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Abortion

Abortion

Topic Overview

Is this topic for you?

This topic is about ending a pregnancy. If you have had unprotected sex in the last 5 days and don't want to become pregnant, see the topic Emergency Contraception.

What is an abortion?

Abortion is the early ending of a pregnancy.

Sometimes abortion happens on its own. This is called miscarriage or spontaneous abortion. But women can also choose to end a pregnancy by getting surgery or taking medicine.

When should you see a doctor?

If you think you might be pregnant, see a doctor as soon as possible. If you are pregnant, this is an important time to learn as much as you can about your options. If you are thinking about having an abortion, it's best not to wait. The earlier you are in your pregnancy, the more options you are likely to have. Also, the risk of problems will be lower.

Your doctor will ask about your medical history and will do a physical exam. You will have lab tests to make sure that you are pregnant. You may also have an ultrasound.

How will you know what decision is right for you?

Deciding to continue your pregnancy or end it is very personal. Counseling may help you to decide what is best for you. If you're comfortable, you can start by talking with your doctor. Family planning clinics also offer counseling to help you decide what is best for you. You may also want to talk with someone close to you who understands how pregnancy and raising a child would affect your life. Carefully think through your choices, which are to:

  • Have a baby, and support and raise your child to adulthood.
  • Have a baby, and place the baby for adoption.
  • Have an abortion.

When can an abortion be done?

It will depend on how many weeks pregnant you are. You may have a choice between a medical abortion (which means taking medicine to end the pregnancy) and a surgical abortion such as vacuum aspiration or dilation and evacuation (D&E).

After 9 weeks, surgical abortion is usually the only option. The risks from having an abortion in the second trimester are higher than in the first trimester.

Abortions done early in the pregnancy can be done by your doctor or gynecologist . Some nurse-midwives, nurse practitioners, and physician assistants may also be trained to do some types of abortions. Abortion services are most likely to be offered at university hospitals and family planning clinics.

Some states in the U.S. have legal restrictions on abortion. Talk to your closest Planned Parenthood or other family planning clinic to learn more about restrictions in your state.

In some states, women younger than 18 will need a parent's permission. A minor can get a court order that will allow an abortion without a parent's consent.

Abortions are rarely done after 24 weeks of pregnancy (during the late second trimester and entire third trimester). Many states have restrictions on abortions after 24 weeks.

How safe is abortion?

Abortions done by doctors are very safe. Less than 1 out of 100 women have a serious problem from an abortion. 1

The safest timing for an abortion is usually during the first trimester. This is when a low-risk medicine or vacuum aspiration procedure can be used.

Will you be able to have children in the future?

The most widely used methods for abortion do not prevent a woman from becoming pregnant later.

Keep in mind that you can get pregnant in the weeks right after an abortion. This is a good time to start using birth control that works well and fits your lifestyle.

It will probably take you 1 to 3 weeks to heal and feel better after an abortion. You should not have sex during this time. But when you do have sex again, be sure to use a condom for several weeks or for as long as your doctor tells you to. This will help to prevent infection.

Frequently Asked Questions

Learning about abortion:

Getting treatment:

Ongoing concerns:

Reasons Women Choose Abortion

The decision to continue your pregnancy or to end it is very personal.

Each year, nearly 1.2 million American women have an abortion to end a pregnancy. 2

The most common reasons women consider abortion are:

  • Birth control (contraceptive) failure. Over half of all women who have an abortion used a contraceptive method during the month they became pregnant. 2
  • Inability to support or care for a child.
  • To end an unwanted pregnancy.
  • To prevent the birth of a child with birth defects or severe medical problems. Such defects are often unknown until routine second-trimester tests are done.
  • Pregnancy resulting from rape or incest.
  • Physical or mental conditions that endanger the woman's health if the pregnancy is continued.

In the United States, 9 out of 10 abortions are performed in the first 12 weeks ( first trimester ) of pregnancy. Most of these are done within the first 9 weeks of pregnancy. 2

Very few abortions are done after 16 weeks of pregnancy. But some women have to delay abortions because they have trouble with paying for, finding, or traveling to an abortion specialist.

Exams and Tests

Exams and tests are used to diagnose a pregnancy and to check for any health conditions you may have that need special consideration. Regardless of whether you know that you would continue a pregnancy or have an abortion, your evaluation will include a medical history, a physical exam, and some laboratory tests.

A physical exam before an abortion includes:

  • Taking your vital signs, such as blood pressure and heart rate.
  • Listening to your heart and lungs.
  • Performing a pelvic exam to find out the size and shape of your uterus. The size of the uterus can help estimate the number of weeks you are pregnant. A pelvic exam also allows your doctor to check the ovaries and fallopian tubes for a possible tubal (ectopic) pregnancy , which would feel like an abnormal mass in the pelvis.

Laboratory tests before an abortion include:

  • A urine pregnancy test to find out if you are pregnant. (You may have missed a menstrual cycle for another reason, such as stress, and not because you are pregnant.)
  • A blood test to find out:
    • Whether you have low blood iron ( anemia ). If you have anemia, your doctor may want you to take some iron supplements before and after an abortion.
    • Your blood type and whether you are Rh-negative. If you are Rh-negative , you should receive a vaccine called Rh immunoglobulin after an abortion. For more information, see the topic Rh Sensitization During Pregnancy.
  • Screening for sexually transmitted infections (STIs) , if you are at high risk for an STI. This is not a routine test before an abortion but may be done to reduce the risk of complications, such as an infection, after the procedure.
  • A Pap smear to check for cervical cell abnormalities ( dysplasia ), if you are due for one (not a routine test before an abortion).

An ultrasound may be done to check your uterus size and shape and to make sure the pregnancy is in the uterus. A transvaginal ultrasound done in the first trimester is the most accurate method of learning how long you have been pregnant.

Choices: Medical Abortion

Medical abortion is the use of medicines to end a pregnancy. Medical abortion can be done up to about 9 weeks of pregnancy.

  • A typical treatment schedule for a medical abortion usually requires at least two visits to your doctor over several weeks. For the first visit, one medicine is taken during the visit and a second medicine is given to be taken at home. Vaginal bleeding may last about 14 days. Usually about 2 weeks after the first medical visit, a follow-up examination is needed to see if you are recovering well and to make sure the procedure worked.
  • Medical care before and after a medical abortion includes physical exams and lab tests, education about what to expect, self-care instructions, information on when to call your doctor, and birth control planning.

Medicines currently available in the United States for inducing abortion are:

  • Misoprostol. This hormone softens and opens (dilates) the cervix and triggers uterine contractions. Misoprostol used alone may end a pregnancy but is much more effective when used with other medicines, such as mifepristone or methotrexate, in first-trimester abortions.
  • Mifepristone and misoprostol. Mifepristone, also known as Mifeprex or RU-486, blocks the effects of the hormone progesterone. This stops the placenta 's growth, softens the cervix, and makes the uterus ready for labor. Misoprostol is then used to start contractions to clear the uterus of all tissue.
  • Methotrexate and misoprostol. Methotrexate interferes with the placenta's growth. It is not as effective as mifepristone and takes longer to abort a pregnancy. Misoprostol is then used to start contractions to clear the uterus of all tissue.

See the What to Think About section of this topic for a comparison of medical abortion and surgical abortion.

Choices: Surgical Abortion

A surgical abortion ends a pregnancy by surgically removing the contents of the uterus. Different procedures are used for surgical abortion, depending on how many weeks of pregnancy have passed.

Care before and after a surgical abortion includes a physical exam and lab tests, education about what to expect, self-care instructions, symptoms that mean you should call your doctor, and birth control planning.

Surgical methods in the first trimester (5 to 12 weeks)

Surgical method in the second trimester

A D&E is most commonly used during the second trimester because it has a lower complication risk than induction abortion.

Nonsurgical method in the second trimester

  • Induction abortion ends a second-trimester pregnancy by using medicines to start (induce) contractions, which expel (push) the fetus from the uterus. If the fetus has severe medical problems, a woman may choose to have an induction abortion.

See the What to Think About section of this topic for a comparison between medical abortion and surgical abortion.

What to Think About

Your abortion options are affected by your medical history, how many weeks pregnant you are, and what options are available in your region. Not all medical or surgical choices for an abortion are available in all parts of the United States or around the world. In the U.S., individual states have restrictions on abortion, such as requiring a waiting period, requiring parental consent for young women under a certain age, or limiting options for pregnancies between 13 and 24 weeks (second trimester).

The following table lists some of the differences between the most commonly used medical and surgical abortion procedures.

Comparing medical abortion and surgical abortion 3
Medical abortion Surgical abortion

Usually prevents a need for surgical treatment

Is invasive and/or surgical:

  • Manual vacuum aspiration (MVA) uses a tube attached to a handheld syringe. It draws tissue out of the uterus.
  • Machine vacuum aspiration uses a tube attached to an electric pump. It draws tissue from within the uterus.
  • Dilation and evacuation (D&E) uses a combination of vacuum aspiration, forceps , and dilation and curettage (D&C).

Can only be used during early pregnancy (up to about 9 weeks)

Can be used from early to mid-pregnancy:

  • Manual vacuum aspiration (MVA) can be used as early as 5 weeks, and as late as 12 weeks after the last menstrual period.
  • Machine vacuum aspiration can be used around 5 to 12 weeks after the last menstrual period.
  • D&E is used between 13 and 24 weeks after the last menstrual period. It uses a combination of vacuum aspiration, forceps , and D&C.

Takes 2 or more medical visits over 3 weeks

Usually takes 1 visit

May take several days to complete (most of the abortion process happens gradually, at home)

Is complete in the time it takes for the procedure

Does not require anesthesia or sedative

Does not require general anesthesia (though it can be used). Local anesthesia , with or without a calming sedative, is typical.

Has a high success rate (about 95%)

Has a high success rate (about 99%)

Causes moderate to heavy bleeding for a short time

Causes light bleeding in most cases

Needs medical follow-up to make sure pregnancy has ended and to check the woman's health

Does not always need medical follow-up

Is a multi-step process

Is a single-step process

In extremely rare cases, leads to severe infection and death (about 1 out of 100,000), slightly higher rate than after surgical abortion.

In extremely rare cases, leads to death (less than 1 out of 100,000)

Pain associated with a medical or surgical abortion ranges from mild to severe and depends on each woman's physical and emotional condition.

Some fetal birth defects or medical problems are not commonly diagnosed until the second trimester, when most routine screening tests are done. There are fewer abortion options during the second trimester.

Abortion and breast cancer

Research suggests that the hormonal changes during pregnancy may be protective and reduce the risk of breast cancer. In the past, there has been concern that an abortion might interrupt these protective hormonal changes and possibly increase the risk of breast cancer. But more recent, carefully done studies have led experts to conclude that there is no link between having an abortion and breast cancer. 4

Before, During, and After an Abortion: When to Call a Doctor

If you think you may be pregnant, see a doctor for a pregnancy test, examination, and pregnancy counseling as soon as possible. If you are considering ending the pregnancy, this is an important time for learning as much as you can about your options. The earlier you take measures to end a pregnancy, the more medical choices you are likely to have and the less your risk of complications will be.

Who to see

Surgical abortions are minor surgeries that require a health professional with specialized training. If a medical abortion is not successful, a surgical abortion must be done as follow-up. This is necessary to prevent infection and blood loss and to end the pregnancy, because medical abortion medicines cause birth defects. The following health professionals can perform abortions:

Some health professionals offer medical abortion only and recommend another health professional if a vacuum aspiration becomes necessary. Other health professionals offer medical abortion and manual vacuum extraction (MVA) if needed. MVA is a simple and effective procedure. Fewer health professionals offer medical, MVA, and surgical abortion services.

Your health professional will give you information about what to expect after an abortion. Normal symptoms that most women experience include:

  • Irregular bleeding or spotting for as long as the first 3 weeks.
  • Cramping for the first 2 weeks. Some women have cramping (like menstrual cramps) for as long as 6 weeks.
  • Emotional reactions for 2 to 3 weeks.

The hospital or surgery center may send you instructions on how to get ready for your surgery. Or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You will probably stay in the recovery area for a period of time and then you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

Signs of complications

Less than 1 out of 100 women who have an abortion have serious problems afterward. 2

Call your doctor immediately if you have any of these symptoms after an abortion:

  • Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
    • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
    • Soaking more than 2 large pads in an hour, for 2 hours in a row.
    • Bleeding heavily for 12 hours in a row.
  • Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
  • Severe pain in the belly that is not relieved by pain medicine, rest, or heat
  • Hot flushes or a fever of 100.4 °F (38 °C) or higher that lasts longer than 4 hours
  • Vomiting lasting more than 4 to 6 hours
  • Sudden belly swelling or rapid heart rate
  • Vaginal discharge that has increased in amount or smells bad
  • Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:

  • Bleeding (not spotting) for longer than 2 weeks
  • New, unexplained symptoms that may be caused by medicines used in your treatment
  • No menstrual period within 6 weeks after the procedure
  • Signs and symptoms of depression . Hormonal changes after a pregnancy can cause depression that requires treatment.

Your ability to become pregnant in the future

Medical abortion and vacuum aspiration do not affect your ability to become pregnant in the future. 1 It is possible to become pregnant in the weeks right after an abortion procedure.

  • Avoid sexual intercourse until your body has fully recovered, for at least 1 to 3 weeks.
  • To prevent infection and pregnancy, it is important to use condoms as directed by your doctor when you start to have intercourse again. This is a good time to also start a highly effective birth control method that fits your lifestyle. For more information, see the topic Birth Control.

Other Places To Get Help

Organizations

American Congress of Obstetricians and Gynecologists (ACOG)
Web Address: www.acog.org

Planned Parenthood Federation of America
Web Address: www.plannedparenthood.org

Related Information

References

Citations

  1. Holmquist S, Gilliam M (2008). Induced abortion. In RS Gibbs et al., eds., Danforth's Obstetrics and Gynecology, 10th ed., pp. 586–603. Philadelphia: Lippincott Williams and Wilkins.
  2. Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online: http://www.guttmacher.org/pubs/fb_induced_abortion.html.
  3. American College of Obstetricians and Gynecologists (2005, reaffirmed 2011). Medical management of abortion. ACOG Practice Bulletin No. 67. Obstetrics and Gynecology, 106(4): 871–882.
  4. American College of Obstetricians and Gynecologists (2009, reaffirmed 2011). Induced abortion and breast cancer risk. ACOG Committee Opinion No. 434. Obstetrics and Gynecology, 113(6): 1417–1418.

Other Works Consulted

  • Centers for Disease Control and Prevention (2011). Abortion surveillance—United States, 2008. MMWR, 60(SS-15): 1–41. Available online: http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6015a1.htm?s_cid=ss6015a1_w.

Credits

By Healthwise Staff
Sarah Marshall, MD - Family Medicine
Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology
Kirtly Jones, MD - Obstetrics and Gynecology
Last Revised August 5, 2013

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