What is a curettage/vacuum aspiration and is it necessary after medical abortion?

Vacuum aspiration (MVA)is a surgical intervention to remove the contents of the uterus. Sometimes this treatment is necessary if there are complications after medical abortion or spontaneous miscarriage.
However in some countries doctors are accustomed to performing a curettage even though it might not be needed for medical reasons. You do NOT need a curettage if the ultrasound shows that there are still some small remains in the uterus (incomplete abortion) or experience some bleeding after 3 weeks AND you do not have any complaints like pain, fever or heavy bleeding. Small remains in the uterus can be treated with an extra doses of Misoprostol or you can just wait until your next menstruation. The uterus will most likely empty itself. The normal menstrual period usually returns after four to six weeks. After a normal menstruation you should not have any remaining tissue left over in the uterus.

However, in case you do have complaints like fever, persistent pain and heavy bleeding, a surgical intervention called vacuum aspiration is needed. Ask the doctor what kind of procedure she/he uses because it is better to have a vacuum aspiration than a sharp curettage or D&C, as this is not necessary in medical abortion below 12 weeks. (vacuum aspiration is less painful and has less risks).

All procedures should be done under local or general anesthesia!

More scientific information:
According to the World Health Organization “If the woman is well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by ultrasound) is an indication for surgical intervention. Remaining products of conception will be expelled during subsequent vaginal bleeding. Surgical evacuation of the uterus may be carried out on the woman’s request or if the bleeding is heavy or prolonged, or causes anaemia, or if there is evidence of infection”. ⁶³ ⁶⁸
If there are remains in the uterus showed by ultrasound but you feel well, the best is to wait still some weeks. If you start to observe signs of complications, you should go back to the doctor immediately. Read in this article "How do you know if you have a complication and what should you do?"
Dilatation and curettage should be used only in case of diagnosed complications and only if vacuum aspiration is not available. Vacuum aspiration is a newer and much safer surgical method and you should always ask for it if you are given a choice between vacuum aspiration and curettage. ⁷⁷ ⁷⁸ ⁸⁴ ⁸⁵ ⁹³ ⁹⁴ ⁹⁵ ¹⁰¹ ¹⁰³

How long will it take before Misoprostol will have effect and for how long will symptoms (bellyache, nausea, blood loss etc.) last?

In most cases Misoprostol will have an effect within 4 hours and you will start…