What happens in the first few days after the abortion?

The level of pain and bleeding varies from woman to woman. In the first few days it's common to have minor pain that can be treated with painkillers. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or diclofenac are effective here. Some women need stronger painkillers. Paracetamol (acetaminophen) doesn't help much. Many women find a hot-water bottle or a heating pad on their stomach soothing.

It is normal to have some bleeding after an abortion. About four to six days after a surgical abortion, a lot of women have an episode of severe pain and heavy bleeding that lasts several hours. The blood may contain clots. That might be followed by minor bleeding for another few days.

The bleeding tends to be heavier after a medication abortion than after a surgical abortion. It lasts nine days on average and can be a bit heavier than during a normal period. Very heavy bleeding is not common, though. In rare cases, women may experience light bleeding for several weeks.

When can you return to your usual activities?

Experts recommend that you rest for the first few days after the abortion. You can get a sick note for your employer if necessary. The sick note doesn’t say why you’re unfit for work. As soon as you feel up to it, you can do whatever you want again.

Healthcare professionals sometimes recommend avoiding tampons, menstruation cups and sex for a while. But there is no scientific proof that this helps to prevent infection or other complications.

When can you start using contraception again and which methods are best?

After an abortion, it can take as little as two weeks for ovulation to start again. Then there’s a chance you could get pregnant. It typically takes about four to six weeks for your period to return after an abortion. So it’s important to start using contraception straight after the abortion.

You can use condoms, diaphragms, an IUD (coil), or hormonal contraceptives. The first few menstrual cycles after an abortion may be irregular and you might ovulate later than usual. It is important to bear this in mind if you use natural birth control.

You can start using hormonal contraceptives again on the day when you have the abortion. It doesn’t have any effect on the abortion. IUDs (coils) can be inserted straight after a surgical abortion. The same goes for medication abortions – if all of the pregnancy tissue has definitely been removed.

If you need emergency contraception, the “morning-after pill” is an option again once five days have passed since having the abortion.

For advice on which type of contraception is suitable for you and your needs, you can talk to your gynecologist or a pregnancy counseling center (Schwangerschaftsberatungsstelle).

How do women feel about the abortion?

Women who have an abortion deal with it in very different ways. It is normal to have mixed emotions as well as feeling anxious and stressed, especially before the abortion. You might have a sense of regret if you decide to have an abortion – even if the decision feels right. Some women have very conflicting feelings and find it almost impossible to decide.

Most women feel relieved after the abortion. But many experience a whole range of different emotions, including a sense of grief, loss or liberation. This is all completely normal. The emotional distress usually passes, though. Any feelings of guilt and shame often have more to do with being worried about what other people think.

The emotions you feel if you have an abortion greatly depend on how much support you get from those close to you and the way you’re treated by the people who work at the counseling center, doctor's practice, clinic or hospital. It is important that anyone advising you doesn’t try to influence your decision and that people try to understand how you’re feeling. You shouldn't feel pressured into making a certain decision. It is about making the right decision for you.

How does abortion affect your mental health?

Having an abortion can be a lot to deal with but it doesn’t usually cause mental health problems or disorders. Research has found that women who are forced to continue with an unplanned pregnancy are more likely to develop mental health issues than if they can choose to have an abortion. Sometimes, people talk about “post-abortion syndrome,” where abortion is believed to cause mental health problems. But there isn’t any scientific proof to back this up.

The risk of mental health issues after an abortion is higher for women who

• have had mental health problems in the past,
• were pressured into the abortion by their partner, family or friends,
• feel very ashamed about having the abortion or keep the abortion secret because they’re scared of people’s reactions,
• don’t get support from their family and friends,
• have a difficult home life due to things like conflicts with their partner,
• experience (sexual) violence at home.

If you’re having problems with your mental health after you’ve had an abortion, you can contact a pregnancy counseling center (Schwangerschaftsberatungsstelle) or a gynecology practice any time. The same goes for your partner. The counseling is free of charge and you can ask to remain anonymous. You can also get help from a psychologist or psychotherapist if you need it.

Does abortion have long-term physical effects?

An abortion doesn’t usually have any effects on future pregnancies – for example, on your ability to get pregnant or on the pregnancy itself. It is not clear whether the risk of premature birth or placenta previa (when the placenta is in the wrong place) is higher in women who’ve had an abortion. Some studies have found a weak link, but other studies haven't.

After just a few weeks, there are no visible signs of the abortion – not even in a gynecological examination.

Sources

• Brauer M, van Ditzhuijzen J, Boeije H, van Nijnatten C. Understanding Decision-Making and Decision Difficulty in Women With an Unintended Pregnancy in the Netherlands. Qual Health Res 2019; 29(8): 1084-1095. [PMC free article: PMC7322937] [PubMed: 30574835]
• Bundeszentrale für gesundheitliche Aufklärung (BZgA). Familienplanung.de: Schwangerschaftsabbruch.
• Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG). Schwangerschaftsabbruch im ersten Trimenon (S2k-Leitlinie). AWMF-Registernr.: 015-094. 2023.
• Georgsson S, Krautmeyer S, Sundqvist E, Carlsson T. Abortion-related worries, fears and preparedness: a Swedish Web-based exploratory and retrospective qualitative study. Eur J Contracept Reprod Health Care 2019; 24(5): 380-389. [PubMed: 31368829]
• Institute for Quality and Efficiency in Health Care (IQWiG, Germany). Evidence report for the S3 guideline on abortion in the first trimester; Commission V21-12. 2023. [PubMed: 35133765]
• Petersen MN, Jessen-Winge C, Møbjerg AC. Scandinavian women's experiences with abortions on request: a systematic review. JBI Database System Rev Implement Rep 2018; 16(7): 1537-1563. [PubMed: 29995714]
• World Health Organization (WHO). Abortion care guideline. 2022.

• IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

  Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

  Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.