There are two main options for people seeking an abortion. Which is best for you depends on your needs and preferences.
Aspiration Versus Medication Abortion
Reasons to choose an aspiration (suction) abortion
- May require fewer office visits.
- Takes a short amount of time (5 to 10 minutes).
- Has a lower risk of an incomplete result compared with medication.
- People don’t typically experience heavy bleeding at home.
Reasons to choose a medication abortion
- Can be used in the earliest weeks of pregnancy.
- Requires no in-person procedures or anesthesia.
- May offer more privacy.
- May provide a greater sense of control.
- May feel more natural than aspiration.
Sometimes it can be completed without a clinic visit. (UCSF requires an initial evaluation that can be completed remotely, along with visiting the clinic in-person to sign forms and obtain the medications.)
Medication abortion can be received through the mail. Four service providers in California are Hey Jane, Choix, FPA Women's Health, and Women’s Health Specialists. The nonprofit Plan C has a search tool to help you find other abortion pill services.
Comparing methods for first-trimester abortion
| Aspiration (suction) abortion | Medication abortion | |
|---|---|---|
| What is it? | A doctor uses a vacuum to empty your uterus. | A combination of medications ends the pregnancy and causes the lining of your uterus to shed. |
| How does it work? | In the clinic, a doctor places a speculum in your vagina. The doctor then numbs your cervix (the outer end of the uterus) and gradually dilates (widens) your cervix to place a tube into your uterus. Then an electric machine or handheld syringe is connected to the tube to apply suction, which empties your uterus. | You first swallow a medication that halts the pregnancy. One to three days later, you take another medication (either by dissolving it inside your cheeks or by inserting it into your vagina) that causes your uterus to have contractions. You will experience cramping and bleeding. |
| How effective is it? | Aspiration abortions are successful 98% of the time. About 2% of people need a repeat procedure or additional intervention. If the procedure is conducted before your pregnancy is visible on ultrasound, you may need a blood test to confirm success. |
Medication abortions are successful 95 to 97% of the time. About 3 to 5% of patients need an additional aspiration procedure due to ongoing pregnancy, prolonged or excessive bleeding, or preference. There are several ways to confirm the abortion was successful, including your symptoms, a home pregnancy test, blood tests or a repeat ultrasound. |
| How far along in my pregnancy can I be? | The range is from as soon as you know you’re pregnant (usually about four weeks) to 14 weeks since the first day of your last menstrual cycle. | The range is as soon as you know you’re pregnant (usually about four weeks) to 10 or 11 weeks since the first day of your last menstrual period. |
| How many clinic visits are required? | Usually just one visit is needed for health education, a physical exam and the procedure itself. You may return to the clinic if you need follow-up care. | Zero to two visits. Initial evaluation can be done in person at the clinic or remotely by video. |
| How long is each appointment? | If you are between four and 10 weeks pregnant, the appointment takes approximately three hours. Later-stage abortions usually require longer or multiple visits. | The first evaluation and discussion last about an hour. |
| Is it painful? | Most people experience cramping during or after the short procedure. | Most people experience strong cramps for one to four hours. Some also experience nausea or other side effects. |
| What kind of pain control will I receive? | In the clinic, the doctor applies numbing medication (local anesthetic) to your cervix and uterus. We recommend ibuprofen (Advil) and acetaminophen (Tylenol) for everyone who can take them safely. Most people also take an oral medication, such as lorazepam (Ativan), for anxiety. If the procedure is done in an operating room (OR), patients can have IV sedation so that they sleep during the procedure. | Most people are satisfied with over-the-counter pain medications, such as ibuprofen (Advil) or acetaminophen (Tylenol). We can prescribe a small number of narcotic pills (oxycodone), if requested. |
| How much will I bleed? | You will likely have light bleeding at home after the procedure for two to three weeks. | You will likely bleed heavily for several hours after taking the second pill. For the next two to three weeks, you may also have blood flow similar to an average day of your period. |
| May I bring a support person with me? | Yes. One friend, partner or family member may accompany you during health education and the procedure itself. If it takes place in the OR, your support person can be with you only beforehand. | Yes. One friend, partner or family member may accompany you during your visit. You should have someone with you at home on the day you take the second medication. |
| Do I need to have somebody with me? | If you opt to take anxiety medication or a narcotic, or if your procedure is in the OR, you need to have someone take you home. | While you’re taking the medications, we recommend you have someone with you and access to a telephone, in case you have any questions or an emergency. |
Comparing risks and side effects
Early abortion is much safer than continuing a pregnancy. Your doctor will explain potential risks and side effects during your appointment. You will be able to express your concerns and ask questions before consenting to the procedure or receiving the medication.
| Aspiration (suction) abortion | Medication abortion | |
|---|---|---|
| Is there a risk of injury? | When the medical instruments and suction are placed in your vagina and uterus, there is a very low risk of cervical injury or uterine perforation. This could require further care or surgery. | Unless you require an additional procedure, there is no risk of injury with a medication abortion. |
| Is there a risk of infection? | There is a small chance of infection after aspiration abortion. You will be given antibiotics, which reduce the infection risk from low to very low. | The chance of infection after medication abortion is very low. We usually don’t recommend prophylactic (preventive) antibiotics. |
| What should I do if I have pain during the procedure? | Let us know. A member of our staff will be with you during the entire procedure and will monitor you during recovery. Doctors and other staff members will manage your side effects, such as pain, cramping or bleeding, as they occur. | Since you’ll be taking the pills at home, you’ll be largely responsible for your own care. We’ll give you written instructions on managing pain and other side effects, as well as phone numbers to call if you have questions. |
| Will I be able to have children in the future? | There is no evidence that aspiration abortion affects a person’s ability to have a baby in the future. | There is no evidence that medication abortion affects a person’s ability to have a baby in the future. |
For more information on abortion safety, see this handout from the UCSF Advancing New Standards in Reproductive Health (ANSIRH) Program or this book by the National Academies of Sciences, Engineering and Medicine.
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.
