What is an Abortion?
An abortion is a procedure to end a pregnancy. It uses medicine or surgery to remove the embryo or fetus and placenta from the uterus. The procedure is done by a licensed health care professional.
The decision to end a pregnancy is very personal. If you are thinking of having an abortion, most health care providers advise counseling. Our registered nurses and pregnancy educators are available now to talk or chat with you about your situation and possible next steps. Click the chat button below, or call us toll-free at 800-672-2296.
What is a Medical Abortion?
Medical abortion doesn’t require surgery or anesthesia. The procedure can be started in a medical office or clinic. A medical abortion can also be done at home, though you’ll still need to visit your doctor to be sure there are no complications.
A medical abortion can be done using the following medications:
- Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). This is the most common type of medical abortion. These medications are usually taken within seven weeks of the first day of your last period. Mifepristone blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol, a different kind of medication, causes the uterus to contract and expel the embryo through the vagina.
If you choose this type of medical abortion, you’ll likely take the mifepristone in your doctor’s office or clinic. Then you will probably take the misoprostol at home, hours or days later. You’ll need to visit your doctor again about a week later to make sure the abortion is complete. This regimen is approved by the Food and Drug Administration (FDA).
If you take the first pill, mifepristone, and change your mind and want to continue the pregnancy, you can reverse mifepristone’s effects but you must start the protocol within 24 hours of taking mifepristone.
- Oral mifepristone and vaginal, buccal or sublingual misoprostol. This type of medical abortion uses the same medications as the previous method, but with a slowly dissolving misoprostol tablet placed in your vagina (vaginal route), in your mouth between your teeth and cheek (buccal route), or under your tongue (sublingual route).
The vaginal, buccal or sublingual approach lessens side effects and may be more effective. These medications must be taken within nine weeks of the first day of your last period.
- Methotrexate and vaginal misoprostol. Methotrexate is rarely used for elective, unwanted pregnancies, although it’s still used for pregnancies outside of the uterus (ectopic pregnancies). This type of medical abortion must be done within seven weeks of the first day of your last period, and it can take up to a month for methotrexate to complete the abortion. Methotrexate is given as a shot or vaginally and the misoprostol is later used at home.
- Vaginal misoprostol alone. Vaginal misoprostol alone can be effective when used before nine weeks of gestation of the embryo. But vaginal misoprostol alone is less effective than other types of medical abortion.
Potential risks of medical abortion include:
- Incomplete abortion, which may need to be followed by surgical abortion
- An ongoing unwanted pregnancy if the procedure doesn’t work
- Heavy and prolonged bleeding
- Digestive system discomfort
You must be certain about your decision before beginning a medical abortion. If you decide to continue the pregnancy after taking medications used in medical abortion, your pregnancy may be at risk of major complications. Medical abortion hasn’t been shown to affect future pregnancies unless complications develop.
When is medical abortion not an option?
- You are too far along in your pregnancy. You shouldn’t attempt a medical abortion if you’ve been pregnant for more than nine weeks (after the start of your last period). Some types of medical abortion aren’t done after seven weeks of pregnancy.
- Have an intrauterine device (IUD).
- Have a suspected pregnancy outside of the uterus (ectopic pregnancy).
- Have certain medical conditions. These include bleeding disorders; certain heart or blood vessel diseases; severe liver, kidney or lung disease; or an uncontrolled seizure disorder.
- Take a blood thinner or certain steroid medications.
- Can’t make follow-up visits to your doctor or don’t have access to emergency care.
- Have an allergy to the medications used.
Having a medical abortion is a serious decision. If possible, talk with your partner, family or friends. Talk with your doctor, a spiritual adviser or a counselor to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.
Our pregnancy educators are available to talk with you. There is no judgement, only education. Please click the chat button below, or call us toll-free at 800-672-2296.
You may be given medications to manage pain during and after the medical abortion. You may also be given antibiotics to prevent infection.
Your doctor will let you know how much pain and bleeding to expect, depending on the number of weeks of your pregnancy. Be sure to have plenty of absorbent sanitary pads on hand.
If you have a medical abortion at home, you’ll need access to a doctor who can answer questions by phone and access to emergency services. You’ll also need to be able to identify complications.
After a medical abortion procedure:
Signs and symptoms that may require medical attention after a medical abortion include:
- Heavy bleeding — soaking two or more pads an hour for two hours
- Severe abdominal or back pain
- Fever lasting more than 24 hours
- Foul-smelling vaginal discharge
After a medical abortion, you’ll need a follow-up visit with your doctor to make sure you’re healing properly and to evaluate your uterine size, bleeding and any signs of infection. To reduce the risk of infection, don’t have vaginal intercourse or use tampons for two weeks after the abortion.
Your doctor will likely ask if you still feel pregnant, if you saw the expulsion of the gestational sac or embryo, how much bleeding you had, and whether you’re still bleeding. If your doctor suspects an incomplete abortion or ongoing pregnancy, you may need an ultrasound and possibly a surgical abortion.
After a medical abortion, you’ll likely experience a range of emotions — such as relief, loss, sadness and guilt. These feelings are normal and our pregnancy educators are available to talk with you about them. Click the chat button below, or call us toll-free at 800-672-2296.
What is a Surgical Abortion?
Surgical abortion is a procedure that ends an undesired pregnancy by removing the fetus and placenta from the mother’s uterus. Surgical abortion is not the same as miscarriage. Miscarriage is when a pregnancy ends on its own before the 20th week of pregnancy.
How is a surgical abortion performed?
Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. Suction is used to remove the fetus from the uterus.
Before the procedure, you will likely have a urine test to confirm your pregnancy, and an ultrasound test check to determine how many weeks pregnant you are.
If you want a free pregnancy test or ultrasound, click here to find a pregnancy center near you. You can click the chat button below or call us toll-free 800-672-2296 and we’ll locate a nearby center for you.
During the surgical abortion procedure:
- You will lie on an exam table.
- You may receive medicine (sedative) to help you relax and feel sleepy.
- Your feet will rest in supports called stirrups. These allow your legs to be positioned so that your doctor can view your vagina and cervix.
- Your health care provider may numb your cervix so you feel little pain during the procedure.
- Your provider will insert a tube into your womb, then use a special vacuum to remove fetal tissue through the tube.
- You may be given an antibiotic to reduce the risk of infection.
- After the procedure, you may be given medicine to help your uterus contract. This reduces bleeding.
What are the risks of a surgical abortion?
- Damage to the womb or cervix
- Uterine perforation (accidentally putting a hole in the uterus with one of the instruments used)
- Excessive bleeding
- Infection of the uterus or fallopian tubes
- Scarring of the inside of the uterus
- Reaction to the medicines or anesthesia, such as problems breathing
- Not removing all of the fetal tissue, requiring another procedure
- You will stay in a recovery area for a few hours. Because you may still be drowsy from the medicines, arrange ahead of time to have someone pick you up.
- Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. Vaginal bleeding can last for a week to 10 days. Cramping most often lasts for a day or two.
- Follow instructions for post-procedure care and attend your follow-up appointments.
States have differing legal requirements and waiting periods you must follow before having an elective abortion. If you’re having an abortion procedure for a miscarriage, there are no special legal requirements or waiting periods required.
Compiled from these resources:
U.S. National Library of Medicine: MedlinePlus
Mayo Clinic: Medical Abortion
Katzir L. Induced abortion. In: Mularz A, Dalati S, Pedigo R, eds. Ob/Gyn Secrets. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 13.
Rivlin K, Westhoff C. Family planning. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 13.