How Do Abortions Work? Understanding the Process Behind Medical and Surgical Abortions

Thinking about or planning for an abortion is different for everyone. Whether you’ve made up your mind or you’re still exploring, we’re here to help you understand your options. There are lots of reasons why someone may decide to end a pregnancy. Whatever your reasons, know this: Abortions are safe and more common than you may think. Here we’ll run through how abortions work and what you can expect if you decide to have one.   

Before an abortion

Terminating a pregnancy is a big decision. For some, it may feel straightforward. For others, it can be very complicated. Either way, it’s an important decision and a personal one. Before having an abortion, a trained abortion provider should carry out a pre-abortion assessment. This may be in person at a hospital or clinic, but it can also happen on the phone or via telehealth. During the assessment, your provider may ask you questions about your reasons for getting an abortion. They shouldn’t try to influence you. But they should ensure that you have the right information and support to make the best decision for you. 

The pre-assessment is also an opportunity for you to ask questions about your options, cost, appointment availability, and what to expect if you decide to have an abortion. No question is unimportant. If you’re not ready to decide, your provider may offer a follow-up consultation. They may also recommend a counselor to help you work through some of the big feelings commonly associated with ending a pregnancy.  

If you make the decision to go ahead with the abortion, you’ll be asked to sign some paperwork. You can change your mind at any time — even after you’ve signed the consent form and booked an appointment. Ultimately, it’s your own personal decision. 

What happens during an abortion?

An abortion works differently depending on which type of abortion you have. The type of abortion you have is usually determined by your preference and how far along the pregnancy is. But other factors — like your health — can come into play, too. 

• An abortion pill (medical, or medication abortion) or a surgical procedure (surgical abortion) can safely end pregnancies at up to 10 weeks.

• Terminating a pregnancy beyond 11 weeks often requires a clinic visit and a surgical procedure (surgical abortion).   

• Terminations in the third trimester are rare and usually happen only in extreme circumstances. 

Medication or ‘pill’ abortion

A medical abortion, or an “abortion pill,” is when you take medication to end a pregnancy. It’s described as “medical” because it uses medication — as opposed to a procedure and anesthesia. You might also have heard it referred to as “Plan C.” 

A medication abortion is a process that requires 2 pills, which you usually take over 2 days.

The first abortion pill

• The first pill contains a medication called mifepristone. This blocks the main pregnancy hormone and stops the pregnancy from growing.

• A specially certified provider must dispense mifepristone. But you don’t have to see a provider in person. 

• Some people experience mild cramping, nausea, diarrhea, or even vaginal bleeding after the first abortion pill. Overall, these symptoms are manageable, and most people are able to go about their day. 

The second abortion pill

• After 1 to 2 days, you come back for the second pill. 

• The second pill contains a different medication called misoprostol. 

• You take the second abortion pill, which will be either dissolved in your mouth or inside the vagina. 

• Misoprostol causes cramping and bleeding, like a heavy period. 

• You can do this safely at home if your pregnancy is 10 weeks or less. 

• In 4 to 6 hours after taking misoprostol, expect heavy vaginal bleeding as your uterus expels the pregnancy. Light bleeding may continue for a few weeks after the termination.

• If you don’t bleed heavily enough to pass the pregnancy, you may need to take additional doses of misoprostol.

Surgical or ‘in-clinic’ abortion

Surgical abortions involve a surgical procedure. For this reason, they’re performed in a clinical setting with pain control. 

There are two main types:

1. Vacuum (or suction) aspiration. This procedure involves dilating (opening) the cervix, inserting a tube into the uterus, and using suction to remove the pregnancy.

2. Dilation and evacuation (D&E). This is similar to vacuum aspiration. But it requires more dilation and uses different tools to remove the pregnancy from the uterus.

A few hours before the procedure, you’ll need to take a medication to help your cervix open up in preparation for the abortion. 

Then comes the pain control. The type of pain relief you get will depend on your personal preference, your individual circumstances, how far along your pregnancy is, and the cost. 

Here are some of the choices you may have:

• Local anesthetic injection. This is injected into the cervix to numb it. 

• Sedation medication. Sedation makes you sleepy, and it’s given either as an injection in a vein or a pill.

• General anesthesia. This is when you’re unconscious during the procedure.  

The surgical abortion procedure itself usually takes between 10 and 20 minutes. Depending on the type of pain relief you had, you may be able to go home within a few hours. Even if it’s longer than that, most people are able to leave the clinic the same day.  

Does an abortion hurt?

Yes, having an abortion can be uncomfortable and even painful. How much pain you feel depends on how far along the pregnancy is and the type of abortion you have.

It also depends on your own health and how you experience pain. Emotions can make pain feel worse. The level of stress, fear, or worry you feel will have an impact on how you experience the abortion.     

In a medication abortion, taking the pills themselves isn’t painful. And most symptoms will start when the second pill starts to kick in. When the second pill takes effect, the cramping and bleeding may feel like a heavy period. But for some, it may feel more painful than that. The more advanced the pregnancy, the more painful a medication abortion can feel.

A surgical abortion is always performed with anesthesia to limit pain during the procedure itself. After, it’s likely you’ll feel some pain and cramping as soon as the medication wears off. Just like with a medication abortion, it’s common to have some cramps and bleeding for a few weeks after a surgical abortion. These symptoms should get better day by day. 

It’s common to experience other symptoms immediately after a medical or surgical abortion, for example: 

• Nausea

• Vomiting

• Diarrhea

• Fever

• Chills

• Dizziness 

What to expect after an abortion

You’ll have cramping and vaginal bleeding for a few weeks after the abortion, so make sure you stock up on period pads. 

Over-the-counter medications like ibuprofen (Advil, Motrin) and acetaminophen (Tylenol) can help with the pain you feel after an abortion. Here are some other things you can try to ease your discomfort and care for yourself: 

• A hot water bottle or heating pad over your abdomen

• A warm shower

• As much rest as you can get

If you had a medication abortion, you’ll need to get a pregnancy blood test (called hCG) or an ultrasound scan. This is to check that the pregnancy has ended and has been fully expelled. If there’s any pregnancy tissue left in the uterus, this can become infected and make you very unwell. 

Both cramping and bleeding should gradually ease day by day. If things feel worse instead of better, it could be a sign that something is wrong. Contact your primary healthcare provider or abortion clinic if you feel that something just isn’t right, or if you experience any of the following symptoms:

• Abdominal cramping that is getting worse, not better

• Heavy vaginal bleeding that isn’t easing up 

• You still feel pregnant

• Fever

• Abnormal vaginal discharge

• Emotions that are getting in the way of your recovery  

Do abortions make it harder to become pregnant?

No. An abortion doesn’t affect your fertility or chance of future successful pregnancies. Menstrual periods will resume within 4 to 6 weeks after an abortion. But your ability to become pregnant will return to normal immediately. When it comes to sex, you can resume sex as soon as you feel up to it. Just make sure you have birth control sorted before, in order to avoid an unplanned pregnancy.  

Talking to someone

It’s normal to experience a range of different emotions after an abortion. And it’s very common to feel a mix of contrasting emotions, too. There’s no right or wrong way to process this decision. If you need to talk to someone about how you’re feeling, your healthcare provider, friends, or family are good places to start. If that’s not an option, or you need to speak to someone confidentially, there are resources available. One example for judgment-free support is All-Options’ free hotline.

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Written by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Reviewed by:

Christina Palmer, MD

Christina Palmer, MD, is a board-certified family physician with a special interest in chronic care management, women’s health, mental health, and preventive care. She has over 10 years of experience in primary care research, innovation, and practice.

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