Abortion and How it Affects Your Health: Choices, Procedure and Risks

An abortion is the medical process of ending a pregnancy, perfomed up to the 24th week of pregnancy, so it doesn't result in the birth of a baby. It is sometimes known as a termination of pregnancy (TOP). The pregnancy is ended either by taking medications (medical abortion) or having a minor surgical procedure (surgical abortion). One in three women will have an abortion in their lifetime.

In this article:
Is abortion necessary?
What are your choices regarding abortion?
What is the abortion procedure?
What happens immediately after an abortion?
Does abortion ever fail?
What are the complications of abortion?

Is abortion necessary?

In certain cases, abortion is necessary to save a woman's life, for example a woman who continues to bleed through her vagina uncontrollably after a spontaneous abortion which occurred naturally. In other cases, and for varied reasons, a woman may request the abortion of a normally progressing pregnancy. In the latter case, women have been known to end up with guilt feelings and the abortion becomes a life changing event with emotional, spiritual, and sometimes physical, complications. This is most likely in an unplanned adolescent pregnancy. See the separate article, Adolescent Pregnancy - Risk Factors, Adverse Effects, Advice on Contraceptive Methods, for more details.

Generally, abortion is a safe procedure, however, there are recognized risks of something going wrong. Some of these risks are discussed below - see complications of abortion below.

What are your choices regarding abortion?

Finding out that you are unexpectedly pregnant can be very worrying. You may feel that you need a solution straightaway. If possible, try to take a few days to collect your thoughts and talk to people. Usually women find out they are pregnant as soon as they miss a period. This makes you very early in the pregnancy. An abortion can take place at any time up to 24 weeks in the pregnancy, so there is no need to rush.

Try to talk to your partner. They may be more supportive than you imagine. If your views are very different, it may be worth asking someone else to be there when you talk about it. You should be aware that your partner cannot make you have an abortion. You should also know that they cannot refuse to let you have an abortion.

Talk to your family. This may seem a frightening idea but most families just want to help if they can. They may be upset or angry at first but this usually changes.

The options are generally:

• To have an abortion.
• To continue the pregnancy and keep the baby.
• To continue the pregnancy and give the baby for adoption after birth.

Abortion services do offer counselling which may be helpful in reaching your decision. Take this option if you are unsure about what to do. You can be referred to the counselling and then choose not to have the abortion. So going to the abortion clinic to have counselling does not mean you have made up your mind to have the abortion.

Taking some time to reach the right decision for you is important. Do not rush into this decision. However, if you decide to have an abortion, the earlier this happens in your pregnancy the better. It is simpler and safer in the very early stages than later on. So if you do decide to have an abortion, do not delay going to your doctor or an abortion clinic.

What is the abortion procedure?

Most abortions take place when the woman is less than 13 weeks pregnant. There are two treatments available.

At your first clinic visit you will be seen by a doctor who will assess your general health and how far along the pregnancy is. They will talk to you about the available treatment options. They may also ask you about what you plan to do for contraception (or birth control) after the abortion. The clinic may be able to help - for example, by fitting a coil after the surgical procedure has been done. They may also offer to take a cervical smear test if you need one.

When you leave this appointment you should have a date to come back to have the abortion.

Medical abortion

For a medical abortion you will be given two types of medicine which together cause you effectively to have a miscarriage. You will be given a tablet called mifepristone to take. You will be asked to stay for a couple of hours, to make sure you are not sick after it. You are then allowed to go home until the next tablet.

After 24-48 hours you are then given a medicine called misoprostol. The timing and the dose of the misoprostol (the second medication) will depend on how far along in your pregnancy you are. It will also affect the options for taking it. You can either let it dissolve under your tongue or inside your cheek, or inside your vagina. Not all these options are suitable at all stages of pregnancy. Some time after this you start to have stomach cramps and vaginal bleeding. Most women will lose the pregnancy sometime after this. If you do not start to bleed you may need more misoprostol doses.

After the second tablet you have a choice whether to stay at the clinic or go home. This is a personal choice. If you prefer to be in your own home, you can be. It may be a good idea to have someone on hand to help or offer support if needed. Some women may be anxious about being at home whilst they lose the pregnancy. They can choose to stay at the clinic until it is all over.

Surgical abortion

Before the procedure, you may have a tablet put in the vagina to help make the neck of the womb (cervix) softer. This helps the procedure go smoothly.

If you have a surgical abortion you will come back to the clinic for the procedure. The procedure is quite quick (normally 10 minutes or less) but you will be asked to stay until the effect of any sedation (or anaesthetic) has worn off. This varies between people but is normally a couple of hours. They will also want to check that you are not bleeding heavily and can pass urine without a problem.

You will normally be given the option of having a surgical abortion while you are awake (with local anaesthetic) or asleep (general anaesthetic). The other option is to be awake but relaxed and sleepy (sedated). Usually in early pregnancy, up to 14-16 weeks, all these options are possible.

• If you are having a local anaesthetic, you will be offered some painkillers before the procedure. An injection inside will numb the neck of your womb (your cervix) to prevent it being too painful.
• If you are having a general anaesthetic, you will have an injection into your arm. You will be asleep throughout the procedure and not be aware of anything.
• If you choose sedation, you will again have an injection into your arm. It will not put you to sleep but will make you feel sleepy and relaxed. You may find you do not remember much about the procedure afterwards.

Then an instrument is carefully placed through the neck of the womb and suction is used to remove the pregnancy from the womb.

At later stages of pregnancy, instead of suction the doctor uses surgical instruments to remove the pregnancy. If you are later into your pregnancy (14-16 weeks pregnant or more) you will be advised to have a general anaesthetic.

What happens immediately after an abortion?

Immediately afterwards, you will usually feel crampy tummy (abdominal) pain, like period pain. You can take simple painkillers such as the ones you might use for period pain - for example, ibuprofen. The pain usually settles in a few hours.

After the abortion it is normal to have some vaginal bleeding. This should be no worse than a period and should stop after a week or so. While you are bleeding you should not use tampons or have sex. This is because you have an increased risk of getting an infection at this time. Be aware that you can become pregnant again immediately after an abortion. This is why discussing contraception with your doctor at the clinic is a good idea.

Infection may make you feel hot and sweaty and a bit sick. There may also be pain in your lower abdomen. The discharge from your vagina might become smelly. If you feel you may have an infection you should talk with your doctor immediately.

You may feel absolutely fine the next day and be able to go back to work. You may feel quite emotional. This is normal and usually settles as your body goes back to normal. If you continue to feel upset it may help to talk with a counsellor about it. Your doctor or your clinic should be able to arrange this.

You will not normally need a follow-up appointment, unless there are problems.

Does abortion ever fail?

Both types of procedure (medical and surgical abortions) usually work very well. There is a small risk that you may continue to be pregnant after both types of abortion. This happens to less than one in a hundred women who have had an abortion.

If your periods do not return or you continue to feel pregnant, you should contact the clinic that treated you. Also, if you continue to bleed after two weeks, or your bleeding is very heavy, or you experience a lot of pain, you should see your GP or contact the clinic that treated you.

What are the complications of abortion

Are there any risks or complications? Yes. No medical procedure is without risks; however, major problems are very rare. The most common complication is infection. This occurs in 1 in 10 procedures.

Possible complications of abortion affecting the uterus

1. Womb infection: This is the most common risk, occurring in 1 in 10 abortions. Before the abortion, the risk is reduced by screening for the bacteria usually responsible and by giving antibiotics. However, if it occurs and if not treated promptly, infections following an abortion can involve other pelvic organs and contribute to infertility in future. Treatment is with antibiotics.
2. Incomplete abortion: This is the next most common, occurring in 1 in 20 abortions. Some times the abortion can be incomplete with unwanted fetal parts left inside the uterus. Any incomplete abortion can lead to complications after the abortion. Further treatment to evacuate the remaining fetal parts is warranted if this is suspected.
3. Continuation of the pregnancy (failed abortion): This occurs in less than 1 in every 100 abortions; further treatment will be needed if this happens.
4. Damage of the entrance to the womb (cervix): This occurs in up to 1 in every 100 surgical abortions. Cervical puncture or tear is a small risk in abortion. Damage or injury to cervix can cause vaginal bleeding which may need a simple surgical repair. It is less common when the procedure is done earlier in the pregnancy.
5. Damage to the womb: This is called perforation. This occurs in 1 in every 250 to 1,000 surgical abortions and less than 1 in 1,000 medical abortions carried out at 12 to 24 weeks. The puncturing or perforation of the uterus during abortion is a major complication. A major reason is the womb becomes softer than it normally is, when it is pregnant. In a surgical abortion, this would be due to improper use of instruments by untrained personnel (quacks). In extreme cases, removal of the uterus (hysterectomy) may be required.
6. Heavy bleeding: Slight bleeding after an abortion procedure is quite common and not serious, however, excessive bleeding requiring treatment is rare, occurring in 1 in 1000 abortions. Serious bleeding is that which needs a transfusion to correct. If you are under 13 weeks pregnant the risk of serious bleeding is 1 in 1,000. If you are over 20 weeks pregnant the risk is 4 in 1,000. If your cervix is torn or punctured, or your womb perforated this may lead to abnormal excessive bleeding. Depending on cause and severity, a blood transfusion may be required. Only rarely, is surgery needed.
7. Infertility: Having an abortion won't affect your chances of becoming pregnant and having normal pregnancies in the future. Many women are able to get pregnant immediately afterwards, so you should start using contraception right away if you don't want this to happen. However, there's a very small risk to your fertility and future pregnancies if you develop a womb infection that isn't treated promptly. The infection could spread to your fallopian tubes and ovaries – known as pelvic inflammatory disease (PID). This is very rare if the abortion is done by a qualified medical personnel. PID can increase the risk of infertility or ectopic pregnancy, where an egg implants itself outside of the womb.
8. Premature delivery: Having several abortions is associated with a slightly increased risk of giving birth prematurely, before the 37th week of pregnancy, in future pregnancies. Talk to your doctor or an abortion advice service for more information if you're concerned about the possible risks of an abortion.
9. Scars in the uterus lining: Asherman syndrome is the formation of scar tissue in the uterine cavity, causing adhesions. It is a rare condition, occurring in women who have had several dilatation and curettage (D&C) procedures. This is not necessarily for an abortion, as D&C procedures are also done for non-abortion reasons. Also severe pelvic infections unrelated to surgery may also lead to Asherman syndrome. Intrauterine adhesions can form after infection with tuberculosis or schistosomiasis.

Other complications of abortion (non-uterine)

10. Mental health: Women who have an abortion are no more likely to experience mental health problems than those who continue with their pregnancy. So generally speaking, women are not affected mentally. However, a very small proportion of women are plagued with guilt feelings after an abortion. These develop emotional and psychological problems including depression, grief, fear of disclosure, eating disorders, suicidal thoughts, anxiety and increased consumption of alcohol.
11. Breast cancer: There is no link between having an abortion and an increased risk of breast cancer.
12. Anaesthesia: The general anaesthesia in current use are safe. General anaesthesia with potential for serious complications are very rarely, if ever, used.
13. Pelvic inflammatory diseases: Womb infection could spread to the fallopian tubes and ovaries – PID (see above). This can be life threatening or lead to infertility and ectopic pregnancy after an abortion. A PID can be identified by the presence of persistent fever.
    But most infections are treated before they reach this stage and you'll often be given antibiotics before an abortion to reduce the risk of infection.

In general, abortions are safe in the hands of qualified medical personnel. However, they can be a disaster if not properly done, or if handled by a quack. So think and consider your choices before you go for an abortion.

Avoid abortion, unless it is obligatory to salvage your health; and if it must be done ensure it is by a qualified medical personnel. See also the separate article, Preventing Unsafe Abortions Amongst Women, for more.

Reference(s):
1). Guttmacher Institute (July 2020). Unintended Pregnancy and Abortion Worldwide. Available Online.
2). British Medical Association (September 2020). The Law and Ethics of Abortion. Available Online.
3). NICE Guidance [NG140] (September 2019). Abortion care. Available Online.
4). Royal College of Obstetricians and Gynaecologists (June 2015). Best practice in comprehensive abortion care. Available Online.
5). US National Library of Medicine. Medline Plus: Abortion. Available Oniline.
6). UK NHS Choices (June 2017). Abortion. Available Online.
7). US National Library of Medicine. Medline Plus: Asherman syndrome. Available Oniline.
8). Wikipedia. Dilation and curettage. Available Online.