Different abortion procedures are available depending on how long you’ve been pregnant, your medical suitability and your preferences. You should be offered a choice of abortion methods, although this isn’t always possible.
Medical abortion
Early medical abortion up to nine or ten weeks of pregnancy
Early medical abortion (sometimes called EMA or the abortion pill) involves taking medication to cause an early miscarriage. It doesn’t involve surgery or an anaesthetic.
Early medical abortion is available up until 9 or 10 weeks of pregnancy, depending on the provider, and you’ll have one, two or three appointments. You’ll always have an assessment first. The procedure may also be started at this time or you may need to have another appointment.
To start the process, you’ll be given a mifepristone tablet to swallow. This blocks the pregnancy hormone. This is usually not enough to end the pregnancy but very occasionally it might be. Occasionally you’ll experience some bleeding after taking mifepristone but usually there won’t be any other effects and you can carry on with your normal activities.
To complete the abortion, you’ll be given prostaglandin tablets, called misoprostol. This may be on the same day as the mifepristone, or at another appointment between 1 and 3 days later. If you’re between 9 and 10 weeks there’ll always be a second appointment at least 24 hours later. You should be able to carry out your usual activities between appointments. Misoprostol can be used in the vagina or taken by mouth. It causes the uterus (womb) lining to break down and you’ll start to bleed. Bleeding usually starts around two hours after taking the misoprostol but may start sooner. You may feel cramping pains similar to period pains; you’ll be offered pain-relieving drugs. The pregnancy is lost with the bleeding like a miscarriage. This usually happens within 4-6 hours but may be quicker or take longer. You’ll usually be able to leave the clinic after taking the misoprostol.
You’ll be given a 24-hour phone number to call if you’re worried or would like to talk to someone at anytime during this procedure.
Medical abortion after nine or ten weeks
The tablets used for early medical abortion are also used for medical abortion later in pregnancy. When abortion is carried out later in the pregnancy, it may take longer, and higher and repeat doses of prostaglandin may be needed, along with painrelieving medicine. The abortion is like having a late miscarriage. You can usually return home on the same day, but sometimes you’ll have to stay overnight, particularly when the abortion is carried out later in the pregnancy.
Surgical abortion
Vacuum aspiration up to 15 weeks of pregnancy
Vacuum aspiration (sometimes called suction abortion) involves a small tube being inserted into the vagina, through the cervix (entrance to the uterus) and into the uterus to remove the pregnancy by suction. To make this easier, misoprostol tablets are sometimes inserted into the vagina before the procedure is carried out to help soften the cervix.
You’ll be offered a choice of suitable pain relief methods, but not all methods are available in every setting. Depending on what you prefer and how many weeks pregnant you are, you may have a local anaesthetic injected into the cervix, conscious sedation (you’re relaxed and sleepy) or a general anaesthetic (you’re asleep).
With conscious sedation, you stay awake but won’t remember everything that happens. Vacuum aspiration takes about 5-10 minutes. You’ll usually go home a few hours after the procedure.
Surgical dilation and evacuation (D&E) from 15 weeks of pregnancy
This method is usually carried out under general anaesthetic. The cervix is gently stretched and opened (known as dilation) to allow special forceps to remove the pregnancy in fragments. Remaining tissue is removed by suction as in vacuum aspiration. The procedure takes 10-20 minutes. You may be able to return home on the same day if you’re healthy and there are no complications.
Abortion after 21 weeks
Abortion at this stage isn’t common. It involves either the surgical dilation and evacuation method, or medical abortion. Whichever method is used, a doctor will ensure the heart of the fetus is stopped so it’s not born alive. You may need to attend one or two days before for medication that is taken in the vagina to soften the cervix, returning for the actual procedure. The procedure feels similar to going into labour and you’ll be offered pain relief. It takes time and you’ll have to stay in the hospital or clinic, sometimes overnight.
For more information on having an anaesthetic, talk to your doctor.