Procedure, recovery, what to expect

A surgical abortion is a medical procedure that terminates a pregnancy. Although the term “surgery” is often used, most abortions are minimally invasive and do not require general anesthesia. Surgical abortions are a good option for people who want their abortion performed in a clinic or hospital.

Medical abortions, which are also an option for most people, mainly take place at home.

Most surgical abortions are completed with a gentle suction technique known as vacuum aspiration. Although you may be in the clinic for a few hours, the procedure itself usually only takes 5 to 10 minutes complete.

Surgical abortion is often a longer option in a pregnancy than medical abortion or the abortion pill. But how far into your pregnancy you can get an abortion depends on your state’s laws and the policies of the clinic or hospital where you go.

Due to recent changes to abortion laws in the United States, it is no longer possible to obtain a surgical abortion in some states. But you still have options: you can have abortion pills mailed to your home. Keep reading to learn more about your options.

It used to be that when you had to terminate a pregnancy in the United States, you had a few options. Since the cancellation of Roe v. Wade in June 2022, pregnant women in many states saw those options disappear. Surgical abortions are no longer available in some states, which means you may have to travel to get one.

Medical and surgical abortions are safe and effective health care procedures. And medical abortion is now a more accessible option for many people.

But there are several reasons why people may choose surgical abortion over medical abortion. These include:

  • Gestational age: If it’s more than 11 weeks since the first day of your last period, medical abortion will no longer be as effective.
  • Procedure time: Surgical abortions are completed after a few hours at the clinic, while medical abortions can take up to 24 hours.
  • Medical staff: Some people prefer to have an abortion under the supervision of doctors and nurses, rather than at home.
  • Confirmation: After a surgical abortion, your doctor examines your uterus to make sure the procedure is complete.
  • Medical background: People with certain health conditions, such as bleeding disorders, may feel safer in a hospital.

How they are different

During a surgical abortion, doctors use gentle suction to remove the contents of the uterus. These procedures are very safe and effective more than 99 percent time. In the rare case that the procedure fails, it can be repeated.

A medical abortion involves taking a combination of drugs (mifepristone and misoprostol) that help end the pregnancy and expel the contents of your uterus.

The abortion pill is effective 94 to 96 percent time in people who have been pregnant for 9 weeks or less. It becomes slightly less effective in the following weeks. However, the dose can be adjusted if necessary.

If a medical abortion fails, it can be completed surgically.

On the day of your procedure, you can expect to be in the hospital or clinic for 3 to 4 hours. Although the procedure itself is quick, you will need to read and sign documents, prepare for the procedure, and spend time in the recovery room.

The preparation

Before your procedure begins, a doctor or nurse may give you medicine to relieve cramping. They may also give you medicine to help open your cervix, the passage between your vagina and your uterus.

Sometimes doctors insert small dilators into the cervix a few hours before your procedure, or even the day before. These dilators absorb fluids from your body. As they slowly enlarge, they stretch your cervix.

Before your procedure begins, you will usually be offered light sedation. Depending on the type of sedation the doctor uses, you may feel drowsy and calm but stay awake or fall asleep completely.

The procedure

An intrauterine aspiration, which is the most common type of abortion, takes about 5 to 10 minutes.

During your procedure, the doctor and nurses:

  1. examine your uterus
  2. insert a speculum into your vagina
  3. stabilize and inject numbing medication into your cervix
  4. insert dilators to open your cervix
  5. insert a tube through the cervix, into the uterus
  6. using gentle suction to remove pregnancy tissue from the uterus

Many people will experience cramping during the procedure, but the cramping usually lessens after the tube is removed from the uterus.

Immediately after your procedure, your doctor may check your uterus to make sure it is completely empty. You will then be transferred to a recovery area to rest.

If more than 16 weeks have passed since your last period, your doctor may perform a modified procedure called dilation and evacuation (D&E). These procedures usually involve stronger suction and additional surgical tools that help your doctor remove pregnancy tissue from your uterus.

The cost of surgical abortions varies depending on several factors. According Planned parenthood, a surgical abortion can cost up to $750, but it often costs less. Factors that can affect the cost include:

  • the state you live in
  • the facility where you receive care
  • whether you can use health insurance
  • whether your insurance plan covers abortion
  • the type of abortion you are getting and the week of pregnancy

Other things to consider include the cost of logistics like travel, childcare, and time off.

Cost shouldn’t stop you from choosing to end a pregnancy. If you are worried about the cost, you can contact the Planned parenthood near you for financial assistance information.

Before your abortion, you will meet with a healthcare professional who will explain the procedure to you and tell you what to expect on the day of your appointment. They can give you instructions on how to prepare for your procedure. It is important that you follow these instructions carefully.

Some things you can do to prepare for your surgical abortion include:

  • arrange for someone to drive you home after the procedure
  • take your pain or dilation medications as directed
  • avoid eating or drinking the morning of the procedure, if instructed to do so
  • follow your doctor’s instructions about when to take (or stop taking) your usual medications, including over-the-counter (OTC) pain relievers like aspirin and ibuprofen (Advil, Motrin)
  • avoid alcohol the day before your procedure
  • buy menstrual pads for post-op bleeding (doctors often recommend pads, but you can use whatever is most comfortable for you)
  • stock up on over-the-counter pain relievers to help treat cramps
  • getting a heating pad or hot water bottle to help relieve cramps

It is important to take it easy on the day of your abortion. Some people are able to return to their usual activities (except heavy lifting) the next day, but others may need more time. You may feel like you have bad menstrual cramps for a few days.

Many people experience bleeding and cramping after an abortion, but others do not. You may have heavier bleeding (like periods), including blood clots or just spotting. Some people continue to have spotting for several weeks.

However, if you have very heavy bleeding – bleeding that goes through two sanitary pads per hour, for 2 hours straight – call your doctor or the clinic where you had your abortion.

Your doctor will give you information on what to expect in the days following your procedure. This will include information about any medications you may need to take.

Your doctor may recommend an over-the-counter pain reliever to ease the cramps. They may also prescribe antibiotics to help prevent infection.

Keep taking your antibiotics until you run out of the vial. It is important, even if you feel well.

Depending on your situation, some doctors will recommend a follow-up appointment a few weeks after your procedure.

Sex and your period

Your period should return about 4 to 8 weeks after your abortion.

Because there is a low risk of infection after a surgical abortion, doctors have different philosophies about when it is okay to resume sexual activity.

Some doctors and clinics advise waiting 2 weeks before inserting anything into your vagina, including tampons. Other doctors say you can have sex whenever you feel ready and use tampons to control post-abortion bleeding, if that’s your preference. Be sure to discuss these details with your doctor.

You can get pregnant right after your abortion, so start using some form of birth control right away. Many doctors are willing to place an IUD in your uterus during your procedure, so you may want to take advantage of this opportunity.

Surgical abortions are very safe procedures. Complications are rare. However, all surgeries carry some level of risk.

Possible complications of surgical abortions include:

  • infection
  • cervical tears or lacerations
  • uterine perforation
  • bleeding
  • retained pregnancy tissue
  • allergic or adverse reactions to medications

When to call your doctor

Abortion complications are rare, but call your doctor or seek immediate medical attention if you experience any of the following symptoms:

  • passing blood clots larger than a lemon for more than 2 hours
  • bleeding heavy enough that you have to change pads once an hour for 3 hours straight
  • foul-smelling vaginal discharge
  • fever
  • pain or cramping that gets worse instead of better, especially after 48 hours
  • pregnancy symptoms that persist after 1 week

Surgical abortion is a safe and effective way to end a pregnancy. People choose surgical abortion for a number of reasons, including preferences and the time since their last period.

Surgical abortions usually involve an aspiration technique that removes pregnancy tissue from the uterus.

You will be given a sedative before your procedure to reduce pain, but you may experience some cramping during the procedure. The cramps can last for a few days, but most people are able to return to normal activities within a day or two.

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