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, abortion is one of the most common medical procedures, and data from 2018 to 2021 published in JAMA Network Open shows it carries a mortality rate of about 0.5 per 100,000 procedures, making it significantly safer than childbirth.
Medication Abortion
Medication abortion uses two pills taken one to two days apart. The first pill blocks progesterone, the hormone that maintains the uterine lining and supports early pregnancy. Without progesterone, the lining begins to break down. The second pill, taken 24 to 48 hours later, causes the uterus to contract and empty.
This method is used in the first 11 weeks of pregnancy and is the most common type of abortion. Success rates are highest early on: roughly 95 to 97 percent effective through the first nine weeks of pregnancy. Between weeks 9 and 10, effectiveness drops slightly to around 93 to 95 percent with a single dose of the second pill, though a repeat dose brings it back above 97 percent. After 10 weeks, medication abortion is less reliable and a procedural option is typically recommended instead.
What Medication Abortion Feels Like
After taking the first pill, most people feel little or nothing. The physical experience begins with the second pill. Cramping and bleeding usually start within one to four hours, followed by several hours of heavy cramping and bleeding with clots. The most intense part generally lasts two to six hours, though it can take longer.
Other common effects include a low-grade fever or chills lasting about a day, along with fatigue, nausea, dizziness, or diarrhea. The whole process typically happens at home. Bleeding similar to a period continues for up to two weeks afterward.
Procedural (Surgical) Abortion
Procedural abortion is done in a clinic or medical office. In the first trimester (up to about 12 weeks), the standard method is vacuum aspiration, where gentle suction is used to empty the uterus. This can often be performed with local anesthesia and over-the-counter pain relief, and it takes only a few minutes. The World Health Organization recommends vacuum aspiration as the preferred surgical method for first-trimester abortion.
Later in pregnancy, a procedure called dilation and evacuation is used. This is typically performed in an operating room with sedation or general anesthesia. The cervix is gradually opened (dilated), and the pregnancy is removed using a combination of suction and medical instruments. This procedure is used in the second trimester, roughly from 13 weeks onward.
Pain Management During Procedures
For vacuum aspiration, pain control usually involves a combination of ibuprofen or a similar anti-inflammatory taken beforehand and a local anesthetic injected into the cervix (called a paracervical block). Research shows this combination reduces both the pain of the procedure itself and discomfort afterward. Verbal support and distraction techniques help people cope, though they don’t necessarily lower pain scores on their own. Anti-anxiety medication can be offered to reduce nervousness but doesn’t affect pain directly.
For dilation and evacuation, sedation or general anesthesia is standard, so most people are either deeply relaxed or asleep during the procedure.
Before the Procedure
A pre-abortion assessment confirms the pregnancy, estimates how far along it is, and checks for any conditions that might affect which method is safest. This typically involves a medical history review and sometimes a pregnancy test, blood work for anemia, or an ultrasound to confirm the pregnancy’s location and timing. Routine lab testing is not a prerequisite for receiving abortion care, according to the WHO. The assessment is tailored to individual circumstances.
Recovery and What to Watch For
Whether you have a medication or procedural abortion, bleeding afterward is normal and typically lasts up to two weeks. It feels similar to a period. Using pads rather than tampons is generally recommended during this time, and most providers advise waiting until bleeding stops before having sex again.
Signs that something may be wrong include heavy bleeding that soaks through more than two thick pads per hour, foul-smelling discharge, fever lasting more than 24 hours, or worsening lower abdominal pain. These can indicate infection or incomplete abortion, both of which are treatable but need prompt medical attention.
Safety Compared to Childbirth
Legal abortion is one of the safest procedures in modern medicine. Between 2018 and 2021, the pregnancy-related mortality rate in the U.S. was 33.2 per 100,000 births, while the abortion-related mortality rate was 0.5 per 100,000 procedures. That means childbirth was roughly 44 to 70 times more likely to result in death than abortion during that period. Serious complications from legal abortion are rare.
Effect on Future Fertility
Abortion generally does not affect your ability to get pregnant in the future. Medication abortion has shown no link to increased risk of pregnancy complications down the line. For surgical abortion, most research finds little impact on future pregnancies, though some studies suggest a small possible increase in the risk of premature birth or low birth weight. Other studies have not confirmed that finding.
One rare complication worth knowing about is scar tissue forming inside the uterus after repeated surgical procedures involving dilation and scraping, a condition called Asherman syndrome. It can interfere with fertility but is often treatable with surgery. This risk is very low after a single procedure.