An abortion ends a pregnancy either with medication or a brief surgical procedure, depending on how far along the pregnancy is. More than half of all abortions in the U.S. are now medication abortions, which involve taking two pills over the course of one to two days. The rest are procedural abortions performed in a clinic. Both are common, well-understood medical processes with high success rates.
Before the Procedure
The first step is confirming the pregnancy and estimating how many weeks along it is, since this determines which method is available. If you have regular menstrual cycles and can pinpoint the date of your last period, an ultrasound isn’t always necessary. The American College of Obstetricians and Gynecologists notes that for patients with a certain last period within the prior 56 days and no signs of ectopic pregnancy, a clinical exam or ultrasound isn’t required before a medication abortion.
Blood tests aren’t routine either. Checking for anemia is only done when there’s a reason to suspect it. Some clinics will check your blood type to determine if you need an injection that prevents a rare immune reaction in future pregnancies. Beyond that, additional testing depends more on state-level legal requirements than medical necessity.
How Medication Abortion Works
Medication abortion uses two drugs taken in sequence. It’s available up to about 10 weeks of pregnancy and works roughly 97% of the time for pregnancies of 9 weeks or less. In 2022, 53.3% of all abortions in the U.S. were performed this way.
The first pill blocks progesterone, the hormone that maintains the uterine lining and sustains a pregnancy. Without progesterone, the lining begins to break down. This pill also makes the uterus more sensitive to contractions. You take it as a single dose, and most people don’t feel much at this stage.
One to two days later, you take the second medication, four small tablets placed between your cheek and gum and held there to dissolve. These tablets trigger the uterus to contract and expel the pregnancy tissue. This is the step where most of the physical experience happens: cramping, bleeding, and passing tissue, often within a few hours. The cramping can range from period-like to significantly more intense, and the bleeding is typically heavier than a normal period. On average, heavier bleeding lasts about 9 days, though lighter spotting can continue for several weeks. In rare cases, bleeding extends up to 45 days.
Most people go through this process at home. You can use a heating pad, take over-the-counter pain relievers, and rest as needed. A small percentage of people will need follow-up care if the medication doesn’t fully complete the process.
How Surgical Abortion Works in the First Trimester
Surgical abortion, more accurately called suction aspiration, is a brief clinic-based procedure typically available up to about 14 weeks. The entire visit takes around three hours for pregnancies under 12 weeks, or five to six hours for those between 12 and 14 weeks (since the cervix needs more preparation at that stage).
You’ll receive pain medication and a sedative beforehand. After those take effect, the doctor numbs the cervix with a local anesthetic and gradually opens it using thin, tapered rods. A narrow, flexible tube is then inserted through the cervix into the uterus. Gentle suction through the tube removes the pregnancy tissue. The suction itself takes about one minute. The full procedure, from start to finish, lasts about 15 to 20 minutes.
For pregnancies closer to 14 weeks, you may be given a cervical softening medication a few hours before the procedure to make dilation easier and more comfortable.
Second Trimester Procedures
Abortions after 14 weeks use a procedure called dilation and evacuation, or D&E. The process has two main parts: cervical preparation, which may begin a day or more before the procedure using small devices that gradually absorb moisture and expand to gently open the cervix, and then evacuation of the pregnancy tissue using suction and specialized instruments. This is done under deeper sedation or anesthesia and takes place in a clinic or hospital setting. D&E accounts for a smaller share of all abortions, since the vast majority occur in the first trimester.
What It Feels Like
Pain levels vary by person and by method. With medication abortion, the cramping from the second set of pills is often the most uncomfortable part. Some people describe it as similar to bad period cramps; others find it more intense. The pain typically peaks within the first few hours and then gradually eases.
With a surgical procedure, the cervical numbing and sedation medication dull most of the sensation. You may feel pressure, tugging, or cramping during the procedure, but sharp pain is uncommon. Afterward, cramping similar to menstrual cramps can continue for a few days to two weeks.
Bleeding patterns differ between the two methods. Surgical abortion generally causes lighter bleeding afterward, while medication abortion produces heavier, more prolonged bleeding. With either method, light spotting can last up to four weeks.
Recovery and What to Expect After
Most people return to normal activities within a day or two, though recovery guidelines suggest taking it easy for the first few days. Avoid lifting anything heavier than about 10 pounds (roughly a gallon of milk) and skip strenuous exercise until you feel ready or your provider clears you.
For the first week, avoid baths, swimming, tampons, and vaginal intercourse. Sexual activity is typically fine again after two to three weeks. Your normal menstrual period will likely return within four to six weeks.
A heating pad on the lower abdomen and over-the-counter pain relievers handle most post-procedure discomfort effectively.
Signs That Need Attention
Some bleeding and cramping are expected, but certain symptoms signal a problem. Heavy bleeding, defined as soaking through one to two pads per hour for two consecutive hours, warrants medical attention. So does a fever, which can indicate infection. Pain that doesn’t respond to over-the-counter medication, or dizziness and lightheadedness, are also reasons to seek care promptly. These complications are uncommon, but recognizing them early makes a significant difference in outcomes.