Abortion

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. Depending on the medicine used, a medical abortion can be done up to about 10 weeks of pregnancy.

• A typical treatment schedule for a medical abortion may require two visits to your doctor. At the first visit, your doctor will give you one medicine to take during the visit or at home. You will take the second medicine 24 hours after the first medicine.
• Bleeding and cramping starts within a few hours after you have taken the second medicine. Cramps may be strong. You can take ibuprofen (also called Aleve or Motrin) to help with pain. Bleeding will be heavier than a regular period and will have some clots until the pregnancy has passed. Vaginal bleeding may last about 14 days.
• You will see your doctor, or go to a lab for a test, 7 to 14 days after taking the medicine. This is to see if you are recovering well and to make sure the medicines 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:

• 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.
• 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.

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)

• Manual vacuum aspiration (MVA) or machine vacuum aspiration uses suction through a small tube to empty the uterus of all tissue.

Surgical method in the second trimester

• Dilation and evacuation (D&E) is typically done when an abortion occurs in the second 12 weeks (second trimester) of pregnancy. It usually includes a combination of vacuum aspiration, dilation and curettage (D&C), and the use of surgical instruments (such as forceps) to clear the uterus of fetal and placental tissue.

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^{footnote 2}

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 10 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 7 to 14 days	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.^{footnote 3}

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:

• Gynecologist
• Family medicine doctor who has special training
• Certified nurse-midwife
• Nurse-practitioner who has special training
• Physician assistant who has special training

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 aspiration (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.^{footnote 4}

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.^{footnote 5} It is possible to become pregnant in the weeks right after an abortion procedure.

• Ask your doctor when it's okay to have sexual intercourse.
• 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.