Abortions are performed using one of two main approaches: medication or a surgical procedure. The method used depends primarily on how far along the pregnancy is. Both are very safe, with major complication rates below 1%.
Before the Procedure
Before any abortion, a clinic visit typically includes a blood test to check for anemia and determine your blood type, screening for sexually transmitted infections, and a pregnancy confirmation through blood or urine testing. An ultrasound is sometimes used in the first trimester and is standard for second-trimester abortions. These steps help confirm how far along the pregnancy is, rule out an ectopic pregnancy (where the embryo implants outside the uterus), and identify any health factors that could affect the procedure.
Medication Abortion (Up to 10 Weeks)
Medication abortion uses two pills taken one to two days apart. It’s available up to 10 weeks of gestation and is the most common method for early pregnancies. When used at or before 9 weeks, it successfully ends the pregnancy 99.6% of the time.
The first pill blocks the hormone progesterone, which the uterus needs to maintain a pregnancy. Without it, the uterine lining breaks down. You take this pill as a single tablet at a clinic or at home.
Between 24 and 48 hours later, you take the second medication: four small tablets placed two in each cheek, where they dissolve over 30 minutes. Any remaining pieces are swallowed with water. This second medication causes the uterus to contract and expel the pregnancy tissue. Most people experience heavy bleeding and strong cramping, similar to a heavy period or early miscarriage. Nausea, vomiting, diarrhea, and a temporary fever can also occur.
The process typically takes several hours after the second set of pills, though the timeline varies. A follow-up appointment or at-home pregnancy test confirms the abortion is complete.
Aspiration (First Trimester)
Aspiration, sometimes called vacuum aspiration or suction abortion, is the most common surgical method during the first trimester. The entire procedure usually happens in a single clinic visit and takes about 5 to 10 minutes for the procedure itself, though you’ll be at the clinic longer for preparation and recovery.
The cervix is first numbed with a local anesthetic. A thin tube is then inserted through the cervix into the uterus, and gentle suction removes the pregnancy tissue. Some providers also use a small instrument to ensure the uterus is fully emptied.
For pain management, clinics offer a range of options beyond the local anesthetic. These include oral pain relievers, moderate sedation through an IV (which keeps you awake but relaxed and less aware of discomfort), deep sedation, or general anesthesia. The combination of an IV pain reliever and a sedative is effective at reducing pain during the procedure. What’s available depends on the clinic, and you can typically discuss your preference beforehand.
Dilation and Evacuation (Second Trimester)
Dilation and evacuation, or D&E, is used for abortions in the second trimester, generally from around 14 weeks onward. It requires more preparation than a first-trimester aspiration because the cervix needs to open wider.
Cervical preparation begins hours or sometimes a day before the procedure. This involves placing small dilators inside the cervix that gradually absorb moisture and expand, along with medications that soften the cervical tissue. By the time of the procedure, the cervix has opened enough for the instruments to pass through safely.
During the procedure itself, the provider uses a combination of suction, specialized instruments, and a curette (a small scraping tool) to remove the pregnancy tissue from the uterus. Sedation or general anesthesia is more commonly offered for D&E than for first-trimester procedures, given the longer duration and greater cervical dilation involved.
After the procedure, the provider examines the removed tissue to confirm the abortion is complete. If there’s any concern that tissue remains in the uterus, further evaluation with ultrasound or blood tests can check for retained tissue, which would need to be addressed to prevent infection.
Recovery After Any Abortion
Bleeding is normal after both medication and surgical abortions. It typically continues for up to two weeks and feels similar to a period, though it’s often heavier in the first few days. Cramping usually lasts two to three days and gradually eases. Many people return to normal activities within a day or two after a surgical procedure, or within a few days after a medication abortion.
Signs that something needs medical attention include bleeding that’s much heavier than a heavy period, a fever that doesn’t resolve, worsening abdominal pain (rather than improving), or discharge with a foul smell. These can indicate an infection or retained tissue, both of which are treatable but shouldn’t be ignored.
How Safe Are These Procedures
Abortion is one of the safest procedures in medicine. Medication abortion carries a 0.4% risk of major complications and a mortality rate below 0.001%. Surgical abortion through aspiration has a major complication rate under 1%. For context, carrying a pregnancy to term carries significantly higher rates of medical complications than either abortion method. The risk of complications does increase with gestational age, which is one reason earlier abortions tend to be simpler and involve fewer steps.