Bleeding a month after miscarriage

What to Expect with Your First Period After Miscarriage

Written by WebMD Editorial Contributors

The grieving associated with miscarriage can last several months. Physically, the first period after a miscarriage may be different from what you usually experience. It can be unusually heavy and cause more discomfort than typical menstruation or be unusually light but with severe emotional distress.

Unusual menstrual symptoms after a miscarriage can be alarming for those who don’t know what to expect. While these issues vary from one person to the next, the following concerns are especially common:

Late periods. Many women return to their regular cycle four weeks after having a miscarriage, but for some women, menstruation may be delayed even longer.

The timing for the first period after a miscarriage largely depends on when the miscarriage becomes “complete.” A miscarriage is complete when the uterus has shed all tissues from the pregnancy. This process can occur naturally, but a dilation and curettage (D&C) procedure may be required. In a D&C, the tissue is surgically removed from the uterus.

After a miscarriage, tissue fragments can remain in your uterus for days or even weeks. The remaining tissue can cause bleeding to pick up again after it appears to have tapered off. The sooner all placental tissue (source of nutrients and oxygen for a baby in the womb) is gone, the sooner your menstrual cycles will return to normal.

Women who were nearing the end of the first trimester or already in the second trimester at the time of miscarriage may take longer to return to “typical” menstruation due to elevated levels of a pregnancy hormone called human chorionic gonadotropin (hCG).

Heavy flow. Regardless of when your first period after miscarriage takes place, it is likely to be heavier than usual. Your body won’t have ovulated during the past cycle, so the endometrial lining (lining of the wall of the uterus) may be thicker. This leads to a heavier flow and may also cause your period to last longer than usual.

Some women experience menstrual clotting for the first time during their initial post-miscarriage period. This is normal and won’t necessarily continue for future periods. Pain as well as other menstrual symptoms, such as acne, food cravings, and tiredness, can also be more significant for the first few post-miscarriage periods.

Given the severity of post-miscarriage periods, some women choose to take a few days off of work to rest and recuperate.

Severe cramps can be managed with help from over-the-counter medications like ibuprofen or acetaminophen. You can also use a heating pad or hot water bottle to ease painful cramps.

Light flow. While many women experience a heavier than usual flow after a miscarriage, others discover that their period is actually lighter. Despite this, other menstrual symptoms may still be more severe than usual.

If you have an abnormally light flow after a miscarriage, monitor your cycle closely for a month or two. Contact your physician if your period still seems unusually light after this time.

While a light period is usually harmless after a miscarriage, it can sometimes be a sign of Asherman’s syndrome. This condition occasionally happens after a D&C and may involve scarring of the uterus.

Hormonal fluctuations. Many women also have major hormonal fluctuations during their first period after miscarriage. These fluctuations may lead to significant emotional distress and symptoms, which sometimes resemble postpartum depression.

The hormonal changes from your first post-miscarriage period may contribute to mental health issues. Nearly one in five women may develop symptoms of major depression or anxiety after miscarriage.

Although many women find that their emotional distress eases significantly after the first post-miscarriage menstrual cycle, for some women, symptoms of depression and anxiety last much longer. If these symptoms continue for more than a month or two after a miscarriage, they could be a sign of a larger problem and should be addressed as soon as possible.

If you’re worried about your mental health after a miscarriage, consider tracking both emotional and physical changes and meeting with a physician six to eight weeks after the loss.

Physical readiness to conceive. The first real period after miscarriage signals that you are physically capable of getting pregnant again. If you don’t feel ready, emotionally or physically, to try for a baby so soon after your miscarriage, you may want to ask your doctor about birth control.

Depending on the severity of the miscarriage, it may be preferable to wait for a few cycles before you try to get pregnant again. This provides more time for physical and emotional recovery and the opportunity to track ovulation. Keep in mind that getting an early period after a miscarriage doesn’t necessarily mean that you have ovulated already.

How Long Does a Miscarriage Last? Physical Symptoms Last 2-8 Weeks

Symptoms of a miscarriage, primarily heavy bleeding and cramping, can last up to two weeks, while lighter bleeding may continue another one to two weeks.
It can take four to six weeks to get a normal period again, and irregular periods immediately following miscarriages are common.
The emotional effects of a miscarriage, which are less often discussed, can be long-lasting and difficult.

Miscarriage is medically defined as the loss of pregnancy up to 20 weeks. After that point, it is technically considered a stillbirth.

However, miscarriage is often used as an umbrella term for pregnancy loss at any point. Miscarriage occurs in about 15%-25% of pregnancies in the United States, and most happen within the first 10 weeks of gestation. Only 5% of women will experience two consecutive miscarriages, and 1% will experience three or more.

There are likely more miscarriages than we know because some occur before the pregnancy is detected by a test, says Amanda Kallen, assistant professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine.

Here are some signs of pregnancy loss, and what to expect if you're experiencing a miscarriage.

How long does a miscarriage last?

Symptoms of miscarriage — primarily heavy bleeding and cramping — can last up to two weeks. Lighter bleeding can last an additional one to two weeks. Depending on how far along the pregnancy was, pregnancy hormone levels can remain high for days or several weeks.

It can take four to six weeks to get a normal period again, though irregular periods immediately following miscarriages are common.

Sometimes, even more complicated than the physical symptoms are the emotional consequences of miscarriage, says Kallen, who herself has had two losses. The psychological pain is complicated by the tendency for women to suffer in silence because there is a societal taboo surrounding miscarriages, Kallen says.

According to research, social support has shown to be crucial in the emotional healing that occurs after pregnancy loss.

"There can be a significant grieving process, and it is often not linear," Kallen says. "Depending on how much time has passed, or if someone has invested time and energy into fertility treatments — or even for someone who got pregnant easily and feels a connection to that pregnancy — the process can last a long time and be complex."

Types of miscarriage and symptoms

Spotting in the first trimester — the initial 12 weeks of the pregnancy — is quite common. But if the bleeding is heavy and accompanied by cramping, it could be a sign of something worse.

"Any bleeding that is soaking a pad within an hour should be carefully evaluated," says Kallen. "Initial instances of bleeding should be at least discussed with a provider. That can be managed with more observation and discussion."

Different types of pregnancy loss:

Chemical pregnancy – Also called "biochemical pregnancy," this is a pregnancy loss that occurs within the first five weeks of gestation. The body makes enough of the reproductive hormone – human chorionic gonadotropin (hCG) – to result in a positive test but does not progress into a clinical pregnancy. About 50%-75% of all miscarriages are believed to be chemical pregnancies. Potential causes include advanced maternal age and chromosomal abnormalities.

Missed miscarriage – In a missed miscarriage – also known as a silent miscarriage or missed abortion – tissues from the placenta and embryo remain in the uterus, but the embryo has died or never properly formed. People who experience this have three options. They can wait it out to see if the body naturally passes the tissue, or take misoprostol, a medication that prevents stomach ulcers but can also help manage miscarriages. The third option is a D&C, or dilation and curettage, which uses either surgical instruments or suctions to remove the tissue manually. The decision depends on each individual's preferences, the circumstances of the miscarriage, and the doctor's recommendation, Kallen says.

First-trimester loss – Missed miscarriages and chemical pregnancies both fall under the umbrella of first-trimester loss. These miscarriages occur in the first 12 weeks of pregnancy. Risk factors include maternal age of 35 or older, chronic conditions like diabetes or thyroid disease, and obesity, along with cigarette smoking and illicit drug use. About 80% of pregnancy loss occurs in the first trimester.

Second-trimester loss – Miscarriages that occur between 12 and 24 weeks of gestation are far less common – only 2%-3% of pregnancies are lost during this time. Unlike earlier miscarriages, the loss is more likely caused by trauma, infections, or clotting disorders, Kallen says. There may also be problems with fetal development or issues with the uterus, such as abnormalities in shape.

Late pregnancy loss – Losses that occur in the final term are often caused by problems with the placenta, birth defects, infections in the fetus or placenta, or umbilical cord complications. Like second trimester miscarriage, diabetes or preeclampsia can also play a role. The use of marijuana, cigarettes, and illicit drugs increases the risk of stillbirth.

When to see a doctor for miscarriage

Kallen says if you experience any bleeding after a positive pregnancy test, tell your doctor, who can further evaluate the status of the pregnancy.

If there are no signs of infection, also called a septic miscarriage, it can be safe to allow the early miscarriage to happen naturally, Kallen says.

But if symptoms of septic miscarriage are present, such as fever, chills, lower abdominal tenderness, and foul-smelling vaginal discharge, an individual should seek immediate medical attention.

If a doctor deems it necessary to use medication to manage the miscarriage at home, some options include:

Misoprostol pills: These are placed in the vagina, which usually leads to cramps and bleeding that will start within two to six hours afterward. Misoprostol may also be prescribed orally.
Ibuprofen: Taking ibuprofen can help with cramps.

"For miscarriages in the second and third trimester, there will need to be medical intervention," Kallen says.

For those having a D&C, doctors will often recommend taking pain medicine beforehand. The procedure usually takes less than 10 minutes and may take place in a doctor's office on an outpatient basis or in the hospital. General or local anesthetic will be used, and most women experience minor cramping and bleeding for a few days after.

Insider's takeaway

Miscarriages are relatively common, and each woman's experience will vary depending on the circumstances. Early pregnancy loss is more common than later miscarriage and can often be managed at home.

If you suspect you are having a miscarriage, always contact your doctor to discuss options. The physical effects can last for several weeks, but the emotional effects, which are seldom discussed, can be long-lasting and difficult.

"Pregnancy loss is different for each individual," Kallen says. "It can be sort of a secret experience because women can go through it without many people knowing. The silence around it is the hardest part."

What causes miscarriages, and disproving common myths
You cannot prevent a miscarriage but there are steps you can take to reduce your risk
A chemical pregnancy is a miscarriage, but doctors say it's a good sign if you're trying to get pregnant
You've had a miscarriage. Here's how long doctors recommend you wait before trying again
How many periods you can miss before you should worry

Lindsay Kalter

Lindsay Kalter is a health freelance writer and contributor to Insider who has held positions with Politico, the Boston Herald, and the American Heart Association. Her work has appeared in publications including The Washington Post, Hour Detroit Magazine, The Dallas Morning News, and WebMD. She has covered topics from mental health and opioid use to cutting-edge medical research and the COVID-19 pandemic.

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Bleeding after abortion: normal or cause for alarm

Uterine bleeding after termination of pregnancy is a common phenomenon in obstetric practice that occurs on the first day after the operation. The intensity and duration of blood loss are individual and depend not only on the characteristics of the female body, but also on the type of abortion. nine0017
Features of bleeding after abortion

Bleeding may be completely absent during the first two days after surgical termination of pregnancy, but later increases to menstrual bleeding and continues in some clinical pictures up to 6 weeks. This pathology indicates a hormonal imbalance, that is, there is insufficient "support" of endometrial tissues, which supports the development of pregnancy. As a result of this bleeding after termination of pregnancy can only intensify, and continue intermittently for several weeks. It is important to understand that here we are talking about pathology.

Most women of reproductive age are concerned about the main question, how long will the bleeding after an abortion last? The question is individual, but if it does not pass more than two weeks after getting rid of the fetus, it is important to urgently contact the local gynecologist. The duration of the hemorrhage also depends on the gestational age: the earlier an abortion is performed, the more likely it is to solve such a piquant problem in a gentle “mode” and without serious consequences. nine0017
Cause of abnormal bleeding after an abortion

The occurrence of bleeding after an abortion should not confuse the patient, but its duration should be a cause for concern. Among the pathological causes of this symptom, the following should be singled out:
- Perforation of the uterus;
- Injury of the cervix;
- Presence of residual fetal tissue;
- Blood clotting disorder;
- The reaction of the female body to individual anesthetics. nine0004
With such diagnoses, along with hemorrhage, there is an obvious violation of the temperature regime, convulsions, general weakness, fainting, hypotension, increased heart rate. It is important not to ignore such signs of shock, but to visit a medical center and a qualified specialist in a timely manner.

How to deal with bleeding after a miscarriage

It is important to understand that to stop prolonged bleeding after a miscarriage at home is impossible, only a competent gynecologist can determine an accurate and effective treatment regimen. Delay in this matter can cost the patient her life.

If the appeal to the doctor is timely, then the first thing the patient is referred for is an ultrasound scan. This accurate clinical examination allows to determine the etiology of the pathological process and the future treatment regimen. If it became known that there is residual fetal tissue in the uterus, additional surgical intervention is necessary to properly clean its cavity. In case of mechanical damage to the uterus or its cervix after interruption, the gynecologist prescribes the repair of the injured area of the uterus, bladder or intestines. nine0017
Possible complications

Bleeding after an abortion is dangerous for women's health and causes serious damage to the woman's reproductive system. Among the potential complications, doctors distinguish infertility, malignant tumors and even death of the patient. Therefore, the problem needs to be addressed in a timely manner, and early termination of pregnancy in order to avoid heavy bleeding.

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Spontaneous abortion (miscarriage)

If the pregnancy ends naturally before the fetus reaches gestational age, this is called a miscarriage or miscarriage. More than half of miscarriages occur no later than 12 weeks of gestation due to fetal abnormalities. The rest falls on the period up to 20 weeks and is associated with pathologies of pregnancy. If the pregnancy is terminated in the second half, it is called preterm labor.

Spontaneous abortion, otherwise known as miscarriage, is one of the most common complications during pregnancy, accounting for 10-20% of diagnosed pregnancies, and is the rejection of a fetus weighing no more than 500 grams. and less than 22 weeks. Unfortunately, with such indicators, the fetus is not viable. Usually 80% of the total number of spontaneous abortions occurs before the 12th week of pregnancy. nine0017
Types of spontaneous abortion

1. Threat of miscarriage - characterized by mild uterine cramps, pulling pain in the lower abdomen and sometimes mild bloody discharge from the vagina.

2. A miscarriage that has begun - is characterized by more severe pain and profuse bleeding. At the same time, the tone of the uterus is slightly increased, and the internal os is closed.

3. Inevitable miscarriage - accompanied by dilatation of the cervix - a fetal egg can be distinguished - with profuse bleeding and severe cramps in the lower abdomen. nine0017
4. Incomplete miscarriage - part of the fetus comes out. The bleeding is so profuse that it can lead to the death of a woman.

5. Completed miscarriage - the fetal egg and the fetus itself are completely out. After that, the bleeding and spasms stop.

The etiology of miscarriage is due to many factors. Among them:

- genetic disorders;

- previous induced abortions;

- too little time has passed since the previous pregnancy; nine0017
- inflammatory infections in the mother, endocrine disorders;

- blood conflict between mother and fetus;

- taking hormonal contraceptives and certain medications;

- smoking during pregnancy and drinking alcohol;

- unknown causes.

To prevent miscarriage, it is necessary to give up bad habits, not to have abortions and to be regularly examined by a doctor.

Spontaneous abortion begins with the appearance of cramping, pulling pains, similar to pain during menstruation. Then bleeding from the uterus begins. At first, the discharge is slight or moderate, and then, after detachment of the fetal egg, abundant discharge with bloody clots begins. The appearance of these symptoms requires urgent hospitalization. nine0017
After examining a woman in a hospital, having determined the degree of detachment of the embryo, one of the following diagnoses will be made:

- the threat of pregnancy - detachment is only outlined or is completely insignificant. In this case, the pregnancy can be saved;

- a miscarriage that has begun - detachment is already quite decent with a pronounced pain syndrome. And in this case, the fetus can be saved;

- abortion in progress - detachment with displacement progresses, labor-like contractions begin. Pregnancy cannot be saved, cleaning is required; nine0017
- incomplete miscarriage - independent exit of a part of the fetus and membranes, curettage is necessary for the final curettage of the uterus;

- late abortion - premature delivery of an unviable baby.

After a miscarriage, a short break in planning and taking preventive measures is recommended to avoid recurrence.

In case of repeated miscarriage, a thorough comprehensive examination is necessary to determine the causes of miscarriage and eliminate them. nine0017
A miscarriage is a severe psychological trauma, especially during the first pregnancy. But do not give up, with a competent approach to planning and bearing, the next pregnancy will certainly end with the appearance of a long-awaited baby.

Causes of spontaneous abortion

1. Doctors call various chromosomal pathologies one of the main reasons: monosomy, autosomal trisomies, polyploidy. They account for 82-88% of spontaneous miscarriages.

2. The second most common cause is disorders in the female genital area: endometritis - inflammation of the uterine mucosa - preventing the implantation of the fetal egg and its development and polycystic ovaries. nine0017
3. Hormonal disorders, namely progesterone deficiency.
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