Abortion became legal in the United States in the 1970s as medical science had progressed enough to make abortions safe and the side effects of abortion not life-threatening.
While abortion laws differ from state to state, most abortions up to week 24 are considered safe and legal. Beyond that, abortions are ill advised as the fetus is considered viable or able to live outside the womb. Abortions beyond the second trimester, or week 27 onward, are illegal in most states unless it is a medical emergency.
There are physical side effects of abortion that you need to be aware of before you take the step. Of course, there are other larger social, cultural, religious, and economic considerations as well as psychological and emotional side effects. In this article, we will discuss the physical aspect only.
Legal abortion is very safe, with very low death rate. Only 7 deaths per million legal abortions are reported per year.
About 8 in every 1,000 abortions have minor side effects like bleeding, vomiting, and fever. Major side effects or complications, such as excessive bleeding or damage to the uterus and cervix, make up only 0.7 per 1,000 abortions. And only 0.7 deaths per 100,000 legal abortions are reported per year.1
There are basically two types of abortion: medical and surgical. The type of abortion you should undergo depends on how long you have been pregnant, counting from the first day of your last period. This is known as the gestational age. But there can be other deciding factors too. This will help you decide which abortion method you could choose.
Side effects of abortion common to both medical and surgical procedures include:
- Pain and cramps
- Nausea and vomiting
- Fever and chills
However, the severity or the duration depends on the type of abortion. The major side effects may vary depending on the procedure.
Side Effects Of Medical Abortion Or Abortion Pills
The FDA-approved procedure of medical abortion involves taking mifepristone, commonly known as the abortion pill, followed by misoprostol after 2 days. Methotrexate is another medicine that can be used instead of mifepristone, but the FDA does not approve of this use.
Studies find that the side effects become more pronounced with every passing week and for women who have conceived for the first time.
Medical abortion is what many choose when they are pregnant for 9 weeks or less. It has worked at 10 weeks also,2 but is not effective beyond that. Medical abortion has side effects. A much-cited classic study by Irving Spitz et al. on 2,015 women who had medical abortion using mifepristone and misoprostol found that the side effects increased with each passing week.3
While it is the major cause of anxiety for most women, bleeding is absolutely normal. Passing blood clots is also normal.
Some women bleed within 8 hours after they are given mifepristone on day 1 but the flow may not be heavy. Some bleed within 4–12 hours after they are given misoprostol on day 3. Both situations are normal.
Most women begin bleeding or passing blood clots within 24 hours of taking misoprostol. This generally lasts for around 17 days.
The amount of blood lost after a medical abortion depends on your body but is usually more than during your periods.
The average duration of bleeding is 13 to 17 days. The Spitz study found that the average duration of post-abortion bleeding is 13 days for women less than 7 weeks pregnant and 15 days for 8 and 9 weeks pregnant women. The heaviest flow was on the day they took misoprostol. Within day 15 the bleeding changed to spotting. Only 1% women reported bleeding 2 months after the abortion.4 Other studies reported the duration to be around 17 days in both 7 and 8 weeks pregnant women.5 6
Very few women require suction curettage to treat the excessive bleeding. Even fewer require a blood transfusion.
Pain And Cramps
Almost all women complain of abdominal or pelvic cramps much like period pain, but the pain intensity is likely more if you abort when 8 or 9 weeks pregnant than when you are less than 7 weeks pregnant.7
Pain usually begins within 3 hours of taking misoprostol and lasts for around 3 days.
You could also get a back pain, though the chances of that happening are low. You may have to take painkillers, but be wary of aspirin, which increases bleeding.
Nausea, Vomiting, And Diarrhea
More than half the women who abort medically report nausea. Vomiting is slightly less common. The incidences increase with increase in gestational age – from week 7 to 9, nausea incidences rose from 61% to 72% and vomiting rose from 26% to 41% in the Spitz study.10
Nausea and vomiting can start even after the first pill. The second pill may increase it. Vomiting should cease in a day, but nausea can last for 2 days.
Nausea can hit you after you take mifepristone and can stay for 2 days. Vomiting too can start after the first pill and last for a little more than 1 day.11
Diarrhea is less common but incidences increase with gestational age and mostly last for a day. In the Spitz study, diarrhea incidences rose from 20% in the 7 week group to 26% in the 9 week group.12
These side effects are not severe and require little to no medicine.
Fever, Chills, Headaches, And Dizziness
About 32% women complain of fever, warm flushes, or chills, lasting around 1 day. Most women get fever as a side effect of misoprostol, and the effects are more pronounced when it is given under the tongue (sublingually) rather than vaginally,13 but getting a fever after mifepristone is not unusual.
Misoprostol can bring about fever, chills, headache, dizziness, and weakness. Most of these should resolve within 2 days.
Nearly half the women complain of dizziness, headaches, and weakness, which are caused by hormonal fluctuations brought about by the misoprostol. The headaches and the weakness will likely last for 2 days and the dizziness should subside in 1 day.14
In most cases, symptoms like pain, nausea, or fever are not worrying though it may take around 15 days for all of them (except bleeding) to completely disappear.
Side Effects Of Surgical Abortion
Surgical abortion involves either removing the fetus and placenta by suction (vacuum aspiration) or by scraping them off the uterus (curettage). If these are combined, the process is known as vacuum curettage, suction curettage, or dilation and curettage (D&C). The other common method is dilation and evacuation (D&E) where the pregnancy is removed with forceps and other instruments. The third type involves inducing labor.
The side effects of surgical abortion are not as severe as those of medical abortion. They may not be related to gestational age, but pain may be more severe for women who have conceived for the first time and those who have painful periods.
Surgical abortion too has side effects but these are not as severe as those caused by medical abortion. In a study, only 6% of the women who had surgical abortion reported severe pain as opposed to the 40% women in the medical abortion group. Just 1% of women in surgical abortion group had severe pain as opposed to 36% in the medical abortion group.15 Overall, surgical abortion seemed to be more acceptable and tolerable than medical abortion.
Bleeding is usually less after surgical abortion. Some women may have scanty bleeding or none for the first few days. It may then become heavy. Others may have an irregular pattern, with the bleeding starting and stopping randomly. You may pass blood clots. This mostly continues for 2 weeks but in rare cases can continue for 3 months.
Pain And Cramps
Surgical abortion by both D&C and D&E can cause cramps and pain both during and after the surgery. That is why they are performed under local or general anesthesia, and most women are given standard painkillers to deal with the post-abortion pain.
Nausea And Vomiting
Nausea and vomiting are common in cases of surgical abortions too. These can also be caused by the anesthesia used during surgery. These usually improve within a few days. Surgical abortion is not known to cause diarrhea.
Chills, Headaches, And Dizziness
Surgical abortion usually doesn’t give you a fever. Chills, shivering, muscle ache, sore throat, dizziness, and confusion can be caused by the general anesthesia during surgical abortion procedures like D&C and can last anywhere from a little while after waking up post surgery to a few days.16 D&C is known to cause dizziness and sweating.
5 Signs Of Complications To Watch Out For
Whether you undergo a medical abortion or a surgical one, look out for the following signs which indicate complications. You need medical intervention or even surgery.
1. Heavy Bleeding
Misoprostol causes heavy bleeding, but if you are soaking up more than 2 maxi sanitary pads within 2 hours or bleeding heavily for 12 hours straight, it’s not normal. If it is accompanied by dizziness or sweating, visit the doctor immediately. Heavy bleeding after medical abortion can indicate incomplete abortion or hemorrhage. It may even indicate an infection.
Heavy bleeding means soaking up 2 maxi pads in 2 hours.
Heavy bleeding and passing of big blood clots after surgical abortion is more worrisome. It may indicate incomplete abortion or perforation of the uterus or the cervix, which can happen during both D&C and D&E. Labor induction can even rupture the uterus. It may also indicate infections.
2. Pain And Tenderness
If the pain is so debilitating that it doesn’t let you stand up and it is accompanied by heavy bleeding, this indicates a complication like incomplete abortion, infection, or hemorrhage. Severe pain without bleeding indicates blood clots in the uterus.17
3. Fever Above 100.4 F
Fever is your body’s way of telling you an infection has occurred. Mild fever is common after medical abortion, but it should go away in 24 hours. If the fever is above 100.4 F and persists despite medicines, you should visit a doctor.
Fever above 100.4 F that stays longer than 4 hours is a sign of infection.
Infections are more common after surgical abortions than medical abortions. So a fever after surgical abortion should be monitored closely, especially if it occurs days after the surgery.
4. Smelly Vaginal Discharge
Some amount of vaginal discharge after abortion is normal. The discharge may be brown in color and slightly smelly, which means that it is old blood. But if the amount is high and the odor is remarkably strong, it indicates an infection.
Heavy bleeding, pain, high fever, and smelly vaginal discharge may appear together or in combinations. If any of these becomes severe, visit your doctor.
5. Symptoms Of Pregnancy
If you experience morning sickness, breast soreness, or other symptoms of pregnancy, you may still be pregnant. The risk is more if you are pregnant for 9 weeks or more. It is rare but surgical abortions may fail too.
Complications Or Major Side Effects Of Abortion
- Failed abortion or continuing pregnancy
- Incomplete abortion
- Damage to the reproductive organs
Hemorrhage Or Excessive Bleeding
Rare and happens with both medical and surgical abortion
Excessive bleeding can be a sign of hemorrhage. Hemorrhage may be caused by certain pre-exisiting medical conditions like weakness of the uterine muscles (uterine atony), lack of blood clotting (coagulopathy), and abnormal attachment of the placenta to the uterus (abnormal placentation). These would cause hemorrhage even after medical abortion. In rare cases, it can be caused by torn cervix or punctured uterus during surgical abortion. It can also be caused if tissues from the pregnancy remain in the body.18
Failed Abortion Or Continuing Pregnancy
Quite rare and happens mostly with medical abortion
Bleeding after a medical abortion does not guarantee a successful abortion. If you continue to experience symptoms of pregnancy, it could be a case of failed or missed abortion. This means that the fetus is still alive. The National Abortion Federation says that this happens in less than 2% cases after medical abortion and in less than 0.03% cases after surgical abortion.19
If your pregnancy continues after taking both the abortion pills, you may have to take another misoprostol or even opt for surgical abortion.
The Spitz study found that for medical abortion, the risk goes up with increase in gestational age – from 1% to 9% in week 7 to 9.20 Taking misoprostol orally rather than vaginally also contributes to the risk.21
Go for a follow-up to check the status of the pregnancy after 2 weeks.
Another rare situation where medical abortion can fail is if you have an undetected ectopic pregnancy where the fetus is outside the womb. Neither mifepristone nor misoprostol can terminate an ectopic pregnancy. While methotrexate can, this usage is not approved by the FDA. However, this situation is rare because the mandatory sonogram before medical abortion can detect ectopic pregnancy in most cases.
Rare and happens mostly with medical abortion
Sometimes, the pregnancy may be terminated, but the tissues and products of pregnancy may not be completely removed from the body. If these remain in the body long enough, they may infect the uterus and the blood.
Incomplete abortions are more common in medical abortions, especially when misoprostol is administered orally rather than vaginally. The incidences also rise from week 7 to 8 by 3%–6%.22 The incidence is below 2% for surgical abortions.
Heavy, persistent bleeding and severe pain often indicates an incomplete abortion. However, sometimes it may not present any symptoms. A follow-up is mandatory.
Rare and happens mostly with surgical abortion
Infections are more common in surgical abortions because of the invasive procedure. Smelly vaginal discharge, high fever, vomiting, and severe pelvic and back pain are the presenting symptoms of an infection of the uterus.
The risk of infections is higher in surgical abortion, but medical abortions where misoprostol is administered in the vagina can carry some risk too. This is why you must visit an authorized clinic.
Having a sexually transmitted disease at the time of abortion raises risk of uterine infections. Infection from bacteria or a sexually transmitted disease may enter the uterus even during the surgical procedure. These bacteria may even cause pelvic inflammatory disorder (PID), which may infect the Fallopian tubes, lead to infertility and increase the risk for ectopic pregnancy. You may experience fever and chills, abdominal pain, foul-smelling vaginal discharge, vomiting, and nausea. In addition, you may also notice unusual vaginal bleeding. PID also causes chronic pelvic pain.23
Women are most vulnerable to the bacteria Clostridium sordellii at the end of their pregnancy, whether after childbirth, miscarriage, or medical and surgical abortion. The infection can lead to sepsis or blood poisoning, which is life-threatening. Symptoms include nausea, vomiting, diarrhea, and abdominal pain without fever.24
Antibiotics may be given before the surgery or after it as post-operative care.
Damage To The Uterus And Cervix
Very rare and happens mostly with surgical abortion
Because both D&C and D&E involves dilating the cervix, improper technique or any error during the surgery can injure or tear the cervix. D&E is also linked with the increased risk of cervical incompetence in subsequent pregnancies, a condition where the cervix opens before the pregnancy reaches term.25 Advanced gestational age and previous C-sections are risk factors for hemorrhage.
The sharp curette used in D&C can puncture the wall of the uterus, which becomes thinner with each passing week. The uterus lining may get scarred and form scar tissues within the uterine cavity. This may lead to Asherman Syndrome which can in turn lead to infertility.26 Labor induction in late-term abortions can even make the uterus rupture.27
Can An Abortion Be Life-Threatening?
While there are occasional news reports of abortions gone awry, maternal death happens in less than 1 in 100,000 abortions.28 However, as the World Health Organization points out, “unsafe abortions” conducted by unqualified personnel using questionable methods are a leading preventable cause of maternal death.29
Unsafe abortions performed by unauthorized people are a leading preventable cause of death of the mother.
By going to a proper trained and authorized medical professional, you can significantly reduce a lot of the risks of complications. Trying to conduct the abortion on your own or through other means to bypass the rules isn’t just dangerous, it is also illegal and stacks the odds against you.
Just be aware that if you have a surgical abortion, you have the risks associated with any kind of surgery. This includes the possibility that blood clots can form and break loose, going to your brain, lungs, or heart. This in turn can cause strokes, pulmonary embolism, or a heart attack.30 So extreme caution is warranted – always pick a reputed licensed medical practitioner.
Besides the immediate side effects from certain procedures, experts also caution that having abortions repeatedly could raise your risk of delivering prematurely in future pregnancies. It could also result in low birth weight of the baby.31 Abortion, however, does not increase the risk of breast cancer.
|↑1, ↑18||Management of postabortion hemorrhage. Society of Family Planning.|
|↑2||American College of Obstetricians and Gynecologists, and American College of Obstetricians and Gynecologists. “Medical management of first-trimester abortion.” Practice bulletin 143 (2014): 676-692.|
|↑3, ↑4, ↑7, ↑10, ↑12||Spitz, Irving M., C. Wayne Bardin, Lauri Benton, and Ann Robbins. “Early pregnancy termination with mifepristone and misoprostol in the United States.” New England Journal of Medicine 338, no. 18 (1998): 1241-1247.|
|↑5, ↑8||Creinin, Mitchell D., Jill L. Schwartz, Helen C. Pymar, and Wendy Fink. “Efficacy of mifepristone followed on the same day by misoprostol for early termination of pregnancy: report of a randomised trial.” BJOG: An International Journal of Obstetrics & Gynaecology 108, no. 5 (2001): 469-473.|
|↑6||Schaff, Eric A., Steven H. Eisinger, Lisa S. Stadalius, Peter Franks, Bernard Z. Gore, and Suzanne Poppema. “Low-dose mifepristone 200 mg and vaginal misoprostol for abortion.” Contraception 59, no. 1 (1999): 1-6.|
|↑9, ↑11, ↑14||Shannon, Caitlin S., Beverly Winikoff, Richard Hausknecht, Eric Schaff, Paul D. Blumenthal, Deborah Oyer, Heather Sankey, Jessica Wolff, and Rachel Goldberg. “Multicenter trial of a simplified mifepristone medical abortion regimen.” Obstetrics & Gynecology 105, no. 2 (2005): 345-351.|
|↑13||Tang, Oi Shan, Carina CW Chan, Ernest HY Ng, Sharon WH Lee, and Pak Chung Ho. “A prospective, randomized, placebo‐controlled trial on the use of mifepristone with sublingual or vaginal misoprostol for medical abortions of less than 9 weeks gestation.” Human Reproduction 18, no. 11 (2003): 2315-2318.|
|↑15||Rørbye, Christina, Mogens Nørgaard, and Lisbeth Nilas. “Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study.” Human Reproduction 20, no. 3 (2005): 834-838.|
|↑16||Effects of Anesthesia. American Society of Anesthesiologists.|
|↑17, ↑30||Induced Abortion Methods & Risks. South Dakota Department of Health.|
|↑19||The Safety of Abortion. National Abortion Federation.|
|↑20||Spitz, Irving M., C. Wayne Bardin, Lauri Benton, and Ann Robbins. “Early pregnancy termination with mifepristone and misoprostol in the United States.” New England Journal of Medicine 338, no. 18 (1998): 1241-1247.|
|↑21||El-Refaey, Hazem, Dhamnasekar Rajasekar, Mona Abdalla, Lynda Calder, and Allan Templeton. “Induction of abortion with mifepristone (RU 486) and oral or vaginal misoprostol.” New England Journal of Medicine 332, no. 15 (1995): 983-987.|
|↑22||Kahn, James G., Betsy Jane Becker, Laura MacIsaa, John K. Amory, John Neuhaus, Ingram Olkin, and Mitchell D. Creinin. “The efficacy of medical abortion: a meta-analysis.” Contraception 61, no. 1 (2000): 29-40.|
|↑23||Induced Abortion Methods & Risks. South Dakota Department of Health.|
|↑24||Clostridium sordelli. Centers for Disease Control and Prevention.|
|↑25, ↑28, ↑31||Dilation and Evacuation (D&E). Michigan Department of Health and Human Services.|
|↑26||Asherman Syndrome. U.S.National Library of Medicine.|
|↑27||Davis, Victoria Jane. “Induced abortion guidelines.” Journal of Obstetrics and Gynaecology Canada 28, no. 11 (2006): 1014-1027.|
|↑29||Haddad, Lisa B., and Nawal M. Nour. “Unsafe abortion: unnecessary maternal mortality.” Reviews in obstetrics and gynecology 2, no. 2 (2009): 122.|