Early Miscarriage: Causes, Symptoms, Risk Management & Recovery

What Is Early Miscarriage?

Early miscarriage is the loss of a pregnancy before 13 weeks of gestation.

The American College of Obstetricians and Gynecologists estimates that early pregnancy loss occurs in around 10% of known pregnancies, although the estimate for all pregnancies is likely to be higher.

You may have heard that exercise, sex, or coffee can cause early miscarriage — but these are just myths. The truth is that in the vast majority of miscarriages, nothing could have been done to prevent miscarriage or ‘save’ the pregnancy.

We understand this is a heavy topic, but we want you to be prepared with the facts. Read on to learn about:

• The signs of miscarriage in early pregnancy.

• How to proactively manage your risk.

• How to look after your physical and emotional health following the loss of a pregnancy.

Early Miscarriage Symptoms: What to Watch For

The most common symptoms and signs of early miscarriage include:

• Vaginal bleeding

• Spotting

• Passage of tissue or fluid from the vagina

• Cramping or pain in the lower abdomen, back, or pelvic area

• Easing or disappearance of early pregnancy symptoms (such as breast tenderness or nausea)

If you are pregnant and experiencing any of the above symptoms, contact your healthcare provider straight away. They can assess your symptoms and run tests to check the health of your pregnancy.

You should also seek immediate medical attention if you are pregnant and experiencing any of the following:

• Very heavy vaginal bleeding (i.e. soaking through a pad within an hour)

• Severe cramping or sharp pain in the pelvic area

• Persistent one-sided abdominal pain

• Fever or chills

• Dizziness or fainting

• Severe nausea

• Shoulder pain

These symptoms may indicate a more serious pregnancy complication in need of immediate attention, such as:

• Infection

• Hemorrhage

• Ectopic pregnancy 

Causes of Early Miscarriage: Why Does It Happen?

Chromosomal Abnormalities 

When a sperm and an egg meet during fertilization, they each bring 23 chromosomes to form 23 pairs of chromosomes. Any abnormality related to these chromosomes can interfere with an embryo’s ability to develop. In some cases, an abnormality can lead to miscarriage.

Approximately 40-65% of miscarriages involve a chromosomal abnormality. This makes it the most common cause of miscarriage. 

Uterine Abnormalities

Abnormal growths in the uterine lining due to fibroids or scar tissue can disrupt blood flow to a developing embryo or fetus. This can increase the risk of miscarriage and recurrent miscarriage.

In rare cases, structural or ‘congenital’ abnormalities can also make it more difficult to sustain a pregnancy. Examples include: 

• Uterine septum - when the uterus is divided into two parts

• Bicornuate uterus - when the uterus is heart-shaped

• Unicornuate uterus - when only half of the uterus has developed

Researchers estimate uterine abnormalities account for 15-42% of cases of recurrent pregnancy loss. 

Infection 

An estimated 15% of early miscarriages are caused by an infection. Infections can make it more difficult for the body to support pregnancy. They can also cause direct harm to a developing embryo or fetus. 

Common infections that may disrupt a pregnancy include:

• Chickenpox

• Cytomegalovirus (CMV)

• Rubella 

• Listeriosis

Hormonal Imbalances

An estimated 8-12% of pregnancy losses are caused by an imbalance of hormones. 

For example, the hormone progesterone supports the developing placenta in early pregnancy. If progesterone levels are too low, research shows there is a greater risk of first-trimester miscarriage. 

Thyroid dysfunction is also associated with an increased risk of miscarriage. An imbalance in thyroid hormones can disrupt the implantation process and placental development. It can also interfere with the balance of other key pregnancy hormones, such as estrogen and progesterone. 

Polycystic Ovary Syndrome (PCOS), a complex hormonal condition, is another risk factor for miscarriage. Research suggests PCOS may have a negative impact on embryo quality and the implantation process. Taking PCOS supplements may help support early embryo implantation and address underlying hormone irregularities. 

Understanding the Risk Factors for Miscarriage

The risk of miscarriage is highest in the very early weeks of pregnancy. It then gradually decreases with each week. One study estimates the chance of miscarriage by week to be: 

• 9.4% after 6 weeks gestation

• 4.2% after 7 weeks gestation

• 1.5% after 8 weeks gestation

• 0.5% after 9 weeks gestation

• 0.7% after 10 weeks gestation

After 20 weeks gestation, the risk of pregnancy loss is estimated to be less than 0.5%. 

There are many different reasons why a pregnancy can end. In most cases, nothing can be done to prevent miscarriage. The following table outlines five key risk factors for miscarriage and what you can do to mitigate your risk.

If you are pregnant or trying to conceive (TTC), you should also take a regular prenatal multi-vitamin. Prenatal multi-vitamins are essential for preventing birth defects, pregnancy complications, and pregnancy loss. 

How Is Miscarriage Diagnosed?

A doctor can use the following tests to diagnose a miscarriage: 

• Blood Test: to check human chorionic gonadotropin (hCG) and progesterone levels. Low hCG and/or progesterone levels may indicate miscarriage. 

• Pelvic Exam: to check the cervix. Miscarriage may be likely if the cervix has begun to open. 

• Ultrasound Scan: to check pregnancy tissue and heartbeat. Miscarriage can be diagnosed if there is an absence of pregnancy tissue or if a heartbeat cannot be detected. 

It may not be possible to diagnose a miscarriage following an initial blood test or ultrasound scan. When this happens, you may need to return for follow-up testing within one to two weeks. 

Treatment Options After a Miscarriage

Following a miscarriage diagnosis, you may be offered the following options for treatment:

• Expectant Management: This involves waiting for the pregnancy tissue to pass naturally — a process that can take one to two weeks. This method is associated with an increased risk of hemorrhage and infection. 

• Medication: This involves taking a combination of misoprostol and mifepristone, which can induce natural miscarriage within 24 to 48 hours. 

• Surgical Management: This involves a dilation and curettage (D&C) procedure, which removes pregnancy tissue from the uterus. Recovery time is typically quicker compared to natural passing. 

If you have chosen to allow the pregnancy tissue to pass naturally (with or without medication), you should expect heavy bleeding followed by lighter discharge. You should seek treatment from your healthcare provider immediately if you experience: 

1. Prolonged bleeding
2. Severe pain
3. Fever

Emotional Recovery and Moving Forward

Managing Feelings of Grief

Pregnancy loss, at any stage, can be a deeply painful and emotional experience. If you’ve experienced a miscarriage, it’s important to allow yourself time to grieve and feel your feelings. 

While there is no ‘correct’ way to grieve a miscarriage, the following strategies can help you heal emotionally: 

• Speak with someone you love and trust.

• If it’s difficult to talk to someone, use art or a journal to express your emotions.

• Take care of your mind and body by getting plenty of rest, eating nourishing foods, and engaging in gentle exercises.

• Seek specialized guidance from a counselor, therapist, or miscarriage support group.

Miscarriage can also be an emotionally difficult experience for your partner, too. As a couple, it’s important to:

• Maintain an open dialogue 

• Listen to each other 

• Give each other space to grieve in a way that feels right 

• Remember that you’re facing grief together as partners and not as adversaries 

Trying Again After Miscarriage

It may take some time for you to feel ready to be intimate with your partner again after a miscarriage. 

As a rule of thumb, you should not have sex until all miscarriage symptoms have gone away. After that, you should wait until both you and your partner feel ready to be intimate.  

Your period should come back within four to eight weeks following a miscarriage. However, it can still take several months for your cycle to follow a consistent pattern. During this transition, there is still always a chance you can become pregnant. 

If you do not want to conceive immediately following a miscarriage, you should use contraception every time you have sex.  

If you do want to conceive, it’s a good idea to seek guidance from your doctor about the best way to plan another pregnancy. 

Monitoring Your Fertility at Home

There are also things you can do at home to monitor your overall reproductive health and fertility following a miscarriage. 

For example, Mira’s at-home Panorama Fertility Lab Test can help identify any underlying hormonal factors that may be contributing to long-term infertility or pregnancy loss. 

To better understand your cycle and ovulation patterns following a miscarriage, you can also start monitoring your hormones with the Mira Monitor and Wands. When tracked in the Mira App, you can see in real time how your hormones fluctuate and change. 

If you’re struggling to navigate the practicalities of planning a pregnancy following a miscarriage, you can also seek personalized support in our Hormone Health Clinic.

When to Seek Medical Help

If you are pregnant, you should contact your healthcare provider immediately if you experience any of the following signs of miscarriage, infection, or ectopic pregnancy:

• Vaginal bleeding

• Spotting

• Passage of tissue or fluid from the vagina

• Cramping or pain in the lower abdomen, back, or pelvic area

• Fever, chills, or foul-smelling discharge 

• Severe abdominal pain, dizziness, or fainting

If you’ve experienced three miscarriages in a row, your doctor may want to run further testing. This will help them diagnose and treat any potential underlying health conditions interfering with your body’s ability to maintain a pregnancy. 

Final Thoughts

The important thing to remember is that having a miscarriage is not your fault and you don’t have to go through it alone.

If you are looking for further emotional support following a miscarriage, you may find the following organizations helpful:

• The Miscarriage Association

• Tommy’s - Baby Loss Information and Support

• March of Dimes - Miscarriage, Loss, and Grief

Frequently Asked Questions

How to confirm a miscarriage at home?

The only way to confirm a miscarriage is by visiting your doctor for a blood test or ultrasound.

What does a miscarriage look like?

The most common visible signs of miscarriage include:

• Vaginal bleeding

• Spotting

• Passage of tissue or fluid from the vagina

How to know if I had an early miscarriage or a period?

It is not always easy to tell the difference between an early miscarriage and your period.

Typically, miscarriage blood is heavier than menstrual blood. However, everyone’s body is different. If you think you’re having a miscarriage, speak with your healthcare provider immediately.

What does a miscarriage of 1-8 weeks look like?

The most common visible signs of miscarriage include:

• Vaginal bleeding

• Spotting

• Passage of tissue or fluid from the vagina

What happens after a woman has a miscarriage?

Following a miscarriage, pregnancy tissue passes naturally within one to two weeks. In most cases, medication and/or surgical management may be necessary to remove all pregnancy tissue from the uterus. Your period should return within four to eight weeks following a miscarriage.

Can you miscarry without knowing it?

Yes. It’s possible to experience a missed miscarriage in early pregnancy if you did not know you were pregnant.

What is a threatened miscarriage?

A threatened miscarriage occurs when there is vaginal bleeding and spotting during pregnancy, but the cervix remains closed and the pregnancy is still viable. Threatened miscarriages must be closely monitored by a doctor and may or may not lead to further pregnancy complications.

Is cramping in early pregnancy normal?

Yes. Light cramping is common in early pregnancy. However, if cramping intensifies and is accompanied by other symptoms of miscarriage, seek help from your healthcare provider immediately.