An abortion involves either taking a series of medications or having a brief in-clinic procedure to end a pregnancy. What happens depends primarily on how far along the pregnancy is and which method you choose. Here’s what each process looks like from start to finish.
Before the Procedure Begins
Regardless of the method, your visit starts with intake and screening. This typically includes a health history review, blood work to check your blood type, and an ultrasound to confirm the gestational age. The World Health Organization updated its guidance in 2022, recommending that blood type testing for Rh factor can be skipped before abortions at less than 12 weeks. Some clinics still perform it routinely. You’ll also discuss your options for pain management and ask any questions before anything begins.
Medication Abortion: What Happens Over Two Days
Medication abortion uses two drugs taken in sequence, typically up to 10 or 11 weeks of pregnancy. It doesn’t involve any instruments or surgery. The process unfolds over one to two days, mostly at home.
The first pill blocks progesterone, the hormone that sustains the pregnancy. Without progesterone, the uterine lining begins to break down. This pill is swallowed at the clinic or at home, and most people don’t feel much from it alone, though light spotting can occur.
Between 24 and 48 hours later, you take the second set of tablets by placing them between your cheek and gum and letting them dissolve. These tablets trigger the uterus to contract and expel the pregnancy. Cramping and heavy bleeding usually begin within one to four hours. The cramping can be intense, often stronger than a typical period, and you’ll pass blood clots and tissue. Many people describe the heaviest part as lasting several hours, then gradually tapering. Nausea, diarrhea, and feeling flushed are common side effects of the second medication, but these typically resolve within a day.
The success rate for medication abortion is around 94 to 97%, with similar effectiveness whether you’re just under six weeks or closer to eight weeks. A follow-up visit or phone call confirms the abortion is complete, sometimes with a second ultrasound or blood test.
First Trimester Surgical Abortion
A surgical abortion in the first trimester (up to about 14 weeks) uses gentle suction to empty the uterus. The entire clinic visit takes roughly three hours if you’re under 12 weeks, or five to six hours if you’re between 12 and 14 weeks. The procedure itself is about 15 to 20 minutes. The rest of the time is preparation, waiting for medications to take effect, and a short recovery period afterward.
Pain Management Options
You’ll have choices for managing pain and anxiety. The most common option is a local anesthetic, an injection near the cervix that numbs the area. Some clinics offer conscious sedation, where you receive medication through an IV that keeps you relaxed and drowsy but still responsive. General anesthesia, where you’re fully asleep, is available at some facilities but isn’t always necessary for first trimester procedures. Most clinics also give you oral pain relievers and anti-anxiety medication about 30 to 60 minutes before the procedure starts.
What Happens During the Procedure
You lie on an exam table with your feet in stirrups, similar to a pelvic exam. The clinician inserts a speculum to see the cervix, then gently opens the cervix using thin, graduated rods. How much dilation is needed depends on how far along the pregnancy is. The general rule is that the opening needs to roughly match the number of weeks of pregnancy in millimeters.
Once the cervix is open, a thin tube is inserted into the uterus and connected to a suction device, either a handheld syringe or an electric pump. The suction removes the pregnancy tissue. You’ll likely feel cramping during this part, ranging from mild to strong, depending on your pain management. Some people feel pressure or tugging. When the uterus is empty, it contracts down, which the clinician can feel through the instrument. The tissue is examined afterward to confirm the procedure is complete.
After the procedure, you rest in a recovery area for a short time. Staff will check your bleeding and make sure you’re feeling stable before you go home. Most people feel well enough to leave within 30 minutes to an hour.
Second Trimester Procedures
Abortions later in pregnancy, generally from about 14 to 24 weeks, require more cervical preparation and use a procedure called dilation and evacuation. The cervix needs to open wider than in a first trimester procedure, so preparation often begins a day or two before.
Small rods made from dried seaweed or synthetic material are placed into the cervix. These absorb moisture and slowly expand over several hours, gently stretching the cervix open. You may need one or two rounds of these, placed 24 to 48 hours apart depending on how far along the pregnancy is. Some cramping and light spotting during this preparation period is normal. Over-the-counter pain relievers are usually enough to manage the discomfort, though stronger medication is sometimes needed.
On the day of the procedure, the clinician uses a combination of suction and specialized instruments to remove the pregnancy. Stronger sedation or general anesthesia is more common for these procedures. Some providers use ultrasound guidance during the process. The procedure takes longer than a first trimester aspiration, and recovery monitoring afterward is typically more involved. Using these gradual dilation methods significantly reduces the risk of cervical injury compared to rapid mechanical dilation.
Recovery and What to Expect Afterward
Vaginal bleeding after any type of abortion can last several weeks, though it’s usually lighter than a period for most of that time. Cramping typically lasts a few days. With medication abortion, the heaviest bleeding happens during the process itself and tapers over the following days. With surgical abortion, bleeding is often lighter from the start since the uterus has already been emptied.
Most people return to normal activities within a day or two after a surgical procedure, and within a few days after a medication abortion. Your period will typically return within four to eight weeks.
How Common Are Complications
Abortion is one of the safest procedures in medicine. A large study of nearly 55,000 abortions found an overall complication rate of 2.1%, and most of those complications were minor. First trimester aspiration had a complication rate of 1.3%, with major complications occurring in only 0.2% of cases. Medication abortion had a slightly higher overall complication rate of 5.2%, but the vast majority of those (4.9%) were minor, such as needing an additional dose of medication or a follow-up aspiration to complete the process.
Serious complications like heavy hemorrhage, infection, or injury to the uterus are rare in clinical settings. Infection after a first trimester aspiration occurs in fewer than 0.4% of cases. Signs to watch for include soaking through two or more pads per hour for two hours straight, a sustained fever, worsening pain, or pain that persists for several days. These symptoms are uncommon but warrant prompt medical evaluation.