Miscarriage: Causes, Symptoms and Emotional Recovery

A miscarriage is the loss of a pregnancy early on, before 20 weeks by the definition Cleveland Clinic uses (the NHS says before 24 weeks). It is common: about 1 in 10 known pregnancies ends this way, and most losses happen in the first 12 weeks.

If you are going through this, please know it is almost never caused by anything you did. This guide explains the signs, causes, care and recovery, both physical and emotional.

Symptoms of Miscarriage

The most common sign is vaginal bleeding, anywhere from spotting to heavy bleeding. Other signs include:

• Cramping or pain in the lower tummy, often stronger than period pain
• Low back pain
• Passing clots, tissue, or pink, grey or white fluid from the vagina

Some women have no symptoms at all, and the loss is found at a routine scan. This is called a missed miscarriage. Remember that light bleeding in early pregnancy is common and often does not mean a loss; our guide to bleeding in early pregnancy explains the difference.

Types of Miscarriage

• Threatened: there is bleeding but the cervix is still closed, and the pregnancy may continue.
• Inevitable: bleeding and cramps with an open cervix, so the loss is likely.
• Incomplete: some pregnancy tissue is still in the womb.
• Complete: all the tissue has passed.
• Missed: the baby has stopped developing but there may be no symptoms.

Why Does It Happen?

Chromosome problems cause about half of miscarriages. This means the baby did not develop as it should from the start, and nothing could have changed that. Other factors that raise the risk include:

• Age: the risk rises after 30 and is higher after 40
• Uncontrolled diabetes or thyroid disease
• Problems with the shape of the womb or the cervix
• Infections, clotting disorders and some hormone problems
• Smoking, alcohol, drug use, and being very underweight or overweight

If you have thyroid concerns, see our article on thyroid problems in pregnancy.

Myths: What Does Not Cause a Miscarriage

Families sometimes blame the mother, which adds guilt to grief. Cleveland Clinic says there is no scientific proof that stress, exercise, sex or birth control pills cause miscarriage. The NHS also notes that once a miscarriage has started it cannot be stopped, so it was not something rest could have prevented.

When to be cautious: go to a hospital urgently if you have heavy bleeding, severe tummy or shoulder pain, fever, foul-smelling discharge, dizziness or fainting. These can mean heavy blood loss, infection or an ectopic pregnancy (see ectopic pregnancy symptoms).

What Care and Treatment to Expect

The doctor will examine you and usually arrange a scan, and sometimes blood tests, to see whether the pregnancy is continuing and whether any tissue is left. If you are Rh negative you may be offered an anti-D injection. Treatment depends on how many weeks you were and on your situation:

• Waiting: many women pass the tissue naturally. The NHS says this usually takes about 2 weeks, sometimes longer, and a scan can confirm the womb is clear.
• Medicine: your doctor may prescribe tablets that help the womb empty. This is generally an option in the earlier weeks.
• A small procedure: removal of the remaining tissue, usually under anaesthesia, often with same-day discharge. It may be advised if bleeding is heavy or if tissue has not passed.

Bleeding and mild cramps can continue for up to 2 weeks. The NHS advises avoiding sex until symptoms stop, to lower the risk of infection. Use pads, not tampons. Your first period may return within 4 to 8 weeks.

Tip: if you pass tissue at home, keep it in a clean container and take it to the hospital so it can be examined.

Coping With Grief

Grief after a miscarriage is real, whether you were 6 weeks or 16 weeks along. You may feel sadness, anger, guilt, numbness or envy of other pregnant women. Emotional recovery often takes longer than physical recovery. Partners grieve too, even if they show it differently.

• Talk to someone you trust, and say what you need, whether it is company or quiet.
• Give yourself time before returning to normal routines.
• Ask your doctor about counselling or support groups.
• Seek help if low mood, hopelessness or anxiety last for weeks or you cannot cope; see our article on postpartum depression and support for the signs of low mood.

Trying Again

Most women who miscarry go on to have a healthy pregnancy later. A miscarriage does not mean you are infertile. The NHS says you can try again when you feel ready physically and emotionally. Some doctors suggest waiting for one normal cycle, so guidance varies; ask your doctor. Early dating is easier if you know your cycle, so you can use our due date calculator once pregnant.

After three or more miscarriages in a row, the NHS advises seeing a doctor for tests and support. A preconception checkup is a good starting point. Our infertility and reproductive care speciality can also help you plan.

Supporting Your Partner and Family

The NHS notes that partners can also feel the loss deeply, and support is available for them too. Simple things help: listen without hurrying to fix things, avoid blaming words, and let her decide who is told and when. Family members can help with meals and chores so that she can rest. If a loss happens again, or you simply need to talk, a doctor or counsellor can point you to support.

When to See a Doctor

See a doctor if bleeding gets worse or returns, clots are large, pain is severe or lasts more than a week, you feel dizzy, weak or have a racing heartbeat, or you have a fever. Also speak to a doctor if you feel very low for a long time.

Talk to a Doctor

You are not alone. Chaitanya Hospital in Kadapa has 24/7 emergency care, and you can book an appointment or call +91 944 103 0587. This article is for general awareness and is not a substitute for a doctor's advice.