An abortion is a medical procedure that ends a pregnancy. It can be done with medication or through a minor surgical procedure, depending on how far along the pregnancy is. In the United States, the vast majority of abortions happen in the first trimester, with only about 11% occurring after 14 weeks.
Medication Abortion
Medication abortion uses two pills, taken one to two days apart, to end a pregnancy up to 10 weeks (70 days) of gestation. It’s sometimes called “the abortion pill,” though it actually involves two separate medications taken in sequence.
The first pill works by blocking progesterone, a hormone the body needs to maintain a pregnancy. Without progesterone, the uterine lining breaks down and the pregnancy can no longer continue. The second pill, taken 24 to 48 hours later, triggers cramping and bleeding to empty the uterus. Most people place the second set of tablets inside the cheek and let them dissolve.
After taking the second pill, bleeding and cramps typically start within a couple of hours. The heaviest bleeding and cramping usually lasts up to 24 hours, though lighter bleeding and spotting can continue for a few weeks. The experience is similar to a heavy, crampy period. Studies show medication abortion has an overall success rate of about 97%, with rates slightly higher at earlier gestational ages (97.5% at 7 weeks or less) and still very high later in the window (95.9% after 7 weeks).
Procedural Abortion
When a pregnancy is further along, or when someone prefers a faster, in-clinic option, a procedural (surgical) abortion is used. There are two main types, and which one applies depends on gestational age.
Vacuum aspiration is the standard method through about 12 to 14 weeks. A thin tube is inserted through the cervix, and gentle suction removes the pregnancy tissue from the uterus. The procedure itself takes only a few minutes and is done in a clinic or outpatient setting. It can be performed with a handheld device (manual vacuum aspiration) or an electric pump.
Dilation and evacuation (D&E) is used for pregnancies beyond 12 to 14 weeks. Because the pregnancy is larger, the cervix needs to be gradually opened beforehand using either small dilating rods or medication. The procedure combines suction with specialized instruments to remove pregnancy tissue. D&E is the most common method for second-trimester abortions.
What Happens Before the Procedure
Before any abortion, a clinician confirms how far along the pregnancy is, since gestational age determines which methods are appropriate. This may involve an ultrasound, especially if there’s any uncertainty about the timing or location of the pregnancy. Blood typing is sometimes done to check for Rh-negative blood type, which can require a simple injection to prevent complications in future pregnancies. Routine lab work beyond these basics isn’t required. A physical exam and medical history review help rule out any conditions that might affect which approach is safest.
Recovery and What to Expect
Recovery from a first-trimester abortion, whether medication or procedural, is relatively quick. After a procedural abortion, most people rest for the remainder of the day and return to normal activities the next day. If sedation was used during the procedure, you shouldn’t drive for 8 to 24 hours depending on the type of sedation.
Some bleeding and cramping in the days following is normal. Signs that something needs medical attention include a fever over 100°F, soaking through more than one pad per hour for three consecutive hours, or severe abdominal pain that doesn’t respond to over-the-counter pain relievers. These complications are uncommon, but knowing what to watch for helps you respond quickly if they occur.
Effects on Future Fertility and Mental Health
One of the most common concerns people have is whether an abortion will affect their ability to get pregnant later. A straightforward, uncomplicated abortion does not reduce future fertility. It doesn’t increase the risk of miscarriage, ectopic pregnancy, or infertility in subsequent pregnancies.
The mental health question has been studied extensively. A large national survey found that when researchers accounted for mental health conditions that existed before the pregnancy, abortion was not a significant predictor of later anxiety, depression, eating disorders, or suicidal thoughts. Women who had abortions were more likely to have had pre-existing mental health conditions than women who carried pregnancies to term, which skewed earlier, less careful analyses. After adjusting for those pre-existing differences, five out of six mental health outcomes showed no statistically significant link to abortion. The one exception was substance use disorders, which remained elevated but was also substantially reduced after accounting for prior conditions.
In short, the best available evidence does not support the claim that abortion causes mental illness. Most people report feeling relief as their primary emotion afterward, though it’s also normal to experience a range of feelings including sadness or ambivalence.
Medication vs. Procedural: How People Choose
Both approaches are safe and effective in the first trimester, so the choice often comes down to personal preference. Medication abortion offers more privacy since most of the process happens at home, but it takes longer and involves hours of heavy cramping and bleeding. Procedural abortion is over in minutes, is slightly more effective overall, and allows the clinician to confirm completion immediately. Some people prefer the control of managing the process at home; others prefer the speed and certainty of a clinic visit. Gestational age narrows the options as pregnancy progresses, since medication abortion is only available through 10 weeks.