Top of the page Abortion Topic OverviewIs this topic for you? This topic is about ending
a pregnancy. If you have had unprotected sex in the last 5 days and don’t want
to become pregnant, see the topic
Emergency Contraception. What is an abortion? Abortion is the early ending
of a pregnancy. Sometimes abortion happens on its own. This is
called miscarriage or spontaneous abortion. But women can also choose to end a
pregnancy by getting surgery or taking medicine. When should you see a doctor? If you think you
might be pregnant, see a doctor as soon as possible. If you are pregnant, this
is an important time to learn as much as you can about your options. The earlier you are
in your pregnancy, the more options you are likely to have. Also, the risk of
problems will be lower. Your doctor will ask about your medical
history and will do a physical exam. You will have lab tests to make sure that
you are pregnant. You may also have an ultrasound. How will you know what decision is right for you? It’s not easy to decide to end a pregnancy. You may need some time to think about your choices.
Counseling may help you to decide what is best for you. If you’re comfortable,
you can start by talking with your doctor. Family planning clinics also offer
counseling to help you decide what is best for you. You may also want to talk
with someone close to you who understands how pregnancy and raising a child
would affect your life. Carefully think through your choices, which are
to: Have a baby, and support and raise your
child to adulthood. Have a baby, and place the baby for adoption.
Have an abortion. When can an abortion be done? It will depend on
how many weeks pregnant you are. You may have a choice between a medical
abortion (which means taking medicine to end the pregnancy) and a surgical
abortion such as vacuum aspiration or dilation and evacuation (D&E).
After 10 weeks, surgical abortion is usually the only option. The risks
from having an abortion in the second
trimester are higher than in the first trimester.
Abortions done early in the pregnancy can be done by
your doctor or
gynecologist. Some nurse-midwives, nurse
practitioners, and physician assistants may also be trained to do some types of
abortions. Abortion services are most likely to be offered at university
hospitals and family planning clinics. Some states in the U.S. have legal
restrictions on abortion. Talk to your closest Planned Parenthood or other
family planning clinic to learn more about restrictions in your state. In some states, women younger than 18 will need a parent’s permission. A
minor can get a court order that will allow an abortion without a parent’s
consent. Abortions are rarely done after 24 weeks of pregnancy
(during the late second trimester and entire third trimester). Many states have restrictions on abortions after 24 weeks. How safe is abortion? Abortions done by doctors
are very safe. Less than 1 out of 100 women have a serious problem from an
abortion.footnote 1 The safest timing for an
abortion is usually during the first trimester. This
is when a low-risk medicine or vacuum aspiration procedure can be used.
Will you be able to have children in the future?
The most widely used methods for abortion do not prevent a woman from becoming
pregnant later. Keep in mind that you
can get pregnant in the weeks right after an abortion. This is a good time to
start using birth control that works well and fits your lifestyle. It will probably take you 1 to 3 weeks to heal and feel better after an
abortion. You should not have sex during this time. But when you do have sex
again, be sure to use a condom for several weeks or for as long as your doctor
tells you to. This will help to prevent infection. Frequently Asked Questions Learning about abortion: What is an abortion? Getting treatment: What is emergency contraception? Who do I need to see? What exams or tests will be done? How is a medical abortion done? How is a surgical abortion done? Do I have a choice about what method is used?Ongoing concerns: What follow-up will I need? Will I be able to have children in the future?Exams and TestsExams and tests are used to
diagnose a pregnancy and to check for any health conditions you may have that
need special consideration. Regardless of whether you know that you would
continue a pregnancy or have an abortion, your evaluation will include a
medical history, a physical exam, and some laboratory
tests. A physical exam before an abortion includes: Taking your vital signs, such as blood pressure
and heart rate. Listening to your heart and
lungs. Performing a
pelvic exam to find out the size and shape of your
uterus. The size of the uterus can help estimate the number of weeks you are
pregnant. A pelvic exam also allows your doctor to check the
ovaries and
fallopian tubes for a possible
tubal (ectopic) pregnancy, which would feel like an
abnormal mass in the pelvis.Laboratory tests before an abortion
include: A urine pregnancy test to find out if you
are pregnant. (You may have missed a menstrual cycle for another reason, such
as stress, and not because you are pregnant.) A blood test to
find out:
Whether you have low blood iron (anemia). If you have anemia, your doctor may want you
to take some iron supplements before and after an abortion. Your
blood type and whether you are Rh-negative. If you are
Rh-negative, you should receive a vaccine called Rh
immunoglobulin after an abortion. For more information, see the topic
Rh Sensitization During Pregnancy. Screening for
sexually transmitted infections (STIs), if you are at
high risk for an STI. This is not a routine test before an
abortion but may be done to reduce the risk of complications, such as an
infection, after the procedure. A
Pap smear to check for cervical cell abnormalities
(dysplasia), if you are due for one (not a routine test
before an abortion).An
ultrasound may be done to check your uterus size and
shape and to make sure the pregnancy is in the uterus. A
transvaginal ultrasound done in the first
trimester is the most accurate method of learning how
long you have been pregnant.Choices: Medical AbortionMedical abortion is the use
of medicines to end a pregnancy. Depending on the medicine used, a medical abortion can be done up to about 10 weeks of pregnancy. A typical treatment schedule for a medical abortion may require two visits to your doctor. At the first
visit, your doctor will give you one medicine to take during the visit or at home. You will take the second medicine 24 hours after the first medicine. Bleeding and cramping starts within a few hours after you have taken the second medicine. Cramps may be strong. You can take ibuprofen (also called Aleve or Motrin) to help with pain. Bleeding will be heavier than a regular period and will have some clots until the pregnancy has passed. Vaginal bleeding may last about 14 days. You will see your doctor, or go to a lab for a test, 7 to 14 days after taking the medicine. This is to see if you are recovering well and to make sure the medicines worked. Medical care before and after a medical abortion
includes physical exams and lab tests, education about what to expect,
self-care instructions, information on when to call your doctor, and birth
control planning.Medicines currently available in the United States for
inducing abortion are: Mifepristone and misoprostol. Mifepristone, also known
as Mifeprex or RU-486, blocks the effects of the hormone progesterone. This
stops the
placenta’s growth, softens the cervix, and makes the
uterus ready for labor. Misoprostol is then used to start contractions to clear
the uterus of all tissue. Misoprostol. This hormone softens and opens (dilates)
the
cervix and triggers uterine contractions. Misoprostol
used alone may end a pregnancy but is much more effective when used with other
medicines, such as mifepristone or methotrexate, in first-trimester
abortions. See the What to Think About section of this topic for a
comparison of medical abortion and surgical abortion.Choices: Surgical AbortionA surgical abortion ends
a pregnancy by surgically removing the contents of the uterus. Different
procedures are used for surgical abortion, depending on how many weeks of
pregnancy have passed. Care before and after a surgical abortion includes a physical exam and lab tests, education about what to
expect, self-care instructions, symptoms that mean you should call your doctor,
and birth control planning. Surgical methods in the first trimester (5 to 12 weeks) Manual vacuum aspiration (MVA) or machine vacuum aspiration uses suction through a small tube to empty the uterus
of all tissue.Surgical method in the second trimester Dilation and evacuation (D&E) is typically done
when an abortion occurs in the second 12 weeks (second
trimester) of pregnancy. It usually includes a
combination of
vacuum aspiration,
dilation and curettage (D&C), and the use of
surgical instruments (such as forceps) to clear the uterus of fetal and
placental tissue.A D&E is most commonly used during the second
trimester because it has a lower complication risk than induction
abortion. Nonsurgical method in the second trimester Induction abortion ends a second-trimester pregnancy
by using medicines to start (induce) contractions, which expel (push) the fetus
from the uterus. If the fetus has severe medical problems, a woman may choose
to have an induction abortion. See the What to Think About section of this topic for
a comparison between medical abortion and surgical abortion.What to Think AboutYour abortion
options are affected by your medical history, how many weeks pregnant you are,
and what options are available in your region. Not all medical or surgical
choices for an abortion are available in all parts of the United States or
around the world. In the U.S., individual states have restrictions on abortion,
such as requiring a waiting period, requiring parental consent for young women
under a certain age, or limiting options for pregnancies between 13 and 24
weeks (second trimester). The following table lists some of the
differences between the most commonly used medical and surgical abortion
procedures. Comparing medical abortion and surgical abortionfootnote 2 Medical abortion Surgical abortion
Usually prevents a need for surgical treatment Is invasive and/or surgical: Manual
vacuum aspiration (MVA) uses a tube attached to a
handheld syringe. It draws tissue out of the uterus. Machine vacuum
aspiration uses a tube attached to an electric pump. It draws tissue from
within the uterus. Dilation and evacuation (D&E) uses a combination of
vacuum aspiration,
forceps, and dilation and curettage (D&C). Can only be used during early pregnancy (up to about 10
weeks) Can be used from early to mid-pregnancy: Manual vacuum aspiration (MVA) can be used as early as 5
weeks, and as late as 12 weeks after the last menstrual period.
Machine vacuum aspiration can be used around 5 to 12 weeks after the last
menstrual period. D&E is used between 13 and 24 weeks after the last
menstrual period. It uses a combination of vacuum aspiration,
forceps, and D&C. Takes 2 or more medical visits over 7 to 14 days Usually takes 1 visitMay take several days to complete (most of the abortion
process happens gradually, at home) Is complete in the time it takes for the
procedureDoes not require anesthesia or sedative Does not require
general anesthesia (though it can be used).
Local anesthesia, with or without a calming sedative,
is typical.Has a high success rate (about 95%) Has a high success rate (about 99%)Causes moderate to heavy bleeding for a short
time Causes light bleeding in most casesNeeds medical follow-up to make sure pregnancy has ended
and to check the woman’s health Does not always need medical follow-upIs a multi-step process Is a single-step processIn extremely rare cases, leads to severe infection and
death (about 1 out of 100,000), slightly higher rate than after
surgical abortion. In extremely rare cases, leads to death (less than 1 out of 100,000)Pain associated with a medical or surgical abortion ranges
from mild to severe and depends on each woman’s physical and emotional
condition. Some fetal birth defects or medical problems are not
commonly diagnosed until the second trimester, when most routine screening
tests are done. There are fewer abortion options during the second
trimester. Abortion and breast cancer Research suggests that
the hormonal changes during pregnancy may be protective and reduce the risk of
breast cancer. In the past, there has been concern that an abortion might
interrupt these protective hormonal changes and possibly increase the risk of
breast cancer. But more recent, carefully done studies have led experts to
conclude that there is no link between having an abortion and breast
cancer.footnote 3Before, During, and After an Abortion: When to Call a Doctor If you think you may be pregnant, see a doctor for a
pregnancy test, examination, and
pregnancy counseling as soon as possible. If you are
considering ending the pregnancy, this is an important time for learning as
much as you can about your options. The earlier you take measures to end a
pregnancy, the more medical choices you are likely to have and the less your
risk of complications will be. Who to see Surgical abortions are minor surgeries
that require a health professional with specialized training. If a medical
abortion is not successful, a surgical abortion must be done as follow-up. This
is necessary to prevent infection and blood loss and to end the pregnancy,
because medical abortion medicines cause birth defects. The following health
professionals can perform abortions: Gynecologist Family medicine doctor who has special training Certified nurse-midwife Nurse-practitioner who has special
training Physician assistant who has special
trainingSome health professionals offer medical abortion only and
recommend another health professional if a
vacuum aspiration becomes necessary. Other health
professionals offer medical abortion and manual vacuum aspiration (MVA), if
needed. MVA is a simple and effective procedure. Fewer health
professionals offer medical, MVA, and surgical abortion services. Your health professional will give you information
about what to expect after an abortion. Normal symptoms
that most women experience include: Irregular bleeding or spotting for as long as
the first 3 weeks. Cramping for the first 2 weeks. Some women have
cramping (like menstrual cramps) for as long as 6
weeks. Emotional reactions for 2 to 3 weeks.The hospital or surgery center may send you instructions on
how to get ready for your surgery. Or a nurse may call you with instructions
before your surgery. Right after surgery, you will be taken to a
recovery area where nurses will care for and observe you. You will probably
stay in the recovery area for a period of time and then you will go home. In
addition to any special instructions from your doctor, your nurse will explain
information to help you in your recovery. You will go home with a page of care
instructions including who to contact if a problem arises. Signs of complications Less than 1 out of 100 women
who have an abortion have serious problems afterward.footnote 4 Call your doctor immediately if you have any of these symptoms after an abortion: Severe bleeding. Both medical and surgical
abortions usually cause bleeding that is different from a normal menstrual
period. Severe bleeding can mean:
Passing clots that are bigger than a
golf ball, lasting 2 or more hours. Soaking more than 2 large pads
in an hour, for 2 hours in a row. Bleeding heavily for 12 hours in
a row. Signs of infection in your whole body, such as
headache, muscle aches, dizziness, or a general feeling of illness. Severe
infection is possible without fever. Severe pain in the belly
that is not relieved by pain medicine, rest, or heat Hot flushes or a fever of
100.4°F (38°C) or higher that
lasts longer than 4 hours Vomiting lasting more than 4 to 6
hours Sudden belly swelling or rapid heart
rate Vaginal discharge that has increased in amount or smells
bad Pain, swelling, or redness in the genital areaCall your doctor for an appointment if you have had any of these symptoms after a recent
abortion: Bleeding (not spotting) for longer than 2
weeks New, unexplained symptoms that may be caused by medicines
used in your treatment No menstrual period within 6 weeks after the
procedure Signs and symptoms of
depression. Hormonal changes after a pregnancy can
cause depression that requires treatment.Your ability to become pregnant in the future Medical abortion and vacuum aspiration do not affect your ability to
become pregnant in the future.footnote 1 It is possible to
become pregnant in the weeks right after an abortion procedure. Ask your doctor when it’s okay to have sexual intercourse. To prevent infection
and pregnancy, it is important to
use condoms as directed by your doctor when you start to have intercourse
again. This is a good time to also start a highly effective birth control
method that fits your lifestyle. For more information, see the topic
Birth Control.Other Places To Get HelpOrganizations
Planned Parenthood Federation of
America www.plannedparenthood.org
American Congress of Obstetricians and Gynecologists
(ACOG) www.acog.org Related InformationBirth Control Miscarriage PregnancyReferencesCitations Holmquist S, Gilliam M (2008). Induced abortion. In RS Gibbs et al., eds., Danforth’s Obstetrics and Gynecology, 10th ed., pp. 586–603. Philadelphia: Lippincott Williams and Wilkins. American College of Obstetricians and Gynecologists (2005, reaffirmed 2011). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882. American College of Obstetricians and Gynecologists (2009, reaffirmed 2011). Induced abortion and breast cancer risk. ACOG Committee Opinion No. 434. Obstetrics and Gynecology, 113(6): 1417–1418. Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.Other Works Consulted Centers for Disease Control and Prevention (2011). Abortion surveillance—United States, 2008. MMWR, 60(SS-15): 1–41. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6015a1.htm?s_cid=ss6015a1_w.CreditsByHealthwise StaffPrimary Medical Reviewer Sarah Marshall, MD – Family Medicine Kathleen Romito, MD – Family Medicine Adam Husney, MD – Family Medicine Specialist Medical Reviewer Rebecca H. Allen, MD, MPH – Obstetrics and Gynecology Kirtly Jones, MD – Obstetrics and Gynecology Current as ofNovember 29, 2017 Top of PageNext Section:
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November 29, 2017Author:
Healthwise Staff Medical Review:
Sarah Marshall, MD – Family Medicine & Kathleen Romito, MD – Family Medicine & Adam Husney, MD – Family Medicine & Rebecca H. Allen, MD, MPH – Obstetrics and Gynecology & Kirtly Jones, MD – Obstetrics and GynecologyHolmquist S, Gilliam M (2008). Induced abortion. In RS Gibbs et al., eds., Danforth’s Obstetrics and Gynecology, 10th ed., pp. 586-603. Philadelphia: Lippincott Williams and Wilkins.American College of Obstetricians and Gynecologists (2005, reaffirmed 2011). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871-882.American College of Obstetricians and Gynecologists (2009, reaffirmed 2011). Induced abortion and breast cancer risk. ACOG Committee Opinion No. 434. Obstetrics and Gynecology, 113(6): 1417-1418.Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.