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
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.
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.
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
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
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.
Abortions done by doctors
are very safe. Less than 1 out of 100 women have a serious problem from an
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.
The most widely used methods for abortion do not prevent a woman from becoming
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.
Learning about 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:
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 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
A physical exam before an abortion includes:
Laboratory tests before an abortion
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.
Medical abortion is the use
of medicines to end a pregnancy. Medical abortion can be done up to about 9 weeks of pregnancy.
Medicines currently available in the United States for
inducing abortion are:
See the What to Think About section of this topic for a
comparison of medical abortion and 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.
A D&E is most commonly used during the second
trimester because it has a lower complication risk than induction
See the What to Think About section of this topic for
a comparison between medical abortion and surgical 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
Usually prevents a need for surgical treatment
Is invasive and/or surgical:
Can only be used during early pregnancy (up to about 9
Can be used from early to mid-pregnancy:
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
Does not require anesthesia or sedative
Does not require
general anesthesia (though it can be used).
Local anesthesia, with or without a calming sedative,
Has a high success rate (about 95%)
Has a high success rate (about 99%)
Causes moderate to heavy bleeding for a short
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
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
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
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
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.
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:
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.
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:
Call your doctor for an appointment if you have had any of these symptoms after a recent
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.
American Congress of Obstetricians and Gynecologists
(ACOG) is a nonprofit organization of professionals who provide health care for
women, including teens. The ACOG Resource Center publishes manuals and patient
education materials. The Web publications section of the site has patient
education pamphlets on many women's health topics, including reproductive
health, breast-feeding, violence, and quitting smoking.
The National Abortion Federation offers a toll-free
hotline that provides referrals for abortion services in the United States and
The Planned Parenthood Federation of American provides
comprehensive reproductive health care and consumer information about family
planning, sexual health, and sexually transmitted diseases (STDs).
The Teen Talk Web site (www.plannedparenthood.org/teen-talk) has information for teens about dating, teen pregnancy, sexual orientation, gender identity, how teens can protect themselves against STDs, and more.
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.
Guttmacher Institute (2011). In Brief: Facts on Induced Abortion in the United States. Available online:
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.
American College of Obstetricians and Gynecologists
(2009, reaffirmed 2011). Induced abortion and breast cancer risk. ACOG
Committee Opinion No. 434. Obstetrics and Gynecology,
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.
August 31, 2012
Sarah Marshall, MD - Family Medicine
& Rebecca H. Allen, MD, MPH - Obstetrics and Gynecology
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