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Miscarriage

What to expect after a miscarriage

Your options during and after experiencing miscarriage

Miscarriage is a common pregnancy outcome, but that doesn’t make it any easier to experience. This article will help you understand what to expect after a miscarriage, your medical options and some tips for recovery. 

Bleeding in early pregnancy is not always indicative of miscarriage (2). Unsure if you had or are having a miscarriage? Read our article Am I having a miscarriage? and call your healthcare provider. 

It’s a common misconception that if you have a miscarriage, you’ll need medical treatment to remove the pregnancy tissue from your uterus. Traditionally, miscarriage was treated by a medical procedure called a surgical evacuation (1). This is a scary sounding term, but it is a simple surgery that removes any remaining pregnancy tissue in the uterus to reduce the risk of infection and hemorrhage, or blood loss (1). This procedure is not always necessary, though, and there are effective alternatives that don’t require surgery (1). Today there are a few different options and it’s up to you and your healthcare provider to choose which one is right for you (2).

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What to do if you think you had a miscarriage

If you think you had or are experiencing a miscarriage, it’s important to get evaluated by a healthcare provider right away. You might need an ultrasound and your healthcare provider may take your blood to test some pregnancy hormones like human chorionic gonadotropin (hCG) and progesterone (2). Certain circumstances like having an ectopic pregnancy (pregnancy outside of your uterus), a molar pregnancy (a rare condition in which the pregnancy develops into a noncancerous tumor), or an infection, might indicate you need urgent surgical care. But in most cases, your preference for treatment should be a major part of deciding how you handle it. Miscarriage is different for everyone, and for most people it is a challenging time (2). It has emotional significance for many people and seeking a thoughtful, caring healthcare provider may help lessen the traumatic impact (2). 

If you have a negative blood type, your healthcare provider may advise you to get a shot called Rhogam within 72 hours of your miscarriage (3). This shot protects you from a blood protein that could be in the fetus's blood and might mix with yours. Your healthcare provider can tell you whether or not you need the shot based on their specific practice guidelines.

If you had a miscarriage recently, we are sorry. We know that feelings around miscarriage are really complicated and the experience is intense. Some people say that they are embarrassed to ask their provider questions about their miscarriage or ashamed they don’t know what’s happening in their body. Here is everything you need to know about what’s happening in your body after a miscarriage and your options for managing it. 

What are the options for handling a miscarriage?

If you have a complete miscarriage, the pregnancy stops developing, or growing, and embryonic cardiac activity stops. The inner tissue of the uterus and any new tissue that has grown, including the embryo, sheds through the vagina (1, 3). This can look like normal period bleeding or may look like spotting (1, 3). 

Sometimes some of the tissue from the pregnancy stays inside the uterus or the pregnancy is not capable of progressing to a live birth. This is called an incomplete miscarriage or nonviable pregnancy (2). If you have an incomplete miscarriage, you’ll need to follow up with your healthcare provider. They will monitor your recovery with an ultrasound and blood tests (2).

Option 1: Let the miscarriage happen naturally

Letting your body take care of the miscarriage on its own is usually an option (2). Healthcare providers call this expectant management and 80% of miscarriages will resolve this way (2). The most important thing to consider about expectant management is your emotional availability to handle this process, which can take six to eight weeks. You also need to be sure that you don’t have an existing infection or an ectopic pregnancy (2). Your healthcare provider may  recommend an ultrasound to look at the thickness of your endometrium (the lining of your uterus) and to see if there is a gestational sac (the cavity of fluid surrounding the embryo) inside your uterus (2). You may need to repeat these tests throughout the next few weeks (2).  

Option 2: Medication to speed up the miscarriage

If the remaining pregnancy tissue doesn’t pass through your vagina during expectant management, it could cause an infection or serious bleeding. Your healthcare provider will likely recommend one of a few options to remove it, including oral or vaginal medication called misoprostol (2, 3). Taking the medication either way is effective, but taking it vaginally may reduce the risk of diarrhea, a potential side effect (2). Success rates vary, but are generally as high as 95% (2). Most people will experience some side effects, like dizziness, headache, and upset stomach (2). As with expectant management, you will need to return to your healthcare provider for follow up tests to make sure the medication is working (2). 

Option 3: Surgery for miscarriage is safe and effective

Surgery to remove the pregnancy tissue, called surgical evacuation with curettage or suction, is an effective and safe option (3). During this procedure, you will probably receive intravenous (IV) sedation to manage your pain (2). You may choose this option if you think it’s best for you personally; there are also other medical reasons that might make it the best option. Your healthcare provider will probably recommend surgery for miscarriage if you are bleeding heavily, have intense pain, or have an infection (2). You may also choose surgery if you want to have the tissue genetically tested (2). Surgery is the final option if expectant management or medication doesn’t work. 

Miscarriage is not your fault

Sometimes people blame themselves for a miscarriage, but miscarriage is never your fault. Most miscarriages happen because the developing embryo had a  chromosomal abnormality (3). This means something unexpected in the genes of the egg, the sperm, or in the two together caused development that is not typical. This variability happens during cell division and doesn't indicate a problem with the DNA of either parent (4). About 70% of early miscarriages are caused by chromosomal abnormalities (5, 6). 

Your mental health after miscarriage is as important as your physical health

The grief that can accompany a miscarriage is real. Some people say this grief is as intense as any other kind of death or loss (2). It’s also ok if you don’t feel grief; emotions are complicated and unpredictable. Studies of people who experience miscarriage suggest that depressive symptoms after miscarriage do get better with time, particulary after the six month mark (7). Yet, for people who don’t have children or people who feel like they didn’t receive supportive healthcare, depressive symptoms may not resolve over time (7). Scheduling a follow up visit with your healthcare provider to discuss the loss may help you process some feelings (8, 9). Stress is associated with poorer mental health after miscarriage (10), so taking time to reduce stress in your life by exercising, meditating, or whatever works for you, might be helpful. 

Recovering from miscarriage varies from person to person

It will probably take a few weeks until your body is feeling back to normal after a miscarriage. If the pregnancy was wanted, it will likely take much longer for you to recover emotionally. If the pregnancy was unplanned, it’s not uncommon to feel some relief along with other complicated emotions. Experiencing a miscarriage might cause you to distrust your body, or cause tension between you and your partner. Many people find therapy to be helpful when recovering from a miscarriage. People with a history of a mood disorder like depression or anxiety should check in with a mental health provider to prevent the recurrence or worsening of a mental health condition. No matter how you feel about your miscarriage, it’s important to follow up with a reproductive healthcare provider within two weeks of the miscarriage ending to talk about family planning going forward and to make sure your body is recovering. Here is a list of online resources and books below that may be helpful as you recover. 

Resources

You can read more about the causes of miscarriage in our article What causes a miscarriage?

Learn how to keep your upcoming cycle predictions accurate in the Clue app by making a special note of this pregnancy here. You can track other experiences like mood, pain, sleep, sex, energy, and more before your next period occurs.

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