Topic Overview

Is this topic for you?

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 Emergency Contraception.

What is an abortion?

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.

When should you see a doctor?

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. 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 examination. You will have lab tests to make sure that you are pregnant. You may also have an ultrasound.

How will you know what decision is right for you?

It's not easy to decide to end a pregnancy. You may need some time to think about your choices. Counselling 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 counselling 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 to:

• Have a baby, and support and raise your child to adulthood.
• Have a baby, and place the baby for adoption.
• Have an abortion.

When can an abortion be done?

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 10 weeks, surgical abortion is usually the only option.^{footnote 1} 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. Abortion services are available at abortion clinics and some hospitals.

Abortions are rarely done after 24 weeks of pregnancy (during the late second trimester and entire third trimester).

How safe is abortion?

Abortions done by doctors are very safe. Less than 1 out of 100 women have a serious problem from an abortion.^{footnote 2}

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.

Will you be able to have children in the future?

The most widely used methods for abortion do not prevent a woman from becoming pregnant later.

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.

Examinations and Tests

Examinations 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 examination, and some laboratory tests.

A physical examination before an abortion includes:

• Taking your vital signs, such as blood pressure and heart rate.
• Listening to your heart and lungs.
• Performing a pelvic examination to find out the size and shape of your uterus. The size of the uterus can help estimate the number of weeks you are pregnant. A pelvic examination also allows your doctor to check the ovaries and fallopian tubes for a possible tubal (ectopic) pregnancy, which would feel like an abnormal mass in the pelvis.

Laboratory tests before an abortion include:

• A urine pregnancy test to find out if you are pregnant. (You may have missed a menstrual cycle for another reason, such as stress, and not because you are pregnant.)
• A blood test to find out:
  • Whether you have low blood iron (anemia). If you have anemia, your doctor may want you to take some iron supplements before and after an abortion.
  • Your blood type and whether you are Rh-negative. If you are Rh-negative, you should receive a vaccine called Rh immunoglobulin after an abortion. For more information, see the topic Rh Sensitization During Pregnancy.
• Screening for sexually transmitted infections (STIs), if you are at high risk for an STI. This is not a routine test before an abortion but may be done to reduce the risk of complications, such as an infection, after the procedure.
• A Pap smear to check for cervical cell abnormalities (dysplasia), if you are due for one (not a routine test before an abortion).

An 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.

Choices: Medical Abortion

Medical abortion is the use of medicines to end a pregnancy. Depending on the medicines used, a medical abortion can be done up to about 10 weeks of pregnancy.^{footnote 1}

• A typical treatment schedule for a medical abortion may require two visits to your doctor. At the first visit, your doctor will give you one medicine to take during the visit or at home. You will take the second medicine 24 hours after the first medicine.
• Bleeding and cramping starts within a few hours after you have taken the second medicine. Cramps may be strong. You can take ibuprofen (also called Aleve or Motrin) to help with pain. Bleeding will be heavier than a regular period and will have some clots until the pregnancy has passed. Vaginal bleeding may last about 14 days.
• You will see your doctor, or go to a lab for a test, 7 to 14 days after taking the medicine. This is to see if you are recovering well and to make sure the medicines worked.
• Medical care before and after a medical abortion includes physical examinations and lab tests, education about what to expect, self-care instructions, information on when to call your doctor, and birth control planning.

Medicines can be used to induce abortion. This often involves taking more than one medicine. The type of medicine may depend on how many weeks of pregnancy have passed. Some medicines are used up to 10 weeks of pregnancy.^{footnote 1} These medicines may include:

• Mifepristone and misoprostol (Mifegymiso). Mifepristone blocks the effects of the hormone progesterone. This stops the placenta's growth and softens the cervix. Misoprostol is then used to trigger uterine cramping to clear the uterus of all tissue.
• Misoprostol. This hormone softens and opens (dilates) the cervix and triggers uterine cramping to clear the uterus of all tissue. Misoprostol used alone may end a pregnancy. But it works much better in first-trimester abortions when it's used with other medicines, such as methotrexate.
• Methotrexate and misoprostol. Methotrexate interferes with the placenta's growth. Misoprostol is then used to triggers uterine cramping to clear the uterus of all tissue.

See the What to Think About section of this topic for a comparison of medical abortion and surgical abortion.

Choices: 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 examination and lab tests, education about what to expect, self-care instructions, symptoms that mean you should call your doctor, and birth control planning.

Surgical methods in the first trimester (5 to 12 weeks)

• Manual vacuum aspiration (MVA) or machine vacuum aspiration uses suction through a small tube to empty the uterus of all tissue.

Surgical method in the second trimester

• Dilation and evacuation (D&E) is typically done when an abortion occurs in the second 12 weeks (second trimester) of pregnancy. It usually includes a combination of vacuum aspiration, dilation and curettage (D&C), and the use of surgical instruments (such as forceps) to clear the uterus of fetal and placental tissue.

A D&E is most commonly used during the second trimester because it has a lower complication risk than induction abortion.

Non-surgical method in the second trimester

• Induction abortion ends a second-trimester pregnancy by using medicines to start (induce) contractions, which expel (push) the fetus from the uterus. If the fetus has severe medical problems, a woman may choose to have an induction abortion.

See the What to Think About section of this topic for a comparison between medical abortion and surgical abortion.

What to Think About

Your 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 Canada.

The following table lists some of the differences between the most commonly used medical and surgical abortion procedures.

Pain associated with a medical or surgical abortion ranges from mild to severe and depends on each woman's physical and emotional condition.

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 trimester.

Abortion and breast cancer

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 cancer.^{footnote 3}

Before, During, and After an Abortion: When to Call a Doctor

Your health professional will give you information about what to expect after an abortion. Normal symptoms that most often occur include:

• Irregular bleeding or spotting for as long as the first 3 weeks.
• Cramping for the first 2 weeks. Cramping (like menstrual cramps) may last for as long as 6 weeks.

Follow your doctor's instructions on what to do at home.

Call your doctor now if you have any of these symptoms after an abortion:

• Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
  • Passing clots that are bigger than a golf ball, lasting 2 or more hours.
  • Soaking more than 2 large pads in an hour, for 2 hours in a row.
  • Bleeding heavily for 12 hours in a row.
• Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
• Severe pain in the belly that isn't relieved by pain medicine, rest, or heat
• Hot flushes or a fever that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden belly swelling or rapid heart rate
• Vaginal discharge that has increased in amount or smells bad
• Pain, swelling, or redness in the genital area

Call your doctor for an appointment if you have had any of these symptoms after a recent abortion:

• Bleeding (not spotting) for longer than 2 weeks
• New, unexplained symptoms that may be caused by medicines used in your treatment
• No menstrual period within 6 weeks after the procedure
• Signs of depression. Hormonal changes after a pregnancy can cause depression that requires treatment.

It's possible to become pregnant in the weeks right after an abortion procedure.

• Ask your doctor when it's okay to have sexual intercourse.
• To prevent infection and pregnancy, make sure to use condoms as directed by your doctor when you start to have intercourse again. This is a good time to also start a highly effective birth control method that fits your lifestyle.