Does having an abortion hurt?

Dear Reader, 

As valid as your question is, there’s unfortunately no clear-cut answer to it. This is because there are different types of abortions that are performed based on how far along a person is in a pregnancy, which method is used, and the fact that each person’s experience with pain can vary drastically. Abortions performed by trained medical professionals are considered very safe; however, like any medical procedure, abortions do carry some risk, including the risk of possible discomfort or pain. That being said, with restrictions that have been put on abortion in the United States (US), some may be choosing to or forced to forgo abortions provided by medical professionals. Those who induce abortion using other methods may face additional pain and higher risk for complications. 

The two major categories of abortion procedures are medication and in-clinic: 

• Medication abortion, is a process in which medication in the form of mifepristone and misoprostol pills is taken orally by the patient at home in order to induce the uterus to expel the embryo or fetus—depending on how far along someone is in their pregnancy—and placenta. This process is similar to what happens during a naturally-occurring miscarriage. Mifepristone works by blocking the hormone progesterone, which is necessary for the embryo to grow in the uterus. Without progesterone, the pregnancy can't continue. It’s worth noting that the legality of mifepristone is currently being debated, which means it may not be available in all parts of the US. Misoprostol causes cramping and heavy bleeding which in turn causes the uterus to contract and expel the embryo or fetus. Medication abortion is performed up to 11 weeks after the first day of the person’s last period and is 97 percent effective. The process usually takes between four to five hours to completely expel the contents of the uterus. In addition to cramping and heavy bleeding, misoprostol may also cause nausea and fever. 
• In-clinic abortions (which use methods such as aspiration, dilation and evacuation (D and E) are performed between 6 to 24 weeks after the first day of the person’s last period and are performed by medical professionals in a health care facility. Vacuum aspiration abortion (also known as suction abortion) involves the use of a device that creates suction to empty the uterus. D and E abortions involve the dilation of the cervix and surgical evacuation of the uterus. 

During both vacuum aspiration and D and E abortions a health care provider should: 

• examine your uterus 
• put a speculum in to see into your vagina 
• inject a numbing medication into or near your cervix 
• stretch the opening of your cervix with a series of dilating rods 
• insert a thin tube through your cervix into your uterus 

List adapted from Planned Parenthood 

At this point, during a D and E abortion, a health care provider will often use a combination of medical tools and a suction device to gently remove the pregnancy tissue out of your uterus. During an aspiration abortion, however, they’ll only use the suction device or machine. They might also use a small surgical tool called a curette to remove any tissue that might be left in your uterus. The procedure usually only lasts between 10 and 30 minutes, but depending on the procedure, patients are often required to stay at the clinic or hospital one to five hours afterward to receive an exam, read and sign forms, and rest in the recovery room. 

Local or general anesthetic may be used for both types of in-clinic abortions which some people describe as uncomfortable "pressure" or pain similar to menstrual cramps when administered. Other common side effects include nausea, sweating, and feeling faint. Less common side effects are heavy or prolonged bleeding, blood clots, damage to the cervix or uterus, or infection. Patients are likely to experience some pain similar to menstrual cramps after the procedure as well, which can be treated with over-the-counter pain medicine or by applying heat— this can be in the form of a warm bath, a heating pad, or a hot water bottle. The side effects can be more severe or prolonged later in a pregnancy that an abortion is performed. After 24 weeks into a pregnancy, abortions are usually only performed for serious health reasons and generally require admission to a hospital. Having a safe, uncomplicated abortion (either medication or in-clinic) generally doesn't impact future fertility. 

While abortion is a very low risk procedure, some people do experience complications. Other rare but potential risks of abortion include: 

• Allergic reaction 
• Blood clots in the uterus 
• Infection 
• Injury to the cervix or other organs 
• Very heavy bleeding (a small amount of bleeding or spotting for a few weeks is normal) 

List adapted from Planned Parenthood 

Certain factors increase the risk of complication, such as the use of anesthesia and sedation as well as how late in one’s pregnancy the abortion is performed. A person’s overall health may impact their risk of complications; if you're considering an abortion, a health care provider should discuss your personal medical history and any risks that apply to you. In extremely rare cases, complications during abortion can be fatal. However, first trimester abortion is significantly less risky than carrying a pregnancy or going through childbirth—in the US, the risk of death associated with childbirth is about 14 times as high as the risk associated with all abortions. 
Aside from the potential physical pain, some people also experience strong emotions related to abortion. Most people report feeling relief after the procedure; however, some feel anger, regret, guilt, or sadness. Hormonal changes resulting from terminating a pregnancy may intensify these feelings; for this reason, it's sometimes helpful to talk with a partner, trusted friend, or a mental health professional prior to and following an abortion to discuss and process feelings. 

With the overturning of Roe v. Wade, many people may not have access to abortion provided by a health care provider, be it medication or in-clinic. Some people may choose to self-manage their abortion by acquiring mifepristone or misoprostol on their own. Others use unsafe methods to expel the fetal tissue which can be incredibly painful and also put the pregnant person's life at risk. Some of the complications associated with this are hemorrhaging, injury to organs in the pelvis, exposure to toxins, and even sepsis. The risks and pain associated with abortion are much higher when it’s done not using a method recommended by medical professionals. For questions around your rights to abortion or legal considerations associated with seeking care, the Repro Legal Helpline and Pegnancy Justice provide legal advice and assistance. 

If you or someone you care about is considering an abortion, you might review detailed descriptions of the different procedures on the Planned Parenthood website. If you're having trouble finding a provider or funding the costs of accessing an abortion, organizations such as the National Abortion Federation and the National Network of Abortion Funds may be able to provide assistance. 

Hopefully these resources will help you have a full understanding of the different types of abortion as well as the varying experiences people have had.