The Different Types of Abortion Care
There is a lot of misinformation about how abortion is done. Learn about the types of abortion care and the difference between medication abortion and procedural abortion.
Medically reviewed by Alyssa Dweck, MS, MD, FACOG
There are two main types of abortion care: medical and procedural. Medical or medication abortion typically involves taking two medications (mifepristone and misoprostol) that first stop the development of the pregnancy and then cause the uterus to empty. Abortion procedures remove the embryo or fetus from the uterus with medical instruments and suction. Here's what you need to know about the different abortion methods.
Medication Abortion ("Abortion Pills")
"Patients can get a medication abortion within the first 10 weeks of pregnancy," says Rebecca Taub, MD, 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."
The medications used for medication abortion are available only by prescription and together are FDA-approved for ending pregnancy.
So, how is a medication abortion performed? Here's an overview of the process:
The first medication you will take is mifepristone. Mifepristone is taken orally and blocks the hormone progesterone, which stops the development of the pregnancy.
Sometime within the next 72 hours, you'll take the second medication, misoprostol. Misoprostol can be taken buccally (in the cheek), sublingually (under the tongue), vaginally, or orally. "This medication causes the uterus to cramp and empty," says Dr. Taub.
Under ideal circumstances, medication abortion is done under the care of a health care provider who can conduct a health evaluation, confirm dating, and ensure the pregnancy isn't ectopic (growing outside of the womb) before prescribing the abortion medication. In most cases, health care providers will also want to conduct a follow-up exam about two weeks later to ensure the medications were effective as an incomplete abortion can lead to complications like infection.
With the changing laws around abortion care across the country, however, not everyone has access to in-person care, and some may seek abortion medication online.
Some people claim medication abortions feel similar to an early miscarriage. As the uterine lining and products of conception leave your body, you'll experience heavy vaginal 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 may be advised to avoid penetrative sex and tampons 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.
Related: How Medication Abortions Work
In-Clinic Abortion Procedures
The other methods of abortion are in-clinic procedures—usually either vacuum aspiration (suction abortion) or dilation and evacuation (D&E abortion). The procedure the health care provider will perform depends on how far along you are in the pregnancy.
Vacuum aspiration
Vacuum aspiration is the most common in-clinic abortion procedure. The procedure uses gentle suction to remove the embryo or fetus from the uterus. A patient can undergo vacuum aspiration throughout the first trimester, says Dr. Taub, and it can also be done in the early second trimester. The entire 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)
During a D&E abortion, the health care provider removes 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 to 15 minutes. You'll be put under mild anesthesia. Depending on your insurance plan and region, a D&E can cost $1,500 or more.
Unlike medication abortion, abortion procedures must be conducted in a health care center or clinic. The procedures are minimally invasive since they "involve no incisions and minimal anesthesia," says Dr. Taub.
Related: Types of Abortion at Different Points in Pregnancy
"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," she adds.
Many people can return to work the next day, although some might want a few days to rest. You'll likely need to avoid penetrative sex for a few weeks after the abortion procedure, and your period should return within four to eight weeks.
Procedural abortions have higher success rates than medical abortions. According to Planned Parenthood, 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 any future pregnancies or fertility.
Related: There's No Such Thing as 'Late-Term Abortion'—Here Are the Facts
How to Choose an Abortion Procedure
Medication abortions are mainly used in the first trimester and are completed at home. Procedural abortions are available later in pregnancy, but they're more invasive (although some people prefer being surrounded by medical professionals during their abortion).
Every person's situation is different, and their needs are unique. A trained health care provider can help you determine what kind of abortion is best for you. Trained confidential counselors like those available at Exhale Pro-Voice can provide emotional support before and after abortion.
Every state and health care practice has different laws and policies regarding abortion care, and those laws and policies can change quickly. Contact your local Planned Parenthood for more information.
Related: Helpful Resources for Finding Abortion Care in Your State
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