Can an Abortion Be Done in a Doctor's Office? What to Expect

When your pregnancy terminates on its own before 20 weeks of pregnancy, this is called a miscarriage or a spontaneous abortion. 

When you end your pregnancy intentionally through medications or surgery, it is called an induced abortion. You may choose to go for induced abortion for either of the two reasons.

• To end an unwanted pregnancy
• If the pregnancy is associated with complications, such as danger to your health or problems in the baby

Medical abortion involves taking one of the following medicines:

• Oral mifepristone and misoprostol: Most common type of medical abortion. 
• Oral mifepristone and vaginal, buccal, or sublingual misoprostol: Involves taking a slowly dissolving misoprostol pill vaginally, buccally (in your mouth between your teeth and cheek), or sublingually (under your tongue).
• Methotrexate and vaginal misoprostol: Mainly used in ectopic pregnancies, when pregnancy occurs outside the uterus. Methotrexate is administered as an injection or vaginally, and misoprostol is later inserted into the vagina. 
• Vaginal misoprostol: May be prescribed when pregnancy is less than 9 weeks along.

Here is what to expect during a medical abortion:

• During the initial visit, mifepristone is administered. Mifepristone is a pill that blocks progesterone, which a hormone needed to maintain pregnancy. It works on the lining of the womb (uterus) by making it so thin that it breaks down.
• After a few days, you return to the doctor’s office and are administered misoprostol. Misoprostol makes the uterus contract and expels the pregnancy tissue or the fetus. You may experience bleeding for about 2 weeks after taking misoprostol.
• Your follow-up visit occurs after about 2 weeks. Your doctor checks if the medication was effective in inducing the abortion. You may have spotting for several weeks.

Depending on where you live, the number of times you need to visit the doctor and the tests you will be asked to undergo can vary.

A medical abortion can cause severe abdominal pain along with other symptoms, such as nausea, vomiting, or diarrhea. You can take pain medications, such as acetaminophen or ibuprofen, to alleviate the pain. Any bleeding will be heavier than your normal period. 

Contact your doctor if you experience:

• Excessive bleeding (requiring more than 2 sanitary pads an hour)
• Fever above 100 F for more than 4 hours
• No pain relief after taking acetaminophen or ibuprofen

Mifepristone is 97% effective at ending pregnancies. If medical abortion fails, surgical abortion is planned.

Surgical abortion involves removing the fetus and placenta from the uterus and can be performed via the following methods, which involve the use of suction to evacuate the womb:

• Manual vacuum aspiration (MVA): Usually done in the first 12 weeks of pregnancy.
• Dilatation and evacuation (D&E): Can be done after the first month of pregnancy and before the end of the 20th week.

Surgical abortion can take anywhere between 10-20 minutes. Here is what to expect during a surgical abortion:

• Before the procedure, sedatives may be administered to help you stay relaxed during the procedure.
• Next, a numbing medicine is injected into the cervix.
• The cervix is stretched with the help of dilating rods.
• A tube is inserted through the vagina to reach the uterus. It is connected to a vacuum pump or a suction machine, which suctions out the pregnancy tissue.
• Your doctor may use a small surgical tool called a curette to remove any remaining tissue in the uterus.

You will likely be discharged on the same day. If you were administered sedatives, you will need someone to drive you home or accompany you.

Similar to medical abortion, surgical abortion can cause strong menstrual cramps. Rest and acetaminophen or ibuprofen are recommended for recovery and pain relief.

Surgical abortion is 100% effective at terminating a pregnancy.

Induced abortions are generally safe if done during the first or second trimesters. 

During the early stages of pregnancy, the risk of life-threatening complications, such as uncontrolled bleeding, are lower. The procedures are unlikely to affect your ability to conceive in subsequent pregnancies.