A miscarriage is a spontaneous pregnancy loss before 20 weeks of gestation. Some 8 to 20 percent known pregnancies end in miscarriage, with the majority happening before the 12th week.
The signs and symptoms of miscarriage vary from person to person. Symptoms may also vary depending on how far along you are. For example, a fetus at 14 weeks will be much larger than a fetus at 5 weeks of gestation, so there may be more bleeding and tissue loss with a later miscarriage.
Miscarriage symptoms may include:
- spotting or bleeding from the vagina
- abdominal cramping or pain in the lower back
- passage of tissue, fluid, or other products from the vagina
Read on to learn more about identifying a miscarriage and what to do if you suspect you’re experiencing one.
Bleeding may start as light spotting, or it could be heavier and appear as a gush of blood. As the cervix dilates to empty, the bleeding becomes heavier.
The heaviest bleeding is generally over within three to five hours from the time heavy bleeding begins. Lighter bleeding may stop and start over one to two weeks before it completely ends.
The color of the blood can range from pink to red to brown. Red blood is fresh blood that leaves the body quickly. Brown blood, on the other hand, is blood that’s been in the uterus a while. You may see discharge the color of coffee grounds, or near black, during a miscarriage.
Exactly how much bleeding you’ll experience depends on a variety of circumstances, including how far along you are and whether or not your miscarriage is progressing naturally.
While you may see a lot of blood, let your doctor know if you fill more than two sanitary pads an hour for two or more hours in a row.
What does a missed miscarriage look like?
You may not experience bleeding or other symptoms with a miscarriage, at least at first.
A missed miscarriage, also referred to as a missed abortion, happens when the fetus has died but the products of conception remain in the uterus. This type of miscarriage is usually diagnosed via ultrasound.
Just as with the amount of blood you’ll see, the duration of a miscarriage will vary from person to person and even from pregnancy to pregnancy.
In many cases, a miscarriage will take around two weeks to pass naturally. Your doctor may prescribe the medication misoprostol (Cytotec) to help a miscarriage pass more quickly. Bleeding may start within two days of beginning the medication. For others, it may take up to two weeks.
Once the miscarriage has started, the tissue and heaviest bleeding should be passed in about three to five hours. After the fetus has passed, you may still experience spotting and mild tissue loss for one to two weeks.
It may be difficult to tell a very early miscarriage from a late period. In fact, many miscarriages happen before a person even knows they’re pregnant.
In general, a miscarriage will cause more intense symptoms than a menstrual period. For example:
- Your menstrual flow may be relatively similar from month to month with heavy days and light days. A miscarriage can also have heavy and light days, but bleeding may be especially heavy at times and last longer than you’re used to.
- Bleeding from a miscarriage may also contain large clots and tissue you don’t normally see during your period.
- Cramps can be a part of your normal monthly cycle, but with a miscarriage, they may be particularly painful as the cervix dilates.
- The color of blood during your period can range from pink to red to brown. If you see a color you’re not used to seeing, it may be a sign of miscarriage.
Always contact your doctor if you’re pregnant and experience bleeding. While a miscarriage can’t be stopped once it starts, you doctor can run tests to help determine if you’re experiencing the loss of your pregnancy or something else.
To diagnose a miscarriage, your doctor will likely perform an ultrasound to look for the baby’s heartbeat, if you’re far enough along to see a heartbeat. Your doctor may also order a blood test to check human chorionic gonadotropin (hcG) levels to see if they’re rising or falling.
If a miscarriage is confirmed, your doctor may suggest “expectant management” or waiting for the miscarriage to pass naturally. This generally happens within two weeks.
The miscarriage may be incomplete if:
- your bleeding is particularly heavy
- you have a fever
- an ultrasound reveals there’s still tissue in your uterus
If this is the case, your doctor may suggest a dilation and curettage (D and C), which is a surgical procedure done to remove remaining tissue. The procedure is done under general or regional anesthesia, and is considered safe. D and C doesn’t usually lead to long-term complications.
It’s important to report any bleeding or pain you experience in your pregnancy to your doctor. In some cases, you may have what’s called a threatened miscarriage, and there may be certain treatments that can help. These include:
- hormone supplements if the bleeding is caused by low progesterone
- a cerclage (stitch in the cervix) if the issue is with the cervix opening prematurely
Speak with your healthcare provider if you’re looking to get pregnant again after a miscarriage. While it may be safe to start trying after your first normal period, you may want to schedule a checkup depending on the cause or the number of miscarriages you’ve had.
The reason for loss isn’t always known, but around half of miscarriages are caused by issues with the baby’s chromosomes.
Other possible causes include:
- uterine issues
- hormonal imbalances
- other health conditions, such as diabetes, autoimmune disorders, or polycystic ovary syndrome
After a miscarriage, you may have hcG in your blood for one to two months, which could lead to a false positive pregnancy test. In most cases, your period will return within four to six weeks, though you may start ovulating almost immediately following a miscarriage.
Speak with your doctor about birth control options if you don’t wish to become pregnant after a miscarriage.
Will I miscarry again?
Having one miscarriage doesn’t necessarily increases your chances of having another. The risk remains around 20 percent.
Two or more miscarriages is referred to as recurrent pregnancy loss (RPL). The risk of miscarriage after two losses is 28 percent. After three consecutive losses, it increases to 43 percent.
Only 1 percent of people experience three or more miscarriages. About 65 percent of those with unexplained RPL go on to have successful pregnancies.
Activities like exercise, work, morning sickness, and sex don’t cause miscarriages. Even things like smoking or drinking alcohol or caffeine, which can lead to other complications, are also unlikely to lead to early pregnancy loss.
A miscarriage can be physically painful, and it may also cause a variety of emotions. While your body may recover in a few weeks, be sure to take time to process your feelings, grieve, and reach out for help when you need it.