10 Common Questions About Miscarriage, Answered

A miscarriage is a pregnancy loss that takes place within the first 20 weeks of gestation. Miscarriages are common, with approximately 10% to 15% of known pregnancies ending in miscarriage, but no two miscarriages are exactly the same.

Someone who is newly pregnant or preparing for pregnancy may have questions about miscarriage, such as: How long does a miscarriage last? What does it feel like? How is a miscarriage diagnosed?

Below are some common questions you might have about a miscarriage, along with answers that can help. As always, be sure to reach out to a health care provider about any specific questions you might have about your pregnancy, especially if you suspect you may be having a miscarriage.

How Long Does a Miscarriage Last?

Despite how it is often depicted in the media, a miscarriage usually does not happen all at once. In fact, a miscarriage can last anywhere from a few days to several weeks, with symptoms like bleeding typically lasting longer the farther along the pregnancy was. Research shows, however, that on average, miscarriage bleeding resolves within two weeks of the diagnosis.

In general, someone experiencing a miscarriage will typically have more bleeding and discharge the longer they had been pregnant, although that can vary based on the type of miscarriage and whether they experienced symptoms like cramping or bleeding:

• Symptomatic miscarriage: The miscarriage occurs with cramping, bleeding, and spotting, indicating the body is releasing the pregnancy contents.
• Missed miscarriage: The embryo or fetus stopped developing, but there are no signs of bleeding or cramping and the body hasn't started the process of releasing the pregnancy on its own.

With a symptomatic miscarriage, the physical symptoms of miscarriage will appear as the first signs that a loss has occurred.

A missed miscarriage, however, may last several weeks, because the body has not recognized that the embryo is no longer developing.

In some cases, the gestational sac can even continue to develop, even without an embryo inside, leading the pregnant person to have expected pregnancy symptoms, like nausea and tender breasts, because hCG is still being produced. This is called an anembryonic pregnancy (a pregnancy without an embryo). It's also known as blighted ovum.

Once a missed miscarriage has been identified, the timeline of the physical miscarriage symptoms can be very similar.

The treatment of a miscarriage can also impact how long the process lasts. For instance, someone may prefer a more immediate surgical procedure to remove the pregnancy contents, while others may prefer to wait for the body to start the process on its own, which can take several days.

Your doctor will advise you on choosing a treatment path based on your preferences and type of miscarriage.

Does Bleeding During Pregnancy Always Mean Miscarriage?

Bleeding, spotting, and cramping are often the first noticeable symptoms of miscarriage, but vaginal bleeding is also very common in healthy, viable pregnancies. According to the American College of Obstetricians and Gynecologists (ACOG), as many as 1 in 4 pregnant people will experience bleeding during the first trimester.

That means that if you see a small amount of bleeding early on in your pregnancy, it doesn't necessarily mean you are having a miscarriage. Because pregnancy increases the number and sensitivity of blood vessels in the pelvic area and on the cervix, bleeding during pregnancy can be caused by other things like:

• Implantation, when the fertilized egg implants into the uterus
• A pelvic exam or Pap smear
• Vaginal penetration and sexual activity
  

The only way to know for sure if your bleeding is from a miscarriage is through an evaluation with your doctor. If you do experience bleeding at any point during your pregnancy, be sure to talk to your doctor to see if further testing is necessary.

What Causes a Miscarriage?

The vast majority of miscarriages, around 80%, happen within the first trimester, or the first 12 weeks of pregnancy. Most first-trimester miscarriages are caused by chromosomal abnormalities, meaning they cannot be predicted or prevented.

Other causes of miscarriage include:

• Problems with embryo development
• Problem with embryo implantation
• Medical conditions
• Certain medications and drugs

In some cases, the cause of a miscarriage is simply unknown.

How Are Miscarriages Diagnosed?

In some cases, a doctor can assess your risk for miscarriage with blood tests. For instance, during early pregnancy, your health care provider may use human chorionic gonadotropin (hCG) tests to measure the amount of the pregnancy hormone in your blood.

If the hCG level is not rising as expected in the first trimester, it can indicate a risk for a miscarriage. However, hCG levels alone are not 100% predictive of a miscarriage, so talk to your doctor about your specific risk.

Your doctor may also perform a pelvic exam and an ultrasound to determine if the pregnancy is developing as expected. If you are having miscarriage symptoms, an ultrasound can be done to rule out or confirm a miscarriage.

Should You Always Go To the ER With a Miscarriage?

An ER visit is not always necessary with a miscarriage. For a confirmed, non-ectopic pregnancy that is ending in miscarriage, it may be more helpful (and much less expensive) to talk with your regular health care provider or prenatal care provider for guidance and treatment.

A doctor can't stop a miscarriage, so your treatment options will vary based on the type of pregnancy loss you are experiencing and how far along you were in your pregnancy.

However, you will likely need to go to the ER for a miscarriage or suspected miscarriage that occurs with any of the following:

• Ectopic pregnancy
• Extremely heavy bleeding
• Severe abdominal pain
• Fever
• Extreme nausea or vomiting
• Loss of consciousness (passing out)

Are Ectopic Pregnancies Always Emergencies?

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tube. Ectopic pregnancies are never viable, meaning the pregnancy will not progress.

Nearly 90% of ectopic pregnancies occur in the fallopian tube, which can be fatal to the pregnant person, so any ectopic pregnancy is nearly always treated like an emergency. If an ectopic pregnancy ruptures, it can cause internal bleeding and be life-threatening.

Rarely, a fertilized egg will implant outside of the uterus in a place that is non-emergent, and early detection and treatment can reduce the risk of rupture and internal bleeding.

There is no way to know where an ectopic pregnancy is without an ultrasound. And because an ectopic pregnancy can be so dangerous, it's important to seek medical attention right away if you experience any symptoms of ectopic pregnancy.

Do Miscarriages Always Have Symptoms?

Not all miscarriages will be symptomatic. Sometimes, the embryo or fetus stops growing and developing, but there are no outward signs of miscarriage like cramping, bleeding, or the passage of tissue. This is called a missed miscarriage.

With a missed miscarriage, the pregnancy loss is often discovered incidentally during a routine ultrasound or when your doctor is unable to find an audible heartbeat on a handheld Doppler by the second trimester of pregnancy.

What Do Miscarriage Cramps Feel Like?

Cramping is a common symptom of miscarriage. Many people describe an early miscarriage as being like a heavy menstrual period.

Miscarriage cramping can occur in:

• The abdominal area
• The pelvic area
• The back

Cramping is also common following a D&C.

The pain associated with miscarriage-related cramping can vary from mild to severe pain that interferes with your ability to go about normal daily activities. If, however, the cramping is severe and ectopic pregnancy hasn't been ruled out, be sure to consult a health care provider. You can also talk to your health care provider about pain management options.

When Does Fertility Return After a Miscarriage?

It is not possible to predict when you will be fertile again after a miscarriage, but for many people, fertility returns very quickly.

Some people will resume ovulating in as little as two weeks after a miscarriage, while others may not have their cycles return for several months. Everyone is different, but if your period doesn't return, be sure to talk to your doctor.

If you don't want to try for another pregnancy right away, doctors advise using contraception when you resume sexual activities that could result in a pregnancy because it can be difficult to determine when you will ovulate again.

When Can You Try for Another Pregnancy After Miscarriage?

The ACOG says there is no reason to delay conception after a miscarriage unless your doctor advises it, so if you want to try to get pregnant after a miscarriage, you can do so as soon as you feel ready.

It used to be common for doctors to recommend waiting for several months or more before getting pregnant again after a miscarriage. However, barring individual medical circumstances, there is no medical reason to delay trying to conceive following a miscarriage. In fact, some research shows that pregnancy rates are higher among those who start trying in the first few months after the pregnancy loss.

If you don't want to get pregnant, talk to your doctor about the best birth control options after a miscarriage.