Abortion is a common experience. It’s estimated that about three in every ten pregnancies worldwide end in abortion (1). In the USA, it’s about one in five (2) and can be up to about two in five depending on the circumstances surrounding pregnancy, such as unintended pregnancy (3).
About one in four women in the USA will have an abortion by age 45 (4).
In the USA as of 2018, most abortions happen in the first nine weeks of pregnancy, and nearly all abortions (9 in 10) happen in the first trimester (the first 13 weeks of pregnancy) (5). Abortion is a safe and effective way to end a pregnancy (6, 7, 8).
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.
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 might miss a period and may have symptoms of pregnancy
If your periods tend to be quite predictable, you may suspect pregnancy as soon as your period doesn’t arrive at the expected time.
Early pregnancy symptoms before an abortion
Hormonal changes cause the early symptoms of pregnancy. There is no “typical” time to begin feeling the symptoms of pregnancy–some people feel different within a week or two after a missed period, but most people will have some symptoms by the sixth week of pregnancy. These symptoms are typically daily and persistent (9). Light spotting can happen early in pregnancy. Up to one in four people experience spotting in the first trimester of pregnancy (10).
What to expect during different 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 procedural abortion, a dilation and curretage (D&C) procedure, or an in-clinic abortion) (11). Your choice may depend on how many weeks pregnant you are, the time each method takes, and whether you prefer to be mainly at home or in the clinic (11). Recommendations and procedures can also vary country-to-country.
When you go 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 may 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 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 (11).
You might also want to prepare for an abortion by having some comforting things around you.If you’re having an in-clinic abortion, you’ll also need to arrange for someone to drive you home if you have sedation medications.
What happens during a medication abortion
A medication abortion is an abortion using pills (11). There are two options for medication abortion: one uses Mifepristone and Misoprostol, and the other uses Misoprostol only. Either way 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 (11).
Most of the time, the first pill you’ll take is a medication called mifepristone, which prevents the progesterone from continuing to support the pregnancy (12). 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 (12).
At home, you’ll take a medication called misoprostol. Misoprostol can be taken 6-72 hours after mifepristone, but the timing and route that your healthcare provider recommends may depend on your local laws and unique medication history (11, 13, 14).
Misoprostol causes your uterus to cramp/contract and your cervix to soften, which pushes out the inner lining and contents. The drug is a type of prostaglandin, similar to what causes regular period cramps (12). The level of cramping, pain, and bleeding can be intense, and may depend on the timing in the pregnancy (15). You can take anti-nausea medication half an hour or so before taking the misoprostol, and can take a pain medication (ibuprofen) before or throughout the abortion process (11). Do not take Aspirin or any pain medication that might increase bleeding (11).
First trimester medication abortions are safe and very effective. More than 95 in 100 people who have a medication abortion need no further treatment (16,17). 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 (6, 17,18).
Benefits of medication abortion:
Depending on your location, a medication abortion could be available as soon as you know that you are pregnant
It could avoid shots or anesthesia, and you will likely have some control over when to take the second pill
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 to process the experience, if that is meaningful to you
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
Depending on location, medication abortions are typically not available as late into a pregnancy as other methods
What happens during a procedural abortion
A procedural abortion is a procedure to remove the contents of the uterus. This happens in a clinic or hospital. Depending on location, a procedural abortion is usually available at any stage of pregnancy, but some clinics don’t offer it after week 12, though, so it’s important to check (19). Once you know how many weeks pregnant you are, the time until your procedure varies. Some people can get their procedure the same day, others have to wait or maybe come back another time to prepare for the procedure (19).
There are medications given at that time of the procedure, such as an antibiotic and pain medication to help with cramping. A healthcare provider will talk with you about pain management options. You may have the choice of being fully awake, sleepy, or asleep during the procedure (11). A local anesthetic is an injection given around 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, but is not always available for routine procedural abortions (11). 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 perform a pelvic exam. 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 smear test). A numbing medication is then injected around the cervix. If you haven’t received any medication or placement of osmotic dilators to prepare your cervix for the procedure, 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 the inside of the uterus, removing the pregnancy tissue, as well as the embryo. The procedure usually takes about 5-10 minutes. After the procedure and once you have recovered from anesthesia medication (if you got them) you can usually go pretty quickly home (19, 20).
First trimester procedural abortions are safe and effective: 99 times out of 100, everything works well the first time (6). 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 USA (6, 12).
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 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 sometimes be done later in a pregnancy than a medication abortion, depending on the local laws and available clinics. They’re also slightly more effective than medication abortions.
Risks of procedural abortion:
It is a procedure; instruments are inserted through the vagina to open the cervix to empty the uterus
Sometimes, 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 sometimes, which is good to be aware of in advance
Some clinics might not offer procedural abortion as early in pregnancy as medication abortion
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 examined whether people felt their abortion decision was the right one for them over the three years after having the abortion (21). About 99 in 100 people felt they had made the right decision when asked about it at various points over the three years following an abortion (20). People report experiencing both positive emotions, such as relief and negative emotions at times related to their abortion. Community stigma and lack of social support can contribute to negative emotions. A recent study in the USA found that people who were denied a wanted abortion were more likely to struggle with poverty, intimate partner violence, and health problems (21-23). People who were able to obtain a wanted abortion had less financial stresses, were able to raise children in more stable environments and were more likely to want more children in the future (21, 24).
Whatever your choices and experiences are when having an abortion, know that you're not alone.
An earlier version of this article was originally published October 1, 2018