How to Terminate an Early Pregnancy: What to Expect

Early pregnancy termination in the first trimester is accomplished through one of two well-established methods: medication abortion, which uses pills to end and expel the pregnancy, or procedural (surgical) abortion, which uses gentle suction to empty the uterus. Both are safe and highly effective, with success rates above 95% and serious complication rates well below 1%. What you actually experience, though, differs meaningfully depending on which method you choose, and the physical reality of either option is worth understanding before you walk in the door.

Medication Abortion and How It Works

The standard medication abortion regimen involves two drugs taken in sequence. The first, mifepristone, blocks the hormone progesterone that a pregnancy needs to continue. Mifepristone was first identified as a progesterone antagonist capable of interrupting early pregnancy without major side effects, and it has been in clinical use for decades.¹ The second drug, misoprostol, is taken 24 to 48 hours later and causes the uterus to contract and expel the pregnancy tissue.

The most commonly used evidence-based regimen is 200 mg of mifepristone taken orally, followed by 800 mcg of misoprostol placed buccally (between the cheek and gum) or vaginally. This combination works for pregnancies up to about 63 days of gestation, with success rates ranging from 95% to 98%.² A large study of buccal misoprostol specifically found a 98.3% success rate through 59 days of gestation.³ Ongoing pregnancy, meaning the medications fail entirely and the pregnancy continues, happens in roughly 1% of cases.

Later in the first trimester, medication abortion still works but becomes somewhat less reliable. A systematic review comparing medical and surgical abortion in the late first trimester found complete abortion rates of about 95% for medication regimens versus about 98% for surgical ones. The combined mifepristone-plus-misoprostol regimen performed significantly better than misoprostol alone in that later window.⁴

What Medication Abortion Feels Like

After you take mifepristone, you likely won’t feel much. The real action starts with misoprostol. Within a few hours of placing the misoprostol tablets, you’ll experience cramping and bleeding as the uterus contracts and empties. The cramping can be intense, sometimes significantly worse than a typical period. Bleeding will be heavy, often with clots, and is a normal part of the process as the pregnancy tissue passes.

A 2025 study of over 500 people undergoing first-trimester abortion found that those who had medication abortions were roughly four to five times more likely to report severe pain and about nine times more likely to report heavy bleeding compared to those who had procedural abortions.⁵ About a quarter of all participants reported severe pain, and about a third reported heavy bleeding. A history of severe menstrual cramps was also linked to more pain during the process. These numbers aren’t meant to alarm you. They mean you should plan for meaningful discomfort and have pain relief on hand, ideally ibuprofen or another anti-inflammatory, plus a heating pad and a comfortable place to rest for several hours.

Common side effects from misoprostol beyond cramping include nausea, temporary fever or chills, and diarrhea. In one large study of medication abortion, about half of participants experienced nausea, over a third had fever, and roughly a quarter had diarrhea.⁶ These side effects are temporary and usually resolve within hours of taking the misoprostol. The heaviest bleeding and most intense cramping typically happen when the pregnancy is passing, which for most people occurs within 12 to 24 hours of taking misoprostol. Lighter bleeding can continue for a week or two afterward.

Procedural Abortion and How It Works

Procedural abortion in the first trimester involves dilating the cervix (sometimes with medication to soften it beforehand) and then using suction to remove the pregnancy tissue from the uterus. The two main suction tools are manual vacuum aspirators, which are handheld syringe-like devices, and electric vacuum aspirators.⁷ Cervical preparation before the procedure can reduce the chance of cervical or uterine injury.⁸

The procedure itself is fast, typically five to ten minutes. Pain management usually involves a local anesthetic injected into the cervix, often with buffered lidocaine, combined with a pre-procedure anti-inflammatory like ibuprofen. Emotional support from a dedicated person in the room and distraction techniques also help. Oral opioids don’t actually decrease the procedural pain, and oral anti-anxiety medications reduce anxiety but not pain itself.⁹ Some clinics offer moderate sedation or general anesthesia, though these carry their own risks and aren’t necessary for most first-trimester procedures.

What you feel during a procedural abortion is cramping, sometimes sharp, primarily during the suctioning. Most people describe it as brief but intense. After the procedure, cramping is usually milder than with medication abortion, and bleeding is lighter. You’ll rest at the clinic for a short observation period and then go home the same day.

Choosing Between the Two Methods

The choice between medication and procedural abortion often comes down to personal priorities and circumstances. Medication abortion lets you go through the process at home, on your own schedule, which many people prefer for privacy and a sense of control. The trade-off is more pain, more bleeding, a longer process that unfolds over hours to days, and occasionally a need for a follow-up procedure if the medication doesn’t fully work. Procedural abortion is quicker and more predictable but requires a clinic visit and a brief surgical experience.

Certain medical conditions may tip the decision one way. When mifepristone is contraindicated, surgical abortion is preferred. On the other hand, medication abortion can be the better option for people who can’t be positioned for a pelvic procedure or who have extreme obesity that makes instrumentation difficult.¹⁰ Your clinician can help work through which method fits your situation.

How Safe Is Early Abortion

First-trimester abortion, by either method, is one of the safest procedures in medicine. Mortality from safe abortion is less than 0.2%.¹¹ Serious complications, while real, are rare. A large study of over 6,000 telehealth medication abortions found that 99.8% were not followed by a serious adverse event, and only 0.25% of patients experienced a serious abortion-related complication.¹²

The complications that do occur include heavy bleeding that requires intervention, retained tissue (where some pregnancy tissue remains in the uterus), infection, and, very rarely, uterine perforation during surgical procedures.¹¹ Retained tissue can cause ongoing bleeding, pelvic pain, and discharge. If untreated, it can lead to infection or, in uncommon cases, scarring inside the uterus.¹³ This is one reason follow-up after any abortion matters.

Before any abortion, clinicians screen for ectopic pregnancy, which is a pregnancy implanted outside the uterus, usually in a fallopian tube. An ectopic pregnancy is a medical emergency that cannot be treated by a standard abortion. Screening typically involves ultrasound and sometimes blood tests. In the large telehealth study mentioned above, 0.16% of patients were subsequently treated for an ectopic pregnancy.¹² History-based screening criteria alone, such as checking for prior ectopic pregnancy or tubal surgery, have low sensitivity for catching ectopic pregnancies, which is why imaging or lab work remains standard.¹⁴

Blood Type and Rh Factor

If you have Rh-negative blood (your blood type has a minus sign, like A- or O-), there’s an additional consideration. When an Rh-negative person carries an Rh-positive pregnancy, their immune system can develop antibodies against the Rh factor, which could cause problems in a future pregnancy. An injection of Rh immune globulin (commonly called RhoGAM) prevents this. Professional guidance recommends that, where feasible, Rh testing and immune globulin administration be offered for induced abortion before 12 weeks of gestation.¹⁵ If you don’t know your blood type, your provider can check it as part of your care.

Recovery and Follow-Up

After a procedural abortion, most people feel well enough to return to normal activities within a day or two. After medication abortion, recovery typically takes a bit longer because bleeding and cramping can persist for a week or more. For either method, you’ll want to avoid placing anything in the vagina (tampons, intercourse) for a period your clinician specifies, usually about a week, to reduce infection risk.

After medication abortion, you need some way to confirm the pregnancy has ended. The traditional approach is a clinic follow-up visit about one to two weeks later. A negative urine pregnancy test on day 14 can help confirm a complete abortion; a positive result at that point means you need further evaluation.¹⁶ Low-sensitivity pregnancy tests (sometimes called “multi-level” tests) perform well for this purpose and have been shown to catch all ongoing pregnancies in studied populations.¹⁷

Research has also found that many people can reliably assess their own abortion outcomes using a combination of symptom evaluation and a home pregnancy test, without necessarily needing a clinic visit. In one study, at least two thirds of participants correctly implemented this self-assessment strategy, and no ongoing pregnancies occurred among women who followed the approach as intended.¹⁸ That said, if you have heavy bleeding that soaks through more than two thick pads per hour for two or more hours, a fever lasting more than 24 hours, or worsening pain several days out, those are signs to contact a clinician.

Fertility Returns Quickly

One thing that catches many people off guard is how fast fertility rebounds. Ovulation can resume as early as eight days after an abortion.¹⁹ That means you can become pregnant again almost immediately. If you want to avoid another pregnancy, starting contraception right away matters. Long-acting methods like IUDs and implants are the most effective options and can be safely placed immediately after either type of abortion.²⁰ But any method is better than none, and there’s no medical reason to wait before starting pills, patches, rings, or injections.

Regarding future fertility when you do want to conceive: uncomplicated first-trimester abortion does not harm your ability to get pregnant later. Research has found no association between induced abortion and secondary infertility or ectopic pregnancy, as long as infection doesn’t complicate the abortion. The risk of preterm delivery or low birthweight in a future pregnancy is also not elevated after a vacuum aspiration compared to a first-time pregnancy carried to term.²¹

Telehealth Medication Abortion

Increasingly, medication abortion is available through telehealth, where you consult with a clinician by video or asynchronous messaging, receive the pills by mail, and go through the process at home. This model has expanded access considerably, particularly for people in areas without nearby clinics. The evidence on safety and effectiveness is reassuring. In a study of over 6,000 telehealth medication abortions, 97.7% were complete without any additional intervention, and serious adverse events occurred in only 0.25% of cases. There was no difference in outcomes between synchronous (live video) and asynchronous (messaging-based) care models.¹²

A separate comparison of telehealth versus in-clinic medication abortion in primary care settings found no significant difference in completed abortion rates between the two approaches.²² Telehealth also tended to be faster, meaning less time between the initial consultation and receiving the medications. If you’re considering this route, check whether telehealth abortion is available and legally permitted where you live, as regulations vary.

Misoprostol-Only Regimens

In settings where mifepristone is unavailable, misoprostol can be used on its own. This matters because mifepristone faces regulatory restrictions in some places, and there are situations where access to the two-drug combination is limited. A study of over 600 people using misoprostol alone found a 98.1% complete abortion rate, with serious adverse events in less than 1%.⁶ Most participants bled for a median of four days and expelled the pregnancy within about 12 hours of starting. Side effects were common but temporary: nausea in about half, fever in about a third, and diarrhea in about a quarter.

The misoprostol-only approach does have a somewhat lower success rate than the combination regimen when looking across the full range of studies, particularly later in the first trimester, where the late-first-trimester systematic review found misoprostol alone achieved about 82% complete abortion compared to about 90% with the combination.⁴ Still, researchers have described the updated misoprostol-only regimen as highly effective and a potential strategy for expanding abortion access.²³

Emotional Experience and Mental Health

People’s emotional responses to abortion vary widely. Relief is among the most commonly reported feelings, but sadness, guilt, or ambivalence are also normal and don’t indicate that something went wrong with your decision. A five-year prospective study that followed women who received abortions and women who were denied them found that being denied an abortion was associated with worse initial psychological outcomes compared to having one. Over time, both groups converged in well-being. The researchers concluded that the findings do not support the idea that abortion harms women’s mental health.²⁴

Pre-existing mental health conditions can affect how you experience abortion. The pain study mentioned earlier found that people who screened positive for depression at baseline were about twice as likely to report severe pain during the process.⁵ This doesn’t mean depression is a reason to avoid abortion; it means that if you’re already dealing with depression or anxiety, it’s worth flagging with your provider so your pain management and emotional support plan can be adjusted accordingly. Some clinics offer counseling before and after the procedure, and reaching out to a therapist or support line can help if you find yourself struggling afterward.

1
PubMed. Termination of early pregnancy by a single dose of mifepristone (RU 486), a progesterone antagonist
2
PubMed Central. Uses of Misoprostol in Obstetrics and Gynecology
3
PubMed Central. Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days
4
PubMed Central. Medical abortion in the late first trimester: a systematic review
5
PubMed. Patients’ experiences with pain and bleeding in first-trimester abortion care
6
PubMed Central. Medication Abortion Safety and Effectiveness With Misoprostol Alone
7
Clinical Obstetrics and Gynecology. First-trimester Procedural Abortion
8
PubMed Central. Surgical methods for first trimester termination of pregnancy
9
ScienceDirect / Contraception. Society of Family Planning clinical guidelines pain control in surgical abortion part 1 – local anesthesia and minimal sedation
10
PubMed. First-trimester abortion in women with medical conditions: release date October 2012 SFP guideline #20122
11
PubMed Central. Post-abortion Complications: A Narrative Review for Emergency Clinicians
12
PubMed Central. Effectiveness and safety of telehealth medication abortion in the USA
13
PubMed Central. Retained Products of Conception (RPOC): Diagnosis, Complication & Management
14
PubMed. Incidence of Ectopic Pregnancy and Diagnostic Accuracy of Ectopic Pregnancy Screening Criteria Among People Seeking Versus Not Seeking Abortion: A Retrospective Case-Control Study
15
American Journal of Obstetrics & Gynecology. Society for Maternal-Fetal Medicine Consult Series #69: RhD testing and immune globulin administration in early pregnancy loss and abortion
16
PubMed. At-home urine pregnancy test assessment after mifepristone and misoprostol for undesired pregnancy of unknown location
17
Contraception. Efficacy of a low-sensitivity urine pregnancy test for identifying ongoing pregnancy after medication abortion at 64 to 70 days of gestation
18
PubMed. Self-assessment of medical abortion outcome using symptoms and home pregnancy testing
19
PubMed. Post abortion contraception
20
PubMed. Contraceptive policies affect post-abortion provision of long-acting reversible contraception
21
PubMed. The effect of pregnancy termination on future reproduction
22
PubMed. Telehealth Medication Abortion in Primary Care: A Comparison to Usual in-Clinic Care
23
PubMed. How Effective Is Misoprostol Alone for Medication Abortion?
24
PubMed. Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study