The Abortion Procedure: Medical and Surgical Methods

Wondering how abortion is done? Learn about the difference between medication abortions and surgical abortions, and figure out how to decide between the two procedures.

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You can undergo two types of abortions: medication and surgical. Medication abortions involve taking two pills (mifeprex or mifepristone and misoprostol) that make the body unable to support a pregnancy. On the other hand, in-clinic surgical abortions remove the fetus from the uterus with instruments and suction. Here's what you need to know about the different abortion methods if you're considering pregnancy termination.

Medication Abortion Procedure (Abortion Pills)

"Patients can get a medication abortion within the first 10 weeks of pregnancy," says Rebecca Taub, M.D., a fellow with Physicians for Reproductive Health and an OB-GYN in Washington. "We use the term 'medication abortion' to clarify that this is a type of abortion done with medication, rather than a surgical procedure."

So, how is an abortion performed medically? Here's an overview of the process:

  • Your doctor conducts a health evaluation and ensures the pregnancy isn't ectopic (growing outside of the womb).
  • You'll take 200 mg of mifeprex (mifepristone) by mouth. Mifeprex interrupts the pregnancy hormone progesterone, provoking the lining of the uterus to thin and shed.
  • Sometime within the next 72 hours, you'll take 800 mcg of misoprostol buccally (in the cheek). "This medication causes the uterus to cramp and empty," says Dr. Taub.
  • Your clinic or healthcare provider will conduct a follow-up exam about two weeks later. They'll make sure the pills worked properly, since an incomplete abortion may lead to infection.

Some people claim medication abortions feel similar to an early miscarriage. As the pregnancy expels from the body, you'll experience heavy bleeding with large clots and cramping. Other side effects include nausea, diarrhea, mild fever, and fatigue. Most symptoms resolve within a few hours or days, although you probably won't be able to have sex or use a tampon for a couple of weeks. Rare but serious complications can include an allergic reaction, very heavy bleeding, or blood clots in the uterus.

"Medication abortion is about 95% effective," assures Dr. Taub. "When it's not effective and you have an incomplete abortion, people may need another dose of misoprostol, or they may need an additional safe procedure (like vacuum aspiration) to remove the remaining contents of the uterus."

Dr. Taub recommends avoiding a medication abortion if you have anemia, bleeding conditions, other severe medical conditions, or are allergic to either medication. Having a medication abortion won't affect your ability to conceive in the future.

In-Clinic Surgical Abortion Procedure

The other abortion procedures are in-clinic surgeries—usually either vacuum aspiration or dilation and evacuation (D&E abortion). The best method depends on the duration of your pregnancy.

Vacuum Aspiration (Suction Abortion): As the most common type of surgically induced abortion, vacuum aspiration uses gentle suction to remove the fetus from the uterus. A patient can undergo vacuum aspiration throughout the first trimester, says Dr. Taub, and it can be done in the early second trimester as well. The entire abortion procedure should take less than five minutes. Depending on your insurance plan and region, vacuum aspiration can cost around $600 to $1,000.

Dilation and Evacuation (D&E Abortion): During this abortion procedure, doctors remove the fetus with suction and tools (specifically forceps, a suction tube, and a curette used for scraping). "The cervix is dilated just enough to protect it and safely remove the pregnancy under ultrasound guidance," explains Dr. Taub. A D&E can be performed during the first 16 weeks of pregnancy, and the procedure usually takes seven-15 minutes. You'll be put under mild anesthesia. Depending on your insurance plan and region, dilation and evacuation can cost $1,500 or more.

Given how abortion is done, these surgical procedures must be conducted in a healthcare center or clinic. The surgeries are minimally invasive since they "involve no incisions and minimal anesthesia," says Dr. Taub. "Women can also think about what kind of birth control they would like, as some methods (such as IUDs) can be easily placed at the time of the abortion."

Recovering from surgical abortion shouldn't be too difficult. "Cramping after an abortion procedure is minimal to moderate," says Dr. Taub. You might also have bleeding that "can start like a period, then lightens to spotting before resolving." Many people are able to return to work the next day, although some might want a few days to rest. You'll likely need to avoid sex for a while after the abortion procedure, and your period should return within four-eight weeks.

Surgical abortions have higher success rates than medical abortions—in fact, Planned Parenthood claims they're more than 99% effective. "Requiring additional treatment for an incomplete abortion afterward, such as a repeat procedure or additional medications, is very rare," says Dr. Taub. Surgical abortions also won't affect your future pregnancies or fertility.

How to Choose an Abortion Procedure

Medication abortions are mainly used in the first trimester, and they have the advantage of being done at home. Surgical abortions allow a person to end their pregnancies later, but they're more invasive (although some people prefer being surrounded by certified professionals during their abortion).

Every person's situation is different, and their needs are unique. Talk to your doctor for more information regarding possible emotional side effects—and don't be afraid to reach out to a mental health professional if needed.

Also, keep in mind that every state and health care practice has different policies regarding abortions, and those laws and policies can change quickly. Contact your local Planned Parenthood for more information, and visit websites like the Safe Place Project to find abortion clinics near you.

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