Abortion

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

If you think you may be pregnant, see a health professional for a pregnancy test, examination, and pregnancy counseling as soon as possible. If you are considering ending the pregnancy, this is an important time for learning as much as you can about your options. The earlier you take measures to end a pregnancy, the more medical choices you are likely to have and the less your risk of complications will be.

If you have had unprotected sex in the past 72 hours, a pregnancy test is not necessary before using emergency contraception medicine to prevent pregnancy. A copper intrauterine device (IUD) can also be used as emergency contraception and can be inserted as late as 5 to 7 days after unprotected intercourse.

Who to see

Surgical abortions are minor surgeries that require a health professional with specialized training. If a medical abortion is not successful, a surgical abortion must be done as follow-up. This is necessary to prevent infection and blood loss and to end the pregnancy, because medical abortion medicines cause birth defects. The following health professionals can perform abortions:

• Gynecologist
• Family medicine doctor who has special training
• Certified nurse-midwife
• Nurse-practitioner with special training
• Physician assistant with special training

Some health professionals offer medical abortion only and recommend another health professional if a vacuum aspiration becomes necessary. Other health professionals offer medical abortion and manual vacuum extraction (MVA) if necessary, which is a simple and effective procedure. Fewer health professionals offer medical, MVA, and surgical abortion services.

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

• Irregular bleeding or spotting for as long as the first 3 weeks.
• Cramping for the first 2 weeks. Some women have menstrual-like cramping for as long as 6 weeks.
• Emotional reactions for 2 to 3 weeks.

The hospital or surgery center may send you instructions on how to get ready for your surgery or a nurse may call you with instructions before your surgery.

Right after surgery, you will be taken to a recovery area where nurses will care for and observe you. You can expect to stay in the recovery area for 1 to 4 hours, and then you will be moved to a hospital room or you will go home. In addition to any special instructions from your doctor, your nurse will explain information to help you in your recovery. You will go home with a page of care instructions including who to contact if a problem arises.

Signs of complications

Less than 1% of all women who have an abortion have serious problems afterward.⁵

Call your health professional immediately 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 sanitary 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 abdomen that is not relieved by pain medicine, rest, or heat
• Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
• Vomiting lasting more than 4 to 6 hours
• Sudden abdominal 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 health professional 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 and symptoms of depression. Hormonal changes after a pregnancy can cause postpartum depression that requires treatment.

Your ability to become pregnant in the future

Medical abortion and vacuum aspiration do not affect your ability to become pregnant in the future.¹ It is possible to become pregnant in the weeks right after an abortion procedure.

• Avoid sexual intercourse until your body has fully recovered, for at least 1 to 3 weeks.
• To prevent infection and pregnancy, it is important to use condoms as directed by your health professional 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. For more information, see the topic Birth Control.

Having several abortions using dilation and curettage (D&C) may create enough scar tissue to reduce a woman's ability to become pregnant and raises the risk of pregnancy complications, including ectopic pregnancy, miscarriage, and placenta previa.¹² However, this method is rarely used.

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Author:	Healthwise Medical Writer	Last Updated: October 6, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology
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