Procedural abortion, what happens at the clinic

In a procedural abortion a trained clinician removes the pregnancy from the uterus through the cervix, with instruments and gentle suction. There are no cuts and no stitches. The World Health Organization describes procedural abortion as safe when it is performed by a trained provider in line with its guideline, and national medical societies such as ACOG, RCOG, FIGO, CNGOF and DGGG publish clinical guidance on how it is done.

Which technique is used depends mainly on how many weeks the pregnancy has lasted, counted from the first day of the last period.

• Vacuum aspiration, the usual technique earlier in pregnancy
• Dilation and evacuation (D&E), the usual technique later in pregnancy
• Both take place in a clinic or hospital and are usually completed in one visit

The WHO Abortion care guideline (2022) recommends vacuum aspiration for procedural abortion before 14 weeks of pregnancy. The clinician gently opens the cervix and uses a thin tube attached to a manual or electric suction device to empty the uterus. The procedure itself usually takes around five to ten minutes. WHO advises against sharp curettage, an older technique, as a routine method.

Before the procedure the clinician may prepare the cervix with medicine, depending on the stage of pregnancy and local protocol. Afterwards you rest in a recovery area until you feel well enough to leave, which is often within an hour or two.

From 14 weeks of pregnancy, WHO describes dilation and evacuation as a recommended method alongside medication abortion. The cervix is prepared and opened more widely, often some hours or a day in advance, and the clinician then empties the uterus with suction and instruments. The procedure takes longer than vacuum aspiration and is performed by providers with specific training and experience.

Because preparation can start the day before, a D&E sometimes involves two visits. Fewer clinics offer it at later stages, so the place of care can be further away. Our abortion gestational limits guide explains how limits differ between countries, and the travel for abortion guide covers care abroad.

Pain control is part of every procedural abortion. The options depend on the clinic, the stage of pregnancy, your health and your preference, and you choose them together with the care team.

• Local anesthesia, an injection near the cervix, often with pain medicine taken beforehand
• Light or moderate sedation through a vein, so that you are relaxed and drowsy but breathing on your own
• Deep sedation or general anesthesia, offered by some clinics and more common for a D&E

With sedation or general anesthesia you need someone to take you home and you should not drive for the rest of the day. The clinic tells you whether to eat or drink beforehand.

A visit at a legal provider usually follows the same steps, although the law in some countries adds counseling, a waiting period or a second appointment. The law card for each country lists those requirements with the source.

Before the procedure

Staff confirm the pregnancy and the number of weeks, often with an ultrasound, ask about your health, medicines and allergies, explain the procedure and the pain relief options and ask for your consent. You can ask questions at every step and you can change your mind.

During the procedure

You lie on an examination table, as for a gynecological exam. A clinician and an assistant are present, and many clinics allow a support person nearby before and after. Cramping is common during the suction.

After the procedure

You rest while staff check your bleeding, blood pressure and how you feel. You receive written aftercare information, a number to call at any hour and, if you want it, contraception.

Most people return to their usual activities within a day or two. It is common to have period-like cramps for a few days and light bleeding or spotting for up to two weeks, sometimes none at all. The next period usually comes four to six weeks later.

Contact the clinic or your local emergency number, such as 112 in the European Union or 911 in the United States and Canada, if you have very heavy bleeding, a fever that lasts, severe pain that pain relief does not ease, discharge with a strong unpleasant smell or you feel very unwell. Our abortion aftercare guide covers the days and weeks after.

• Usual activities within a day or two
• Cramping for a few days, light bleeding for up to two weeks
• WHO does not require a routine follow-up visit after an uncomplicated procedure
• Contraception, including an IUD or implant, can often be started at the same visit

A procedural abortion is quick, happens in a clinic with staff present and is usually finished in one visit. A medication abortion avoids instruments and can partly take place at home, but takes longer. Both are described as safe by WHO. The right option depends on the stage of pregnancy, your health, your preferences and what is legal and available near you, and you decide it together with a doctor.

• World Health Organization, Abortion care guideline (2022)
• American College of Obstetricians and Gynecologists (ACOG), clinical guidance on procedural abortion
• Royal College of Obstetricians and Gynaecologists (RCOG), guidance on abortion care
• International Federation of Gynecology and Obstetrics (FIGO), recommendations on abortion care

This page is general information and not medical advice. Medical decisions are made together with a doctor. Read our sources and editorial policy.