ConditionWomen's & pregnancy health
Induced Abortion
An induced abortion is the deliberate ending of a pregnancy using medicines (medication abortion) or a procedure (aspiration or dilation and evacuation). When done with recommended methods, it is one of the safest procedures in medicine, with serious complications in well under 1 in 100 cases. Cramping and bleeding are expected afterward. Heavy bleeding, fever or severe pain need prompt care. Laws on access vary widely by state and country, but follow-up medical care for complications is available everywhere.
Also called: Pregnancy termination, therapeutic abortion, elective abortion, medication abortion, surgical abortion
At a glance
- What it is
- Ending a pregnancy with medicines or a procedure.
- Methods
- Medication abortion (usually up to 10 to 12 weeks) and procedural abortion (aspiration or D&E).
- Effectiveness
- Medication abortion works in about 95 to 98 in 100. Procedural abortion in over 99 in 100.
- Expected afterward
- Cramping and bleeding, often heavier than a period for medication abortion.
- Warning signs
- Very heavy bleeding, fever lasting over 24 hours, severe pain, foul-smelling discharge.
When to get help
Call 911 or go to the ER
- Soaking through 2 or more thick pads an hour for 2 hours in a row, or feeling dizzy, faint or short of breath
- Severe abdominal pain, especially on one side, with no or light bleeding after taking abortion medicines (possible ectopic pregnancy)
- Fainting, confusion, or a fast heart rate with fever
See a doctor within a day or two
- Fever of 38 °C (100.4 °F) or higher lasting more than 24 hours after taking misoprostol, or any fever starting days later
- Foul-smelling vaginal discharge or worsening pelvic pain in the days after
- No bleeding within 24 hours of taking misoprostol
- Pregnancy symptoms continuing after 1 week, or bleeding that continues heavily beyond 2 weeks
Book a routine appointment
- Follow-up to confirm the pregnancy has ended (a home urine test about 4 weeks later, a blood test or an ultrasound)
- Choosing contraception
- Emotional support if needed
Methods of induced abortion
| Medication abortion | Aspiration (procedural) | Dilation and evacuation (D&E) | |
|---|---|---|---|
| Timing | Usually up to 10 weeks in the US label, up to 12 weeks in WHO guidance | Usually up to about 14 to 16 weeks | Usually from about 14 weeks |
| How it works | Mifepristone blocks progesterone, then misoprostol causes the uterus to contract and empty | Gentle suction removes the pregnancy through the cervix | Cervix is softened and opened, then instruments and suction are used |
| Where | At home after a clinic or telehealth visit, depending on local law | Clinic, takes about 5 to 10 minutes | Clinic or hospital |
| Anesthesia | None | Local numbing, with optional sedation | Local and sedation or general |
| Bleeding | Heavy for several hours, then lighter for 1 to 2 weeks | Light to moderate for a few days | Light to moderate |
| Success | About 95 to 98 in 100 | Over 99 in 100 | Over 99 in 100 |
Later in pregnancy, an induction of labor with medicines may be used in a hospital.
Before an abortion
- Confirming pregnancy and gestational age: by the date of the last period, an exam or an ultrasound.
- Checking for ectopic pregnancy if there are risk factors or symptoms.
- Blood type: some people who are Rh-negative may be offered Rh immune globulin, particularly later in pregnancy. Recent guidance allows it to be omitted before 12 weeks.
- Discussing options and contraception, and ensuring the decision is your own.
- Testing for sexually transmitted infections in some settings.
What to expect after an abortion
Medication abortion
- strong cramping and heavy bleeding with clots, usually starting 1 to 4 hours after misoprostol and peaking over the next several hours
- passing the pregnancy tissue
- temporary side effects of misoprostol: nausea, vomiting, diarrhea, chills and a low fever on the day it is taken
- bleeding or spotting that can continue on and off for up to 2 to 4 weeks
Procedural abortion
- cramping during and for a short time after the procedure
- light bleeding or spotting for up to 2 weeks
- most people return to normal activities the next day
Self-care
- ibuprofen is effective for cramping. Follow the label dose. Acetaminophen (paracetamol) can also help
- a heating pad on the lower belly
- use pads rather than tampons if advised, so you can monitor bleeding
- rest as needed
- your next period usually returns in 4 to 8 weeks
- ovulation can return within 2 weeks, so contraception should start right away if you want to avoid pregnancy
Possible complications
Serious complications are rare. Possible problems include:
- Incomplete abortion or retained tissue: ongoing heavy bleeding or pain, treated with more medicine or an aspiration
- Ongoing pregnancy: more common after medication abortion, treated with a repeat dose or aspiration
- Heavy bleeding needing treatment, rarely a transfusion
- Infection of the uterus (septic abortion): fever, pelvic pain and foul-smelling discharge, treated with antibiotics
- Injury to the cervix or uterus: rare with procedural abortion
- Missed ectopic pregnancy: abortion medicines do not treat a pregnancy outside the uterus
Unsafe abortion, performed by untrained people or with harmful methods, is a major cause of maternal death worldwide. Seek medical care promptly for any complication; treatment of complications is standard medical care.
Recovery and emotional wellbeing
Most people recover physically within days. Feelings afterward vary: relief is the most common emotion, and some people also feel sadness or grief. Large studies and major medical organizations have found that having an abortion does not increase the risk of depression or other mental health disorders. Support from a counselor, trusted person or helpline can be useful for anyone who wants it.
Future fertility and pregnancy
An uncomplicated abortion does not affect future fertility or the health of future pregnancies. Repeated procedural abortions carry a very small risk of scarring inside the uterus.
Frequently asked questions
How does a medication abortion work?
It uses two medicines. Mifepristone blocks progesterone, a hormone the pregnancy needs. Misoprostol, taken 1 to 2 days later, makes the uterus contract and empty, causing cramping and heavy bleeding similar to an early miscarriage.
How much bleeding is normal after an abortion?
After a medication abortion, bleeding is often heavier than a period, with clots, for several hours. It then becomes lighter and can continue on and off for 2 to 4 weeks. Soaking 2 or more thick pads an hour for 2 hours in a row is too much and needs urgent care.
Is induced abortion safe?
Yes, when performed with recommended methods by trained providers, abortion is very safe. Serious complications occur in well under 1 in 100 cases, and the risk of death is lower than that of continuing a pregnancy to birth.
Does abortion affect future fertility?
An uncomplicated abortion does not affect your ability to get pregnant or have a healthy pregnancy later. Fertility returns quickly, often within 2 weeks, so start contraception right away if you do not want to become pregnant.
What are the warning signs after an abortion?
Get care for very heavy bleeding, fever lasting over 24 hours or starting days later, severe or worsening pain, foul-smelling discharge, no bleeding after misoprostol, or continuing pregnancy symptoms after a week.
Sources
This guide was written from current patient and clinical guidance, including:
- American College of Obstetricians and Gynecologists (ACOG): Induced abortion FAQ; Medication abortion up to 70 days of gestation
- World Health Organization: Abortion care guideline (2022)
- National Academies of Sciences, Engineering, and Medicine: The safety and quality of abortion care in the United States
- Society of Family Planning: Clinical recommendations
- MedlinePlus (US National Library of Medicine): Abortion, medical; Abortion, procedural