The abortion process: Everything you need to know

Disclaimer: Abortion laws and medical practices vary according to where you live. Always check the status of abortion in your area.

Abortion is a procedure many will experience in their lifetime, for a whole array of reasons. According to the World Health Organization (WHO), around 73 million abortions occur globally each year, which equates to almost 3 out of every 10 (29%) pregnancies ending in termination.

It’s vital that the abortion process is done safely. While first and foremost, that means they should be carried out under the care of a licensed medical professional, it also means having a full understanding of what the procedure entails. Knowledge is power, after all.

Here, with the help of OB-GYN (obstetrician and gynecologist) Dr. Jenna Flanagan, we explain the process of terminating a pregnancy: from the different types of abortion (abortion pills and surgical abortion) and how long an abortion takes, to how early you can have an abortion and what the expected recovery time is.

What is an abortion?

An abortion is the name given to any procedure that ends a pregnancy. Also known as the termination of a pregnancy, there are two types of abortion: medical and surgical. 

That means a health care provider will either use medication (usually in the form of pills) to perform a medical abortion or an in-clinic surgical procedure to remove the pregnancy tissue (this is the embryo or the fetus — an embryo turns into a fetus at 8 weeks of pregnancy) as well as the placenta. The type of abortion you have largely depends on how many weeks pregnant you are, but there are other factors to consider, too, which we’ll explain later on. 

In the UK, Germany, France, Italy, and New Zealand, most abortions are typically carried out before 12 weeks of pregnancy, while in the US, 93% of abortions take place before 13 weeks. Scroll down to read more on how early you can have a termination or when it might be too late to have an abortion.

It’s worth noting that a miscarriage occurring before 20 weeks of pregnancy is sometimes called a “spontaneous abortion” in medical terminology. This can be a bit confusing because miscarriages aren’t a decision to end a pregnancy. If you want to read more on miscarriages and why they can happen, you can find all the information here.

Abortion process: How to have a safe abortion

Abortions should always be supervised (either in person or remotely) by a licensed health care professional. Before considering an abortion, you must always seek medical advice as soon as possible. “There are complications that can arise as a result of an abortion that have lasting health impacts or may be immediately dangerous to your health and body. Therefore, properly trained professionals  with experience, support staff, and follow-up plans are essential for safe abortion care,” says Dr. Flanagan.

Laws on abortion differ by country and region. If you live in a place where abortion isn’t legally (or easily) accessible, it can be harder to get this advice. But wherever you live and whatever your circumstances, the fundamental thing to remember is to speak to a licensed medical professional before taking any steps toward having an abortion.

Support is important when it comes to making any firm decision about whether or not you want to continue with a pregnancy, because having an abortion is a major decision that can take its toll emotionally. Perhaps you have a partner, a family member, or a trusted friend you can discuss it with. If this doesn’t feel like an option for you, know that there are other avenues you can explore, such as a counselor or someone from an organization specializing in abortion. 

“Seeking support prior to an abortion is a personal choice; however, it is likely better for your emotional and physical recovery to have the support of someone who trusts and supports you and your decision and health,” says Dr. Flanagan.

If you decide to have an abortion in an area where it’s legal, a health care professional will make sure you undergo a series of pre-care tests beforehand. These will likely include an evaluation of your medical history and your overall health, a physical exam, and an ultrasound to confirm your pregnancy and to establish how many weeks pregnant you are. A blood test is also usually done to check your blood type and your hCG levels. You will also then be offered information and support to check that an abortion is definitely what you want (known as “informed consent”) to ensure you’re aware of the potential risks and to decide which procedure is best for you.

What types of abortion are there?

There are two main types of abortion to consider:

• Medical abortion (also known as the abortion pill), where medications are used to end the pregnancy
• Surgical abortion (there are two methods — more on those later), where the pregnancy is removed in a gynecological procedure

As for the medical abortion vs surgical abortion question, which one you choose depends on a number of things, including personal choice, how many weeks pregnant you are, and any other affecting health factors that may be relevant to you. Your health care provider will be able to help guide this decision.

Medical abortion (“the abortion pill”)

A medical abortion is when medication is given in the form of two pills (taken a day or two apart) to end a pregnancy. It doesn’t require any surgery or anesthesia, making it a more appealing choice for some. It has a success rate of 99.6% when carried out before 9 weeks of pregnancy, but the success rate reduces the further along you get.

When can you get a medical abortion?

It’s medically possible for the abortion pill to end pregnancies up to and after the 12-week mark. However, the dosage can differ depending on how many weeks pregnant you are. Generally, the advice is that a medical abortion using the most common combination of pills (more on that below) is advisable up to 11 weeks of pregnancy; beyond that point, your health care provider may encourage you to explore a surgical abortion.

As different countries and states have different rules on abortion, however, the cutoff point may be even earlier. Always check the laws in your area carefully and consult with your health care provider.

How does the abortion pill work?

There are a few different combinations of medication you may be prescribed to terminate a pregnancy, some of which are taken orally and some inserted into the vagina. The most common combination you’ll be given is one oral mifepristone tablet followed by one ​​misoprostol pill.

Mifepristone works by blocking the hormone progesterone, which thins the lining of the uterus and stops the embryo or fetus from growing. It also “primes the uterus for expelling the pregnancy, which is the job of the second medication,” explains Dr. Flanagan. 

The second pill, misoprostol, which is used 24 to 48 hours after the first tablet, tells the uterus to contract, causing the pregnancy tissue to be expelled via the vagina. This process will result in cramping and bleeding that’s typically heavier than a period, anywhere between 4 and 24 hours after using the second medication.

Often, a medical abortion procedure is started in a medical office or clinic, where you’d take the first pill under the supervision of a health care professional. However, this can also be done at home in some places around the world, for example in the UK. If this is an option for you, you’d still require the careful supervision of a medical professional remotely. They would be responsible for prescribing the medication in the first place, making sure you understand how to take it safely, and being on hand in the event of any complications.

What are the side effects of the abortion pill?

As described above, it’s expected that a medical abortion will result in cramping and potentially heavy bleeding, so make sure you stock up on plenty of absorbent sanitary pads. Your health care provider should be able to let you know roughly how much bleeding to expect based on how many weeks pregnant you are. These symptoms are the pregnancy termination taking place, and while they may feel unpleasant for a short time, they are completely normal. Other side effects of taking the abortion pill may include:

• Nausea
• Vomiting
• Fever
• Chills
• Diarrhea
• Headache

You might be given some pain medication to take during the medical abortion and again afterward if needed. An infection resulting from the abortion pill is rare (although having sex and using tampons in the 2 weeks afterward may slightly increase your chances, so avoid these), but if it happens, then your doctor will give you antibiotics. Symptoms you should seek medical help for include:

• Very heavy bleeding (soaking 2 or more pads an hour for 2 hours) 
• Severe abdominal pain
• Severe back pain
• A fever that lasts over 24 hours
• Foul-smelling vaginal discharge

Preparation and recovery after the abortion pill

Understandably, symptoms resulting from an abortion can cause discomfort and sometimes pain. That’s why, even if the pills are taken in a clinical setting, it’s recommended that you return to a comfortable place in between and after doses — ideally at home, if it’s nearby and is a safe and relaxing environment. You probably won’t be able to go about your normal routine while the abortion is happening, so try to plan for this. It’s very important to look after yourself and surround yourself with things that make you feel good during this time, as it’s totally natural to feel vulnerable both physically and emotionally.

After having a medical abortion, you’ll likely be offered a checkup visit with your health care provider to ensure you’re healing correctly and to check that the termination worked properly.

Reasons for a medical abortion

An individual’s reasons for having an abortion are personal to them. However, there are a number of specific reasons they might choose to have a medical abortion over a surgical abortion. These include:

• Medical abortions are typically used early on in pregnancy.
• Medical abortions are less invasive than surgical procedures.
• Medical abortions may be done at home (at least partially, and fully in some parts of the world).

Surgical abortion

A surgical abortion ends a pregnancy by removing the embryo or fetus tissue and the placenta from the uterus in a procedure that can only be carried out at a clinic or in a hospital. This is because it either requires anesthesia (local or general) or sedation (conscious or deep). A surgical abortion is increasingly becoming known as a “procedural” abortion because it doesn’t always involve any surgical cutting. It has a success rate of 99.8% for abortions before 9 weeks of pregnancy. There are two methods of surgical abortion, which are:

• Vacuum aspiration (either manual or electric methods for creating the vacuum)
• Dilatation and evacuation

You can read more on what each involves in the sections below.

When can you get a surgical abortion?

This depends on the individual laws in your country or state; however in general, surgical abortion can be completed “to the upper limit” of the abortion gestational age in your region, says Dr. Flanagan. In some places, that upper limit is set at 24 weeks (the point of potential viability, when a fetus could survive outside the uterus). There are also areas where exceptions can be made for special case terminations that need to be carried out much later in the pregnancy (for example, due to health-threatening conditions). 

The WHO confirms that you can safely have a surgical abortion both before and after 14 weeks of pregnancy, but different surgical procedures are recommended at different points. For a surgical abortion at less than 14 weeks pregnant, a vacuum aspiration is recommended. Over 14 weeks, dilation and evacuation is recommended.

What happens in a surgical abortion?

The process of a surgical abortion differs depending on whether you’re having a vacuum aspiration or if you’re having a dilatation and evacuation. A vacuum aspiration is a 10- to 20-minute process that involves “inserting a suction curette that looks like a big straw into the uterus and applying a vacuum to the curette to remove the tissue from the uterus,” explains Dr. Flanagan. The suction can either be created by hand (manually) or electrically using a machine to generate a more powerful vacuum.

A dilatation and evacuation is a procedure that also takes around 10 to 20 minutes. The surgeon uses a speculum (the same instrument that’s used in a Pap smear) as well as suction and other instruments to remove the pregnancy tissue from the uterus. Before the procedure, you will need to have “cervical preparation.” This can involve taking mifepristone and misoprostol tablets (the same ones used in a medical abortion) to soften the cervix, or cervical dilators can be placed within the cervix. These techniques will make it easier and safer to dilate your cervix during the surgery.

Anesthesia or sedation are typically used in both procedures to reduce pain during the procedure. If a local anesthetic or conscious sedation is used, meaning you’re awake but numbed in certain areas, some discomfort may still be felt during the procedure.

What are the side effects of a surgical abortion?

In terms of what to expect, Dr. Flanagan says the side effects of a surgical abortion are “very similar” to those of a medical abortion. This includes “mild to moderate bleeding and moderate to mild cramping, which can be managed with over-the-counter pain medications.” 

Keep an eye out for the same concerning symptoms listed above for medical abortions, including very heavy bleeding, pain, or signs of infection, and seek medical attention if you spot any. “Very rarely, there can be injury to the uterus during the procedure, called perforation or scarring of the uterus,” says Dr. Flanagan, who adds, “Both of these are extremely rare and, even if they occur, do not often have lasting side effects.”

Recovery after a surgical abortion

In order to aid recovery, ensure you’re keeping to reduced activity for 2 weeks with pelvic rest (no sex and no tampons). “Once the bleeding decreases, activities can be slowly increased. Cramping and bleeding will lessen after the immediate days following the procedure,” says the OB-GYN.

Depending on where you have your procedure. A 2- to 3-week follow-up after a surgical abortion may be offered, but all clinics will give a detailed list of symptoms and side effects to look out for afterward and information about when to seek help.

It’s also important not to ignore the emotional side effects that you may feel after terminating a pregnancy. “Any emotion that someone experiences during the abortion process is normal, whether it be sadness, relief, worry, or grief,” reassures Dr. Flanagan. “Your care provider can offer support and resources to help you navigate the process and answer any questions that come up along the way, as well as offer assistance for emotional support as well.”

Reasons for a surgical abortion

An individual’s reasons for having an abortion are incredibly personal to them. However, there are a number of specific reasons they might choose to have a surgical abortion over a medical abortion. These include:

• Surgical abortions are typically used later on in pregnancy.
• Surgical abortions take less time than medical abortions and require less follow-up.
• If the person has an intrauterine device (IUD)
• If there is a suspected ectopic pregnancy
• If the person has certain medical conditions (such as heart and blood vessel diseases; liver, kidney, or lung disease; or uncontrollable seizures)
• If the person is using certain medication (such as blood thinners or steroids)
• If the person has an allergy to the medication used in the abortion pill

How early can you have an abortion? When is it too late to have an abortion?

Some people, upon discovering they are pregnant, will know decisively that they are unable to continue with their pregnancy and will want to terminate it quickly. Usually, this is possible with both medical and surgical abortions (although if you choose a surgical abortion, a vacuum aspiration would be the preferable procedure at this stage).

Depending on which clinic you go to, some providers offer abortions based on the first positive pregnancy test, so approximately starting at 4 weeks of pregnancy, Dr. Flanagan explains. Other providers may require confirmation of a pregnancy in the uterus via an ultrasound before starting the process, which may push the earliest possible point for termination back to around 5.5 weeks of pregnancy.

In terms of success rates, studies that have looked into very early medical abortions (within the first 6 weeks of pregnancy) appear to conclude that these tend to be just as successful as medical abortions after the 6-week mark. Similarly, research has found that ​​surgical abortion is “safe, practicable and successful” as early as 3 weeks into pregnancy.

The question of when it’s too late to have an abortion isn’t always a straightforward one to answer, because the legal limit in your country or state generally determines this. Some areas have a cap of 24 weeks with an exception for life- or health-threatening conditions, while other places may restrict it much earlier. Always seek out the rules where you live to make sure you understand this fully.