When considering an abortion, pain is likely the number one concern. Some people will tell you that they experienced "a bad period", while others may say their cramping was far worse. Some people describe cramping similar to a strong period, while others experience more intense pain. While all abortions can be associated with varying levels of discomfort, there isn't a universal "level" of pain that every person will experience. The most severe cramping typically occurs after taking misoprostol, which causes the uterus to contract and pass the pregnancy. In contrast, Pain-management options may include medication, local anesthesia, and conscious or moderate sedation. WHO recommends against the routine use of general anesthesia.
In addition, the most intense pain doesn't need to continue throughout the length of the abortion. Typically, Pain often changes throughout the process. It may begin mildly, become stronger over several hours, and then ease after the pregnancy passes.
Why an Abortion Can Cause Pain
During an abortion with pills, misoprostol causes the uterine muscles to contract, helping the pregnancy pass through the cervix. You may feel this as cramping. These contractions help the pregnancy pass through the cervix. These contractions will be felt as cramping. It might not feel like normal menstrual cramping. Many people have reported feeling a dull ache in the lower part of their abdomen. Others report having strong wave-like sensations that build up, last briefly, and then disappear. Opening the cervix to empty the uterus during a surgical abortion may lead to additional pressure and discomfort. How much you feel depends partly on the pain relief or anesthesia being used.
What Does an Abortion With Pills Feel Like?
The intensity of cramping and bleeding during an abortion with pills varies from person to person and may increase later in pregnancy. From an abortion using pills vary in intensity from person to person. Sometimes the first symptom that you experience is a dull ache that later becomes more painful. The cramping is often worse during the most intense part of your abortion, as cramps may come closer together and become more severe, alongside increased bleeding and the possibility of passing blood clots or pregnancy tissue. This is typically when the physical discomfort reaches its peak for most people; however, this intense cramping does not have to continue throughout the entire process.
After Mifepristone: Often Not Much Happens
After taking mifepristone, you may feel much the same as usual.
Some people will be able to tell that something is going on because they may experience slight spotting or bleeding, nausea, or mild cramping.
Other than those minor symptoms, many people are able to go about their day without noticing much of a difference.
If you expected the abortion process to begin immediately, you may wonder whether the medicine is working.
Mifepristone is designed to block progesterone, a hormone needed to support the pregnancy.
Misoprostol Is Usually When the Cramps Begin
Misoprostol causes the uterus to contract and empty. This is usually when you'll notice the abortion process becoming more noticeable, with symptoms that include cramping, heavy bleeding (heavier than your normal menstrual flow), and passing blood clots and/or pregnancy tissue.
You might experience some of these symptoms as mild and gradual, but they could be quite severe and come in "waves" instead of causing constant pain. Some people report experiencing diarrhea, nausea, vomiting, chills, dizziness, and/or a low-grade fever after taking misoprostol. When stomach cramps, diarrhea, and uterine cramps occur simultaneously, it may be particularly exhausting for people having an abortion at home.
When the Pain Is Usually Strongest
Cramping may become more intense as the pregnancy is passing.
There could be a point when bleeding becomes heavier, contractions occur more regularly, and/or blood clots become larger.
After the pregnancy passes, cramping normally begins to decrease gradually over time.
It's possible to continue experiencing cramping after the pregnancy has passed; however, it can typically be more manageable.
How Long the Cramping Can Last
The strongest pain usually lasts for several hours and is rarely longer than that. Less severe cramping may come and go during the same day, as well as for several days after the initial symptoms. Cramping at this stage will likely feel similar to your normal menstrual cramps. Bleeding often lasts longer than the pain. In many cases, you will continue to bleed or spot for several weeks even though the strong cramping has stopped.
Surgical Abortion: A Different Kind of Experience
A surgical abortion (also known as a procedural abortion) usually takes less time than an abortion with medication because the pregnancy is removed during a medical procedure. How much you feel depends largely on the pain relief available to you. Pain-management options may include medication, a local anesthetic to numb your cervix before instruments are inserted into the uterus, and conscious or moderate sedation. General anesthesia is used less commonly but may be available in some settings
During the Procedure
If you are awake, you may experience a feeling of pressure or a pulling sensation in addition to cramping as your cervix is opened and the pregnancy is removed from the uterus. The cramping can be quite severe; however, it is usually relatively short-lived. Sedation may help you feel drowsy and less anxious, so you may remember less of the procedure than you would without sedation. General anesthesia will keep you asleep during the procedure.
If possible, ask your healthcare provider which pain-management options are available before the procedure.
The Hours Afterward
Period-like cramping is common after a surgical abortion. The cramping will generally be most intense directly after the procedure; however, as time progresses, it will usually decrease. In addition to cramping, some people experience bleeding or spotting after the procedure. Some people report feeling fine within a short amount of time after the procedure, while others may go home and need nothing but a warm shower, food, and a couple of quiet hours.
What Factors Can Affect Abortion Pain?
You can't predict exactly how your abortion will feel based on someone else's experience.
The length of the pregnancy and the type of procedure that was used for the abortion, in addition to your typical level of discomfort from menstrual cramps, prior pregnancy or birth experiences, and the way your body reacts to uterine contractions, can all affect how strong the cramps feel.
In addition, stress may make the experience even more uncomfortable. When you are stressed, fearful, or constantly worried about whether the next sensation is "normal," it may make it more difficult to relax while experiencing cramps.
This doesn't mean the discomfort isn't real. It simply means that feeling comfortable, having privacy, having clear information and a plan for managing pain can all make a difference.
Managing Pain During an Abortion
You do not have to wait until the pain becomes unbearable before doing something about it.
If you are having an abortion with pills at home, prepare your pain relief before taking misoprostol. It is much easier to reach for something that is already beside you than to start looking for medicine while you are bleeding and having strong cramps.
Medicines Used for Pain Relief
Non-steroidal anti-inflammatory medicines, or NSAIDs, such as ibuprofen, are commonly recommended for abortion pain when they are safe for you to use. The World Health Organization recommends routinely offering pain management during medical abortion.
Follow the instructions from your healthcare provider or trusted abortion service about what medicine to take and when.
If NSAIDs such as ibuprofen are not safe for you, acetaminophen or paracetamol may be another option. If you have allergies, stomach ulcers, kidney problems, another medical condition, or take other medicines, speak with a healthcare professional before choosing pain relief. You can also contact the safe2choose counselors for information and support.
Avoid using aspirin for abortion pain unless a healthcare professional has specifically advised you to take it, because aspirin can increase bleeding.
Small Things That Can Make the Hours Easier
Heat can help with cramps. Try placing a heating pad or hot water bottle on your lower abdomen or lower back.
Some people prefer lying curled slightly on their side. Others feel better walking around the room between stronger cramps or standing under a warm shower.
Keep water within reach. If you can eat, simple food such as toast, crackers, fruit, or soup may be easier than a heavy meal, especially if misoprostol is making you nauseous.
There is no position you need to stay in for the abortion to work, so move around and change positions whenever you want.
Preparing Before the Abortion Starts
A bit of preparation can help reduce some of the minor annoyances that may occur during these already hectic few hours.
If you are using abortion pills at home, prepare your space before taking misoprostol.
First, set up your space.
Find a place where you have privacy and easy access to a bathroom.
Have sanitary pads, pain relief medication, drinking water, snacks/light meals, comfortable clothing, a heating pad/hot water bottle, tissues, your phone, and a charger nearby.
It is also possible to watch a familiar show or series, play a podcast, or create a playlist before starting.
Support and a Plan for Getting Care
You do not need to have someone in the same room with you if you would rather have privacy. You may prefer having a partner or friend nearby, or simply letting someone you trust know what is happening so they can help you get medical care if needed.
It can help to know where you could seek medical care if needed. Have your emergency contact numbers (the number of your abortion provider, the name and address of the clinic or provider where you obtained your medication, etc.) readily available.
Warning Signs That Need Medical Attention
- Very heavy bleeding, such as soaking through more than two large sanitary pads per hour for two consecutive hours.
- A fever or flu-like symptoms that last more than 24 hours after taking misoprostol.
- Vaginal discharge that looks or smells unusual.
- Severe or increasing pain that does not improve with pain medication.
- Severe pain on one side of the abdomen, especially with dizziness, fainting, or shoulder-tip pain. These symptoms can be signs of an ectopic pregnancy and require urgent medical evaluation.
Is It Normal to Have Very Little Pain?
Yes. Many people experience significantly less pain than anticipated.
People who take mifepristone can expect minimal or no symptoms, or only very mild symptoms. People who use misoprostol are likely to have varying experiences with the amount of cramping.
Use the bleeding pattern and other signs to assess how the abortion is progressing rather than relying solely on cramping. If there is no bleeding after taking misoprostol as instructed when bleeding would normally be expected, contact your abortion provider or an abortion support service.
Does Stronger Pain Mean the Abortion Worked?
No. The level of pain from an abortion doesn't determine whether the abortion will be successful.
One person may experience severe cramping for several hours, while another may need pain medication and still experience relatively little discomfort.
Pain may be present during an abortion due to uterine contractions as the abortion progresses; however, it cannot tell you how much of the pregnancy has passed or whether the abortion is complete.
A decrease in pregnancy symptoms can be reassuring, but the clearest way to confirm that the abortion worked is to take a home pregnancy test four to five weeks after using the pills. Testing sooner may still give a positive result even after a successful abortion. If the test is still positive after five weeks, your pregnancy symptoms continue, or you are unsure about anything, contact the safe2choose counselors for free and confidential support.
