled pain, fever, or loss of consciousness (2, 4).   

Abortion is different for everyone 

There is no “normal” way to feel after an abortion; it is ok to feel however you feel. If you’re comfortable talking about your abortion, opening up to others might feel helpful. You’ll likely find people in your group of friends who have had abortions, too. Some people like to take it easy and rest after an abortion, while others like to keep going and stay busy. Whichever your preference, listen to your body. If you do too much after an abortion, it may remind you that you need to slow down. 

You can read about what to expect the day of an abortion in our other article, here.

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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