Pregnancy can be terminated with medication or a procedure, depending on how far along you are. Most terminations happen in the first trimester, and the method available to you is largely determined by gestational age, counted from the first day of your last menstrual period.
Medication Abortion: Up to 10 Weeks
Medication abortion uses two drugs taken in sequence. The first blocks progesterone, the hormone that sustains a pregnancy. Without progesterone, the uterine lining breaks down and the pregnancy can no longer continue. The second drug, taken 24 to 48 hours later, triggers uterine contractions that expel the pregnancy tissue. The process is similar to a heavy, crampy period, though the intensity varies from person to person.
The FDA approves this regimen for pregnancies up to 70 days (10 weeks) of gestation. Within that window, the combined two-drug regimen has a success rate of roughly 95%. Beyond 10 weeks, effectiveness drops. One study of self-managed medication abortion between 9 and 16 weeks found that about 85% of people using the two-drug combination completed the abortion without needing a follow-up procedure, and 93% completed it when including those who did need procedural intervention afterward.
In the United States, the first medication can only be prescribed by a certified healthcare provider and dispensed by a certified pharmacy. It can be sent by mail or picked up in person. Before receiving a prescription, you’ll review and sign a patient agreement form that outlines the risks. Some states have additional restrictions on access, so the process varies depending on where you live.
If the first drug is unavailable, the second drug can be used on its own, though it is less effective. This is sometimes the only option in settings where the first medication is restricted.
What Medication Abortion Feels Like
After taking the second medication, most people experience cramping and bleeding within a few hours. The cramping can be intense, often stronger than a typical period, and may come in waves. You’ll pass clots and tissue. Bleeding is heaviest in the first several hours and then gradually lightens. Some people also experience nausea, diarrhea, or chills, which typically resolve within a day.
Heavy bleeding that soaks through two or more thick pads per hour for two consecutive hours is a sign something may be wrong. Fever lasting more than 24 hours, foul-smelling discharge, or worsening pain in the days after can signal infection or incomplete abortion, both of which require medical attention.
Aspiration Procedure: Up to About 14 Weeks
An aspiration abortion, sometimes called vacuum aspiration or suction abortion, is a brief in-clinic procedure. A thin tube is inserted through the cervix into the uterus, and gentle suction removes the pregnancy tissue. The procedure itself typically takes 15 to 20 minutes, with a recovery period of about 30 to 40 minutes in the clinic before you go home.
You’ll receive pain management, which usually includes a local anesthetic injected near the cervix and sometimes a sedative or nitrous oxide (gas and air). The cervix may need to be gently dilated to allow the tube through. During the suction, you’ll likely feel cramping that ranges from moderate to strong. Most people describe the discomfort as intense but brief.
Aspiration is highly effective, with very low rates of complications. Serious risks like infection, heavy bleeding, or damage to the uterus are uncommon.
Dilation and Evacuation: Second Trimester
After about 14 weeks, the standard procedure is called dilation and evacuation, or D&E. It is more involved than a first-trimester aspiration because the cervix needs significantly more preparation.
For pregnancies at 20 to 24 weeks, at least one day of cervical preparation is required before the procedure. Small absorbent rods called osmotic dilators are placed in the cervix the day before. These gradually expand overnight, slowly opening the cervix to minimize the risk of injury. In some cases, medications are also given alongside the dilators to soften the cervix further and make the procedure easier. The actual D&E uses a combination of suction and surgical instruments to empty the uterus.
D&E is performed under sedation or general anesthesia. It is a well-established procedure with decades of safety data, though it does require a provider with specialized training. As pregnancy advances, fewer clinics offer the procedure, and it becomes harder to access in many parts of the country.
Before the Procedure
Regardless of the method, you’ll need your gestational age confirmed. This is typically done with an ultrasound, though early pregnancy can sometimes be dated based on your last menstrual period alone. Knowing the gestational age determines which options are available to you.
If you’re 8 or more weeks pregnant, blood type testing is recommended to check your Rh factor. About 15% of people are Rh-negative, meaning their blood lacks a specific protein. If you’re Rh-negative and 8 or more weeks along, you’ll receive an injection that prevents your immune system from producing antibodies that could affect a future pregnancy. If you’re under 8 weeks, this testing isn’t necessary.
Recovery and What to Expect After
Bleeding after an abortion, whether medication or procedural, can last up to four weeks, though it’s often intermittent rather than continuous. The heaviest bleeding typically occurs in the first few days. You can generally return to normal activities the next day, adjusting based on how you feel and avoiding anything that increases pain.
Pregnancy symptoms tend to fade quickly. Nausea and fatigue usually resolve within about three days. Breast tenderness takes longer, typically 7 to 10 days, and some breast firmness or fluid leaking is normal for the first three to four days.
To reduce the risk of infection, avoid inserting anything into the vagina, including tampons, for two weeks after the procedure. Vaginal intercourse should also wait two weeks. Fertility can return very quickly, sometimes within days, so contraception should be discussed and started right away if you want to prevent another pregnancy.
Complications to Watch For
Serious complications from abortion are rare, but knowing the warning signs matters. The main risks are incomplete abortion (where some tissue remains), heavy bleeding, and infection. Signs that need prompt medical attention include:
- Soaking through two thick pads per hour for two or more hours in a row
- Fever lasting more than 24 hours or a high fever at any point
- Increasing pain that doesn’t respond to over-the-counter pain relief, especially if it worsens over days rather than improving
- Foul-smelling vaginal discharge, which can indicate infection
An incomplete abortion, where pregnancy tissue hasn’t fully passed, is the most common complication of medication abortion. It’s typically resolved with an aspiration procedure. For surgical abortions, the complication rate is lower because the provider can confirm complete evacuation at the time of the procedure.