Do abortions hurt and what to expect

Abortion is a safe and effective way to end a pregnancy, but like many medical treatments, it can come with a range of short term side effects—including pain and discomfort. Understanding what to expect can help you prepare for the process and take care of yourself. History and medicine haven’t done the best job at validating gynecologic or pelvic pain, let alone treating it. There are well-documented gender biases when it comes to taking pain seriously for people who can become pregnant, and it is all too common to feel medically gaslit and told that pain is “just hormonal,”  “in your head,” or that “you’re just being emotional.” 

The experience of pain is deeply personal, and differs from person to person. As with many medical procedures, some people might experience pain with their medication abortion, while others do not. There is a strong mental and emotional component to all people’s pain, and at Hey Jane we take pain seriously and want to be sure to prepare our patients as best we can for what to expect. Here are some general things to keep in mind as you research or plan for potential pain with an abortion.

Are abortions painful?

Sometimes, but not always! Every person reacts to pain differently, and what may be slightly uncomfortable for one person may be severely painful for another. The level of pain experienced during an abortion can depend on several factors: the type of abortion, how far along the pregnancy is, access to pain relievers like ibuprofen or Tylenol, and pain tolerance or past experiences.

Abortion pills (medication)

Abortion pills may cause minimal or no pain, brief but intense pain (usually right before passing a clot or tissue), off-and-on pain (similar to contractions), or consistent pain for one or more hours. Pain is a spectrum, and it’s difficult to predict.

People don’t usually report pain when they take the first medication of treatment, mifepristone, which blocks the hormone progesterone and stops a pregnancy from growing. Most patients experience pain after taking the misoprostol pills, the next step of treatment (if they do have pain at all). 

Misoprostol softens the cervix and causes the walls of the uterus to cramp, helping to empty it. This cramping is the main source of pain during a medication abortion, and is most intense right before passing blood clots and tissue. Some patients also report that during this more intense part of treatment, the pain can feel like it shoots into their anus or rectum. 

At Hey Jane, our patients' experiences with pain range from feeling fine during treatment while working 16-hour shifts, to describing their pain as the worst period cramps they’ve ever had. If you’re worried about pain, you can always reach out to a trusted member of your care team to make sure you have comfort medicines or techniques to reduce your symptoms.

Vacuum aspiration (in-clinic)

The pain experienced during vacuum aspiration can feel more intense than a medication abortion, but for a much shorter amount of time. Once the cervix is dilated and gentle suction removes the pregnancy tissue, most people feel a major improvement after 5 to 20 minutes. There is some pain and discomfort when a speculum is inserted into the vagina for better visibility, and if you have a local anesthetic injected into your cervix before the numbing kicks in. There can also be cramping after the procedure for a few weeks as the uterus shrinks back to normal, but it should get less uncomfortable with each day.

Dilations & evacuation (in-clinic)

A D&E abortion is typically performed during the second trimester (after 13 weeks) and can be more painful than other methods because the cervix (opening of the uterus) needs to stretch more and be suctioned for longer due to how far along the pregnancy is. The pain can feel like intense or severe menstrual cramps, but varies with each person. Similar to a vacuum aspiration, the cervix is dilated before using a combination of gentle suction and scraping to remove the pregnancy tissue. Some people experience discomfort when a speculum is inserted into the vagina, but you can always let your provider know if you need to take a break before they try inserting it again. There can also be pain and discomfort if you have a local anesthetic injected into the cervix, and as the cervix is dilated. There may also be cramping for a few weeks after the procedure as the uterus returns to its typical non-pregnant size, but it should get better each day.

Are in-clinic or medication abortions more painful?

Both methods come with some pain, but in different ways. In-clinic (procedural) abortions are usually more intense but for a shorter, and more predictable, amount of time. Medication abortion pain may be less intense overall, but can ebb and flow with peaks and valleys and last longer than a procedural abortion (which are usually 5-10 minutes). 

While pain is one of the ways you can evaluate what type of abortion to have, other factors like how fast you can get treatment, cost, and logistics of transportation and child care can also be important. The needs of a parent getting an abortion may be different than, say, a college student or someone traveling to a state where abortion is more accessible.

How long does the pain last after an abortion?

For a medication abortion, the pain usually peaks 2.5-4 hours after taking the misoprostol. Once the products of conception (blood clots and tissue) have passed, however, people tend to feel near immediate relief. The pain should completely dissipate after 12-24 hours.

For procedural abortions performed in a clinic, cramping can last for a few weeks as the uterus returns to its typical form without pregnancy. This discomfort should improve as the days and weeks go by. If it doesn’t, you should contact your provider.

Common side effects of abortion

Both medication and procedural abortions can cause side effects. Knowing what to expect can help you prepare and manage them effectively.

Abortion pills (medication)

• Abdominal or stomach pain or uterine cramping
• Back pain
• Diarrhea
• Dizziness
• Headache
• Nausea or vomiting

In-clinic abortions (procedural)

• Nausea
• Vomiting
• Fever
• Sweating
• Dizziness
• Cramping
• Bleeding
• Blood clots

How to manage abortion pain

Everyone is different when it comes to pain and what helps. With all medications and supplements remember to always check the label and use as directed. The amount of medicines that have Tylenol (acetaminophen) as an ingredient might surprise you! If you have any questions, you can ask a trusted provider. 

To minimize the pain during and after an abortion, a person can try:

1. Taking over-the-counter (OTC) pain relief medications in accordance with labeling, such as:

• Ibuprofen: This is the medication that we have the best evidence on for helping medication abortion related pain. It is included in most Hey Jane shipments unless Tylenol is requested.
• Tylenol: This tends to be safe for most people to take and evidence suggests that, while it doesn’t work quite as well as ibuprofen, it can provide a lot of relief.  It can be included in your Hey Jane shipment instead of, or in addition to, ibuprofen.
• A combination of ibuprofen and acetaminophen (Tylenol): This is safe if you tolerate both medicines, as Tylenol goes through your liver and ibuprofen processes through your kidneys.

2. Taking opioid pain medications as directed by your in-person provide

While studies have shown that taking prescription-strength ibuprofen and Tylenol together are as effective as opioid medications for pain during a medication abortion, everyone’s experience is different. Some people might feel their pain experience would be improved with opioid pain medications. Due to controlled substance regulations, we are unable to prescribe this category of pain medications. However, if you have them prescribed to you it is safe to take them as directed with your medication abortion treatment. Opioid pain medications are safe to take in combination with ibuprofen and Tylenol, just make sure to double check that they are not already mixed with ibuprofen or Tylenol (acetaminophen) as some brands of opioid medications are. Because opioid pain medications can be highly addictive, it is very important to follow the instructions of your in-person provider and only take as much medication as you need to control your pain.

3. Smoking or ingesting cannabinoid products (e.g. marijuana or CBD) where permitted by law

Some studies suggest that a sizable proportion of people in states with progressive marijuana policies use marijuana during first-trimester medication abortion and find it helpful in managing pain. These studies also suggest that marijuana can help decrease nausea for these patients, which we know can contribute to increased pain and discomfort. Marijuana is subject to different restrictions in different states, so it is important to confirm what is permitted in your state before you use it.

4. A specific diet or supplements, such as:

• Avoiding caffeine, which can narrow blood vessels—yes, even in the uterus! It can also dehydrate you a little.
• Eating anti-inflammatory foods like leafy green vegetables, ginger, and nuts, and drinking green tea.
• Taking omega-3 polyunsaturated fatty acid supplements to reduce inflammation.
• Taking vitamin D or magnesium supplements, which may help reduce inflammation.

5. Using pain-relieving tools, such as:

• A heating pad or hot water bottle on your lower back or abdomen.
• A transcutaneous electrical nerve stimulation (TENS) unit that helps raise the threshold for pain signals (resulting in a lower perception of pain) and stimulate the release of endorphins from the peripheral nerves and the spinal cord to reduce pain.

5. Certain activities, such as:

• Getting extra rest
• Massaging your lower back and abdomen
• Yoga
• Taking a warm bath
• Relaxation or breathing exercises
• Walking
• Exercising regularly (studies have found that people who exercise tend to have less menstrual pain)

6. Treatments, such as:

• Acupuncture
• Acupressure (can be done on your own or by a professional)

When to seek help for pain during a medication abortion

No one likes to be in pain, but when you feel the cramping remember it means the medications are doing their job—especially if this pain begins after taking the misoprostol. Remember that you know your body best, and you can always reach out to your provider for help with pain management.

Pain and ectopic pregnancies 

There are times when pain is not a good sign. Please watch out for:

• Severe one-sided belly pain
• Shoulder pain
• Feeling lightheaded or dizzy

While rare, these can be signs of an ectopic pregnancy (a pregnancy outside of the uterus, usually in the tubes) which requires evaluation and treatment in an emergency room as soon as possible as it can be life threatening. 

If you develop pain that does not get better with pain medication, please let your care team know and consider going to your nearest emergency room. The Hey Jane Treatment Guide provides more detailed guidance about what to do about pain which may be indicative of a medical emergency.