Disclaimer: Abortion laws and medical practices vary according to where you live. Always check the status of abortion in your area.
Lots of us have questions about abortion, especially as the rules around when (and if) you can access a termination differ from country to country — and now in the US, state to state.
First up, let’s look at the stats: There are 73 million induced abortions globally every year, according to the World Health Organization (WHO). That means that 61% of unintended pregnancies end in termination, as do 29% of all pregnancies (many of these are terminated for medical reasons).
Shockingly, WHO research shows that 45% of all abortions are unsafe because they’re either performed by someone who isn’t qualified, happening in an environment that doesn’t meet minimal medical standards, or both. Unsafe abortions are a leading but preventable cause of maternal death, or longterm issues like infertility, making access to safe, timely abortion and aftercare crucial.
When it comes to abortion aftercare, lots of women and people who menstruate want to know what to expect after an abortion: from how long you’re likely to bleed to how to manage the pain and when your periods start again. Knowledge is power after all, especially when it comes to our bodies, so we’re here to provide the facts on abortion side effects.
With this in mind, we asked Flo board members Dr. Jenna Flanagan, an OB-GYN (obstetrician and gynecologist), and Lorna Hobbs, a clinical psychologist, to answer the biggest questions around abortion aftercare.
Simply put, an abortion is a procedure to end a pregnancy. There are many reasons why someone might have an abortion, including when the pregnancy is unlikely to survive full term, danger to the mother’s life, or personal choice to end the pregnancy.
Whatever the reason, there are two types of abortion: medical (usually two pills taken 24 to 48 hours apart to bring on a miscarriage) or surgical (also know as procedural, this is when an operation takes place in a clinic or hospital to end a pregnancy). Remember: Both of these methods are safest when they are overseen by a qualified health care professional, in line with WHO advice.
Usually after an uncomplicated, safe surgical abortion, overseen by medical professionals, you’ll be able to go home shortly afterward to recover. This is because the risk of complications and serious side effects is low early on in pregnancy.
Depending on where you live, a medical abortion will either take place in a clinic or at home. Two pills are prescribed that must be taken 24 to 48 hours apart (your healthcare provider will explain exactly when to take them). At a clinic, you usually take the first pill under medical supervision and are then sent home to take the second one.
Dr. Flanagan explains what will typically happen next. “Usually for a medical abortion, the follow-up is either lab work, examination, or ultrasound imaging in the 1 to 2 weeks following to ensure the abortion process has completed,” she says. You can usually take a home pregnancy test 2 weeks after the termination to make sure the abortion has worked.
An incomplete medical abortion means that some of the pregnancy tissue remains in the uterus. Often, someone experiencing this will have symptoms, such as continued signs and symptoms of pregnancy like nausea and fatigue, and prolonged and irregular bleeding, usually accompanied by clots and labor-like cramps. If you’re at all worried, then make sure you get checked out by a doctor.
“For [surgical] abortion, some clinics have a 2-week standard post-procedure checkup, while other clinics don’t necessarily require a formal follow-up but encourage it if desired by the patient,” Dr. Flanagan adds. “Certainly [they will want to see the patient] if the symptoms are worrisome for a complication, including bleeding, excessive pain, or signs of infection.”
"Pain usually lasts around three days, but gets better each day"
Just like after any medical procedure, you’re likely to experience a few physical side effects following an abortion. The most common are:
- Vaginal bleeding
- Pain and cramping
“After an abortion, whether it’s medical or surgical, generally the side effects will be mild to moderate menstrual-like cramping and vaginal bleeding similar to that of a menstrual cycle,” Dr. Flanagan explains. “During a medical abortion, the bleeding can be heavier but generally tapers to the levels of a period. Over the next few days after the abortion, the cramping and bleeding overall should continue to improve.”
It’s important to note that for a few hours when the pregnancy tissue is passing, it is normal to have quite heavy bleeding — soaking through a pad frequently — along with severe cramping. Your medical professional will give you instructions on what to expect and suggestions for medications to manage the few hours when the severe cramping takes place.
Scroll down to find more information on how long bleeding and pain should last.
Some side effects can be a sign that something isn’t right. If you experience any of the below following an abortion, then seek medical advice right away.
“Typically, if bleeding becomes excessive, such as large golf ball-sized clots; saturation of a large maxi pad in the span of an hour [or soaking 2 or more pads an hour for 2 hours]; or heavy bleeding with dizziness, lightheadedness, or fainting, [that] should indicate the need for urgent evaluation,” Dr. Flanagan says. Remember that heavy bleeding and severe cramping are to be expected during a medical abortion, but that should not be the case afterwards.
“Excessive pain that isn't managed well with over-the-counter medication like ibuprofen should also prompt an evaluation. Fever, pus-like discharge vaginally, or malaise [general feeling of discomfort or illness] with worsening pelvic pain in the week following an abortion should prompt medical evaluation. Other side effects like intractable [uncontrollable] vomiting or concerning symptoms not improving with supportive care should trigger an evaluation.”
Vaginal bleeding is the most common side effect of both types of abortion, but how heavy you bleed can depend on which type of termination you’ve had. Some women report lighter bleeding or spotting after a surgical abortion, whereas heavier bleeding is more common following a medical abortion.
Dr. Flanagan says, “For a medical abortion, the bleeding is usually the heaviest 4 to 24 hours after taking the second medication that induces uterine cramping. For the surgical procedure, [bleeding is typically heaviest] immediately after and during that next 24 to 48 hours, but overall bleeding is usually less after the procedure.
“In both cases, vaginal bleeding can last 2 to 4 weeks after an abortion; however, it will continue to become lighter as time passes, and many patients experience the bleeding stopping sooner than that.”
If you experience increased cramping or stomach pain, very heavy bleeding, or a fever, then you should seek medical help immediately.
Pain, such as cramping, is a normal and expected — but uncomfortable and unpleasant — part of having an abortion.
Over to Dr. Flanagan again: “During a medical abortion — or if the surgical abortion is performed with minimal sedative pain medication — the majority of the pain during the process is experienced as intense uterine cramping, similar to moderate or severe menstrual cramps,” she says.
“Generally, after the tissue has passed during a medical abortion — or upon completion of the [surgical] procedure — the pain and discomfort improve rapidly to mild/moderate cramping. The cramping is usually experienced in the pelvic/lower abdominal area. Some people described back pain/cramping as well.”
Usually, the pain lasts for around 3 days after a termination, but gets better each day. Taking nonsteroidal anti-inflammatory drugs such as ibuprofen can help. You might also find the things you do to manage period pain can take the edge off, such as using a hot water bottle.
"Whatever you’re feeling, your emotions are totally valid and normal"
While studies have found that having an abortion doesn’t mean you’re at a higher risk of developing conditions like anxiety, depression, or post-traumatic stress disorder later on, every situation is different, and the emotions around it will be, too.
“The way a person feels after having an abortion will vary from person to person, and is dependent on multiple factors,” clinical psychologist Hobbs explains. “Experiencing symptoms of emotional distress is not the same as experiencing a mental health problem. The vast majority of people do not have long-term mental health problems following an abortion.
“Many of these feelings may be linked to the circumstances that led to the pregnancy and the need for an abortion, rather than the abortion itself. For many, these feelings will pass, as they do with other stressful life events.”
According to Hobbs, “some common emotions or experiences” after an abortion include:
- Relief — feeling that you made the right choice
- Guilt — that you had to make this decision
- Shame — often linked to the stigma surrounding abortion
- Grief or a sense of loss
- Isolation — often linked to the harmful stigma and secrecy surrounding abortion
- Blame or anger (self-directed or toward others)
- Low mood
- Worry/anxiety about having sex again and/or another pregnancy
- Being surprised by your feelings
- Feeling a mixture of feelings (e.g., relief and sadness)
Just know that whatever you’re feeling, your emotions are totally valid and normal. “A person doesn’t need to justify their emotions or feel bad about having them,” she adds. “Most people who consider their options carefully and who feel confident about their decision when they made it will continue to feel this way after the abortion. But it is common to experience a range of emotions after an abortion.”
Talking can make all the difference for some. “This could be with friends or family, in a peer or support group (in person or online) with others who have been through a similar experience, or through post-abortion counselling,” Hobbs says. “Most people feel they only need a few appointments, but some may need a bit longer.”
Remember too “that hormonal shifts (a decrease in progesterone and estrogen levels following the abortion) can cause changes in or low mood,” according to Hobbs.
She says some things you can do to take care of you include “taking time for yourself (go for walks, read, have a movie marathon), writing down your thoughts or feelings (no one ever needs to read what you write), working on self-compassion (we’re much harder on ourselves than others), and finding activities that help manage stress (such as physical activity or meditation).” You can return to regular exercise whenever you feel ready.
Your cycle will usually return to normal relatively quickly after having an abortion.
Eighty-three percent of women will ovulate (when the ovaries release an egg for fertilization) within one month, according to the American College of Obstetricians and Gynecologists. The WHO says ovulation can happen quicker than that, as early as 8 to 10 days after a termination.
Either way, Dr. Flanagan says it’s important to start birth control “immediately after or at the time of an abortion” if you are planning on having sex that could result in pregnancy. Your clinic should provide this or refer you to somewhere that can before you’re discharged.
Dr. Flanagan explains the options: “Birth control pills, patch, or ring, as well as the implant, can be started immediately or shortly after the medications are taken for the abortion. At the time of a surgical procedure, all these options are available including insertion of an intrauterine device (IUD) as part of the surgical abortion. If an IUD is desired after a medical abortion, this requires a follow-up appointment to ensure the abortion process has completed and it is safe to insert an IUD into the uterus.”
"Vaginal bleeding is the most common side effect of both types of abortion"
Human chorionic gonadotropin, or hCG, is the hormone your body produces when you’re pregnant. Pregnancy tests work by looking for hCG in your urine and then, if it’s found, show a positive result.
Often, it takes a while for the hCG that was made during pregnancy to stop circulating around the body after an abortion. Studies suggest levels will start to drop after around 7 days, but you might still have traces in your system up to 30 days later. Bear in mind, therefore, that this might cause a false-positive pregnancy test.
When you start having sex again after an abortion is your decision. You might feel ready right away or want to wait a while; do whatever feels right for you. However, it’s recommended that you wait at least 2 weeks to have penetrative sex after an uncomplicated medical or surgical abortion. Longer if you’re still experiencing bleeding.
Dr. Flanagan explains why: “If bleeding is still ongoing, more time may be recommended prior to engaging in sexual activity that involves penetration into the vagina, as it is important to monitor for any signs of infection or complications related to the abortion procedure.”
Remember, too, that starting a reliable form of birth control is essential if you’re having sex that could lead to pregnancy.