Abortion is done one of two ways: with medication or with a brief surgical procedure. The method depends primarily on how far along the pregnancy is. Both are common, safe, and highly effective, with success rates between 95 and 98 percent.
Medication Abortion
Medication abortion uses two different pills taken one to two days apart. It’s approved for pregnancies up to 70 days (10 weeks) of gestation, and it’s the most common method during that window. The process happens mostly at home rather than in a clinic.
The first pill blocks the hormone progesterone, which a pregnancy needs to continue. You take it by mouth as a single dose. Then, 24 to 48 hours later, you take four smaller tablets of a second medication by placing two in each cheek pouch and holding them there for 30 minutes before swallowing any remnants with water. This second medication causes the uterus to contract and empty.
Within a few hours of the second pill, you’ll experience cramping and heavy bleeding, heavier than a normal period. This is the abortion itself happening. Most people pass the pregnancy tissue within four to six hours, though it can take longer. Nausea, diarrhea, and low-grade fever are also common during this phase. The cramping typically lasts two to three days and gets less intense each day. Lighter bleeding can continue for one to two weeks afterward.
Medication abortion is successful 95 to 97 percent of the time. About 3 to 5 percent of patients need a follow-up aspiration procedure because of an ongoing pregnancy, prolonged bleeding, or personal preference.
Surgical Abortion: Vacuum Aspiration
The most common surgical method is vacuum aspiration, sometimes called suction aspiration. It can be used from very early pregnancy through the first trimester and, in some cases, into the second trimester. The entire procedure takes about 5 to 10 minutes in the clinic, though preparation and recovery add time on either side.
Before the procedure, the cervix needs to be opened enough to allow a thin tube through. If it isn’t already dilated, a medication is given a few hours beforehand to soften and open it. You’ll also receive pain management, which varies by clinic and preference. Options include a local anesthetic injected into the cervix to numb it, nitrous oxide gas to create a calm “twilight” state, or intravenous sedation combined with local anesthetic. An anti-inflammatory painkiller is typically given about an hour before.
During the procedure itself, the clinician inserts a thin, flexible tube (called a cannula) through the cervix into the uterus. The tube is connected to a gentle suction source, either a handheld syringe or an electric pump. The suction empties the uterus in a matter of minutes. The clinician confirms the procedure is complete by checking that the tissue corresponds to what’s expected for the gestational age, and by feeling for the uterus contracting around the tube, which signals it’s empty.
Aspiration abortion is successful about 98 percent of the time. Roughly 2 percent of patients need a repeat procedure or additional intervention.
Later Procedures
Abortions after the first trimester use a procedure called dilation and evacuation, or D&E. This involves more cervical preparation, which may begin a day or more before the procedure using small dilators placed in the cervix that gradually expand it. The procedure itself uses a combination of suction and surgical instruments to empty the uterus. It’s performed under stronger sedation or anesthesia and takes longer than a first-trimester aspiration, but it remains a same-day outpatient procedure in most cases.
Recovery After Either Method
Regardless of the method, bleeding is normal and expected. After a medication abortion, bleeding can be quite heavy for the first day and then taper over one to two weeks. After a surgical procedure, bleeding is generally lighter and shorter. Cramping is common with both and usually resolves within two to three days.
Most people return to normal activities within a day or two after a surgical abortion, and within a few days after a medication abortion. Fertility can return almost immediately, so contraception is a consideration right away if you want to avoid another pregnancy.
Signs of a Problem
Serious complications are rare. When abortion is performed using standard methods by trained providers, the mortality rate is less than 1 per 100,000 procedures. Still, a few specific symptoms after either type of abortion warrant prompt medical attention: a fever over 100°F, soaking through one pad per hour for three consecutive hours, severe cramps that don’t respond to over-the-counter pain relief, worsening abdominal pain, or foul-smelling discharge. These can signal an infection or incomplete procedure, both of which are treatable but shouldn’t be ignored.