Miscarriage is a type of pregnancy loss that most commonly occurs during early pregnancy. There are physical symptoms associated with miscarriage, but it can also be very challenging to emotionally recover from the loss of a pregnancy. Please know that you are not alone, and there are treatments and resources available to help.

What is a miscarriage?

A miscarriage, or early pregnancy loss, is the loss of a pregnancy in the womb prior to 20 weeks gestation. Miscarriages can happen for a variety of reasons, but the vast majority of miscarriages cannot be prevented or stopped once they have started.

Miscarriage is very common. According to the American College of Obstetricians and Gynecologists (ACOG), about 10 in 100 known pregnancies end in miscarriage. In most cases, miscarriage is not recurring, and the person who miscarried will go on to have a successful pregnancy in the future.

What causes a miscarriage?

The cause of miscarriage is not known, but the majority are not caused by anything the pregnant person might have done or not done. Miscarriage is usually a random event. ACOG importantly notes: “Working, exercising, stress, arguments, having sex, or having used birth control pills before getting pregnant do not cause miscarriage.” Few medications cause miscarriage, and morning sickness — the nausea and vomiting common in early pregnancy — also does not cause it, according to ACOG.

“Some women who have had a miscarriage believe that it was caused by a recent fall, blow, fright or stress. In most cases, this is not true,” ACOG says. Some pregnant people may even have a miscarriage before they know they are pregnant.

Chromosomal abnormalities or abnormal development, problems with the uterus or cervix, or infections are frequent causes of repeat miscarriage.

Miscarriage Symptoms

It’s important to talk to your obstetrician if you have any of these symptoms:

• Vaginal bleeding is the most common symptom; however, bleeding in early pregnancy can also occur for other reasons.
• Cramping — similar to what you may experience during a period — or severe pain in the lower abdomen or belly
• Back pain
• Fever
• A gush of fluid from your vagina, even if you do not have pain or bleeding
• Tissue passing from the vagina
• Loss of pregnancy symptoms like nausea, breast tenderness or feeling the baby move — a sense of not “feeling pregnant” anymore

Types of Miscarriage

There are several types of miscarriage. If you are experiencing bleeding or cramping, especially during the first trimester, it’s important to contact your obstetrician or other clinician. Common types of miscarriage include:

• Threatened miscarriage: This means there is a possibility of miscarriage. It involves mild vaginal bleeding, with or without abdominal pain or cramping. Bleeding is usually light, but can be heavier, and symptoms could last several days or weeks. It occurs most commonly in the first trimester, but is possible up to 20 gestational weeks. In most cases, such pregnancies go on without more problems.
• Incomplete miscarriage: This describes a pregnancy loss when some tissue remains in the uterus after a miscarriage begins. It can include moderate to severe vaginal bleeding, sometimes with a noticeable passage of tissue, and pelvic and lower abdominal pain.
• Complete miscarriage: This means all fetal tissue has passed out of the uterus, and the pregnancy is lost. It is common for miscarriages that happen in the first 14 weeks of pregnancy, and complete miscarriage typically involves heavy vaginal bleeding and severe abdominal pain. Sometimes, an ultrasound can be performed to confirm that no fetal tissue remains in the uterus.
• Missed miscarriage: This means the pregnancy has stopped developing. Pregnancy tissue remains in the uterus, and the loss can happen without any symptoms such as bleeding or pain, so it may go unnoticed. This is typically diagnosed with an ultrasound.

Talk to your obstetrician if you experience two losses in a row to see if you may need a further workup or could benefit from a consultation with a fertility specialist.

Treatment for Miscarriage

If you experience symptoms of a miscarriage, your doctor may ask you to come in for a visit, which will potentially include an ultrasound, blood tests or pelvic exam. If it is determined that you are having a miscarriage, your doctor will walk you through what to expect and the options for managing the end of pregnancy. Treatment or management of your miscarriage will depend on how far along you were in pregnancy, as well as your overall health, age and other medical factors. Pregnancy tissue will often pass naturally in about one to two weeks, but sometimes medicine or surgery may be required to help fully remove or pass the tissue.

There are three options to help manage or treat symptoms after a miscarriage. One of these options may be recommended over the others by your doctor, depending on factors such as age, medical history and how large the pregnancy has grown. Miscarriage can be dangerous if pregnancy tissue does not naturally pass and without further treatment.

Wait-and-See Approach to Miscarriage

If choosing to wait and see whether the miscarriage passes naturally, bleeding will occur as the body works to push the miscarriage tissue through the vaginal canal. This usually takes up to two weeks, but may take longer.

With both this approach and a medicated approach, bleeding occurs — some of which may be heavy — and cramping, diarrhea and nausea are possible. With an early miscarriage, the tissue may look like a blood clot mixed with gray-white material, or it may look like a clear, fluid-filled sac.

Medication for Miscarriage

Medication can help speed the process of passing pregnancy tissue. Sometimes, this may be recommended by your physician or be offered as a treatment option. Some medications are taken orally, and some may be inserted into the vagina, depending on what your doctor prescribes. In rare cases, medication may not be effective enough to pass all miscarriage tissue, in which case surgical treatment will be required. It is important to follow up with your doctor to make sure the medication effectively helped pass all pregnancy tissue, and no further treatment is required.

Surgery for Miscarriage

The most common type of surgery after miscarriage is called dilation and curettage (D&C). During a D&C, the cervix is widened, and pregnancy tissue is removed with a suction device. Surgery for miscarriage may be recommended if the pregnancy has advanced to when medication is less effective or if it is determined to be your safest option by your clinician, depending on how far along your pregnancy was and any risk factors you may have.

How long does a miscarriage last?

It can take a couple of months to make a full physical recovery from a miscarriage. Avoid sexual intercourse and inserting anything into the vagina, including tampons, for a minimum of one to two weeks to avoid infection. Most people begin their period again after four to six weeks, but becoming pregnant is possible as soon as two weeks after an early miscarriage.

The emotional repercussions of miscarriage may take longer to recover from. Grieving the loss of a pregnancy can take time and may require the support of friends, loved ones, therapists, support groups or other resources. Everyone grieves differently, but some people find it helpful to have a memorial for the pregnancy they lost.

Who is at an increased risk for miscarriage?

Although there is no one cause that always leads to miscarriage, there are risk factors that may increase the chances. Those who are more at risk may include:

• People who have already had two or more miscarriages
• People older than age 35
• Smokers
• Pregnant people who consume alcohol or use street drugs
• Pregnant people using certain harmful medications
• Pregnant people who have been exposed to harmful chemicals (like paint thinner)
• People who become pregnant while using an intrauterine device (IUD)
• People affected by social or economic determinants of health

There are also medical conditions that can increase the risk of miscarriage, including:

• Autoimmune disorders
• Obesity
• Hormone issues (like polycystic ovary syndrome)
• Diabetes
• Thyroid conditions
• Kidney or congenital heart disease
• Severe malnutrition

Pregnancy After Miscarriage

In most cases, a person who miscarries once or even twice will have a successful pregnancy in the future. There isn’t a way to prevent a miscarriage from happening, but there are things you can do to prepare for pregnancy and stay healthy during pregnancy.

Pregnancy After Repeat Miscarriage

People at higher risk of miscarriage or people who have experienced repeat miscarriage may need additional support to have a successful pregnancy. It may be helpful to consult with medical professionals who have specialized training related to miscarriages:

• Fertility specialist (reproductive endocrinologist or REI): A consultation with a fertility specialist can help provide options for planning a pregnancy and may be especially beneficial after repeat miscarriage. Fertility specialists can also assist with treating certain risk factors that may increase the chance of miscarriage.
• Maternal-fetal medicine specialist: People at a higher risk for miscarriage may also benefit from the support of a maternal-fetal medicine (MFM) specialist. They specialize in guiding pregnant people through high-risk pregnancies, and have knowledge and training that a general Gyn/Ob may not have.