Abortion options by trimester
Abortions are legal throughout much of the world, but laws vary.
- 61 countries, including much of Europe, allow abortions without any restrictions.
- 26 countries ban abortions altogether, with no exceptions.
- The remaining countries allow abortions with restrictions, such as to save the mother’s life or protect her health.
Abortion is legal in the United States during the first and second trimesters of pregnancy. Most abortions are done during the first trimester of pregnancy. The first trimester refers to the first 12 weeks of pregnancy.
Some states allow abortions until the 24th week, which is at the very end of the second trimester. Others prohibit it after 20 weeks.
Third-trimester abortions are often done only if the mother’s or the baby’s life is in danger.
A medical abortion is performed through taking two medications in pill-form: mifepristone (Mifeprex) and misoprostol (Cytotec). These two drugs work together to end a pregnancy.
You can use this method until your 10th week of pregnancy.
A medical abortion isn’t for everyone. Your doctor might suggest that you avoid this method if:
- your pregnancy has implanted outside of the uterus (ectopic pregnancy)
- you’re allergic to mifepristone or misoprostol
- you have a bleeding disorder or you take blood thinners
- you have severe liver, kidney, or lung disease
- you have an intrauterine device (IUD)
- you’ve been taking corticosteroid drugs for a long time
A doctor or nurse will give you mifepristone in the office or clinic. This drug blocks the hormone progesterone, which the embryo needs to implant in your uterus and grow.
You’ll get misoprostol to take home with you. You take it a few hours or up to 4 days after the first pill. You can either take the medicine by mouth or by placing the pills into your vagina. Misoprostol makes your uterus contract to push out the pregnancy tissue.
You’ll start to cramp and bleed heavily 1 to 4 hours after taking misoprostol.
Other symptoms after taking the pills include:
- passing small blood clots
- nausea and vomiting
Most people pass the pregnancy within 4 to 5 hours after taking the pills. Others take up to 2 days. You might want to take a couple of days off from work because of the discomfort.
Your periods should restart about 4 to 6 weeks after your abortion.
You’ll start to ovulate about 3 weeks after you take the medicine. Once you ovulate, you can get pregnant again. Your doctor might recommend that you wait to have sex for a week or two after your abortion.
A medical abortion shouldn’t affect your ability to get pregnant in the future.
The cost of the abortion pill varies from clinic to clinic. Expect to pay between $300 and $800. Some insurance companies will cover the cost.
Methotrexate and misoprostol (MTX) is an abortion method you can use in your first 7 weeks of pregnancy.
Methotrexate is a cancer drug. Just as it stops cancer cells from multiplying, it stops cells in the embryo from multiplying. Misoprostol then contracts the uterus to release its contents.
This method takes longer than mifepristone and misoprostol, and it’s rarely used for planned abortions. Doctors mainly use it for women who have a pregnancy outside their uterus, an ectopic pregnancy. An ectopic pregnancy can be life-threatening if it continues.
You shouldn’t use this method if:
- you have liver, kidney, or inflammatory bowel disease
- you get seizures more than once a week
- you take blood thinners
- you’re allergic to methotrexate or misoprostol
- you have a blood clotting problem
- you have severe anemia
- you have an IUD
You get methotrexate in your doctor’s office. It comes as a shot or a pill that you take by mouth. You’ll take the misoprostol pills 4 to 6 days later at home, either by mouth or by inserting them into your vagina.
The abortion will start within 1 to 12 hours after you take the medicine. You’ll have cramps and bleeding. The bleeding may be heavy for 4 to 8 hours.
You may want to take a few days off from work because of the discomfort.
It can take a few days or weeks for the abortion to finish. Some people take up to a month. In 1 to 2 percent of people, the medicine won’t work. If it doesn’t work, you’ll need to have a surgical abortion.
Side effects from methotrexate and misoprostol include:
- nausea and vomiting
- low-grade fever
Your periods should restart a month or two after your abortion.
The abortion shouldn’t affect your ability to get pregnant in the future. Your doctor might advise you to wait a week or two before having sex again.
The cost of methotrexate and misoprostol can range from $300 to $1,000. Some insurance companies will cover it.
Vacuum aspiration is done during the first trimester (first 12 weeks) or early second trimester (12 to 16 weeks) of pregnancy. It’s also called suction aspiration.
Some people choose vacuum aspiration as the main method for having an abortion. Others need it after a medical abortion fails to end their pregnancy.
This method might not be right for you if you have:
- an abnormally shaped or functioning uterus
- blood clotting disorders
- a pelvic infection
- serious health problems
Vacuum aspiration uses gentle suction to pull the fetus and placenta out of the uterus. You’ll have this procedure at a clinic, doctor’s office, or hospital.
Vacuum aspiration isn’t painful, but you may feel some cramping because your uterus will contract as the tissue is removed.
The procedure only lasts 5 to 10 minutes. You may need to stay at the clinic for a few hours afterward to make sure the abortion is complete. Some clinics will do your procedure on the same day as your first appointment.
Side effects after a vacuum aspiration procedure can include:
- bleeding or spotting
You might need to take a day or two off from work because of the discomfort.
Avoid sex for at least a week after the procedure. Your periods should return about 4 to 6 weeks afterward.
Having this type of abortion shouldn’t affect your ability to get pregnant in the future. Your doctor might advise you to use birth control to prevent a pregnancy in the first few weeks after your abortion.
A vacuum abortion costs between $600 and $1,000.
The further along you are in your pregnancy, the more the procedure will cost. Some insurance companies will cover part or all of the cost.
Dilation and evacuation (D&E) is an abortion procedure that’s used in the second trimester,
It’s usually recommended for someone who’s delayed getting an abortion, or for someone who chooses to end a pregnancy because the fetus has a severe abnormality or medical problem.
D&E uses a combination of vacuum aspiration, forceps, and dilation and curettage (D and C). The procedure may be done over a two-day period.
On the first day, the doctor dilates (or widens) your cervix to make it easier to remove the pregnancy tissue. On the second day, the doctor uses forceps to remove the fetus and placenta, a tube to suction out the uterus, and a scoop-like instrument called a curette to scrape out the uterine lining.
You’ll have this procedure in a hospital or a clinic. A D&E can be painful, but your doctor can give you a numbing medicine to prevent discomfort.
The procedure takes less than 30 minutes. You can go home on the same day.
Side effects from a D&E include:
Side effects can last for two weeks after the procedure. You may need to take off a few days from work due to discomfort.
You’ll need to wait for about two weeks to have sex after the procedure. Avoid heavy exercise for one week.
Your periods should restart 4 to 8 weeks after the procedure. Having a D&E shouldn’t affect your chances of getting pregnant in the future. Ask your doctor how long to wait before trying to conceive afterward.
A D&E can cost more than $1,500. The price depends on where you have it done and how far along in your pregnancy you are.
Some health insurance plans will cover part or all of the cost.
An induction abortion is done in the second trimester of pregnancy. It may be an option if you’re past the 24th week of pregnancy and can no longer get a D&E procedure.
This method is rarely used in the United States.
You’ll get medicine that puts you into labor. Your uterus will contract to release the pregnancy. Your provider might also use suction or a spoon-like instrument called a curette to clean out your uterus.
This procedure is done in a hospital or specialized clinic. You’ll feel intense cramps as your uterus contracts. Your healthcare provider will give you sedatives or an epidural to relieve the pain.
It can take several hours or more than a day to complete the procedure.
Side effects from an induction abortion can include:
- nausea and vomiting
You may need to take a day or two off from work to recover afterward.
You’ll need to avoid sex for 2 to 6 weeks after your procedure. Ask your doctor how long to wait. You should be able to go back to your regular activities within a couple of weeks.
Your period should restart within a month or two after the procedure. Having an induction abortion shouldn’t affect your ability to get pregnant in the future. Ask your doctor how long to wait before trying to conceive again.
Because this procedure is performed late in the pregnancy, it can cost $3,000 or more. Some health insurance companies may cover the cost.
A late-term abortion can have different meanings.
Some consider an abortion ‘late-term’ if it’s done after the 20th week of pregnancy. Others say it’s when it’s done in the third trimester. Still others consider it late when the fetus is viable, meaning it could survive outside the womb.
You may have a late abortion if:
- you had trouble deciding whether to have an abortion
- financial reasons kept you from having the procedure earlier
- you’re underage and afraid to tell your parents
- the fetus isn’t viable or has a serious medical condition
- the pregnancy jeopardizes your health
Procedures that can be done in the third trimester include:
- induction abortion
Complications are rare for late-term abortions. But the risks increase the further along you are in your pregnancy.
Even if an abortion is performed late in your pregnancy, it shouldn’t affect your ability to conceive in the future.
Emergency contraception isn’t an abortion pill. If you’re already pregnant, it won’t end the pregnancy.
You can buy emergency contraception without a prescription at a drugstore. You don’t need to be a certain age to buy it.
Contraception after an abortion
Having an abortion will end your current pregnancy. If you’re sexually active and don’t desire another pregnancy, you should talk with your doctor about contraception options.
This is important to do before you begin having sex after the abortion. There are many options available, many of which don’t require a daily pill.
Talk with your doctor to see which method would be best for you and how soon you can start it after the abortion.
You can get an abortion from a specialized clinic, hospital, or, if you’re in the United States, a Planned Parenthood health center. Not all doctors offer this service.
Although abortion is legal in every state, it’s not always easy to find a provider. Some states have fewer abortion providers than others. A few states, like Kentucky, have only one clinic.
To find a qualified abortion provider in your area, visit these resources:
If an abortion clinic isn’t available where you live, you might have to travel to another state.
Some providers now offer medical abortions over the phone or computer through telemedicine. Yet 19 states require the doctor who performs the abortion to be in the room during the procedure.
Mental health resources
It’s normal to feel a range of emotions after an abortion. You might feel regret, relief, guilt, or shame. Some people may become depressed afterward. Each person reacts differently.
To find support after an abortion, reach out to these organizations:
If you’re having trouble recovering emotionally, talk to a trained psychologist, therapist, or social worker.
An abortion can affect your partner, too. Include them in the discussion or encourage them to also seek support.