Miscarriage
Your health expert: Mr Kuponiyi, Consultant Obstetrician & Gynaecologist
Content editor review by Liz Woolf, October 2023
Next review due August 2026
A miscarriage means loss of a pregnancy during the first 23 weeks. Most miscarriages happen in the first 12 weeks, and sometimes even before you know you’re pregnant.
A miscarriage can be distressing for you and your partner. If you’re prepared for what to expect and get the support you need, it may help you to cope.
About miscarriage
Up to one in four pregnancies end in miscarriage. But the true rate may be higher because many pregnancies end before people know they’re pregnant.
Your risk of miscarriage falls as your pregnancy progresses. An early miscarriage means it has happened less than 13 weeks into the pregnancy. Other terms you may hear include ‘complete’ miscarriage, which means all the pregnancy tissue is out of the womb. ‘Incomplete’ means some has been left behind and you may need treatment.
A threatened miscarriage means there has been bleeding but you’re still pregnant. This doesn’t always mean you’ll go on to have a miscarriage. In pregnancies where there has been early bleeding that stops by 12 weeks, up to nine out of 10 will go on to full term.
Causes of miscarriage
There’s often no obvious reason for miscarriage. Miscarriages before five weeks are sometimes called chemical miscarriages . These are often caused by a problem with genetic material (chromosomes). Doctors think most early miscarriages happen because the baby isn’t developing normally.
The risk of miscarriage increases with age. Half of all pregnancies in women aged 40 to 44 end in miscarriage, compared to one in four for women aged 35 to 39. Men over 45 have a 40 percent higher risk of miscarriage than men in their 20s.
Sometimes a problem with the development of your placenta leads to miscarriage. Late miscarriages (after week 13) are often caused by an infection, such as bacterial vaginosis.
Recurrent miscarriage means losing three or more pregnancies in a row. About half the time, doctors can't find a reason. But sometimes a cause is found, including:
- antiphospholipid syndrome (APS), thrombophilia, or other medical conditions that increase blood clotting
- a hormone condition – for example, polycystic ovary syndrome, diabetes or thyroid problems
- physical problems – for example, an unusually shaped womb or a weak cervix (neck of the womb)
- genetic abnormalities
- vitamin D deficiency
Lifestyle factors may also increase the risk of miscarriage. Miscarriages are more likely if you’re very overweight, smoke or drink alcohol.
Symptoms of miscarriage
The main symptom of a miscarriage is vaginal bleeding. This is usually light bleeding or spotting at first and may continue for several days. As the miscarriage progresses, you may have heavy bleeding, pass blood clots, and have painful cramps in your tummy (abdomen). This is usually worse than period pain and can spread to your pelvis and back.
Bleeding in early pregnancy doesn’t always mean miscarriage. But if it increases or becomes heavier than a normal period, a miscarriage is more likely.
You might not get any symptoms if you’ve had what’s called a delayed or silent miscarriage. But you may notice your pregnancy symptoms have lessened or stopped. You may only find out that you have had a miscarriage when you go for a routine scan.
If you have vaginal bleeding, or pain that concerns you, contact your GP or midwife for advice. If you have severe pain or bleeding, seek urgent medical help.
Diagnosis of miscarriage
If you see your GP, they’ll assess you and do a pregnancy test, unless you’ve done one already. They may refer you to your local Early Pregnancy Assessment Unit (EPAU). This depends on your symptoms and how many weeks pregnant you are.
At the EPAU, you’ll have an ultrasound scan. This is to check if you’ve had a miscarriage and whether there’s still any tissue in your womb. A very early pregnancy may not show up on the scan and you may need to have a repeat scan after a week or so.
You may need blood tests to check levels of the pregnancy hormone, beta-human chorionic gonadotrophin. You usually need two tests, two days apart.
Recurrent miscarriages
If you’ve had three or more miscarriages in a row, your GP will refer you to a specialist. They'll also arrange some tests, which may include:
- blood tests to check for blood clotting disorders
- blood tests to check your thyroid hormone levels
- blood tests for levels of antibodies that may affect your pregnancy
- scans, usually ultrasound, to check the structure of your womb
- genetic testing of you, your partner, and of tissue from a lost pregnancy (if available)
Managing an early miscarriage
Your healthcare team will do their best to help you through this difficult time. You can read more about the emotional impact in our After a miscarriage section.
You might not need any medical or surgical treatment for a miscarriage. They usually happen naturally in time. You’re likely to have period-like tummy cramps and heavy bleeding. You may also pass some clots. But some people don’t have much bleeding at all.
You can take over-the-counter painkillers, such as paracetamol, to help with pain. Doctors don’t recommend using ibuprofen during pregnancy, so don’t take that unless your doctor has confirmed that you are definitely having a miscarriage.
After two weeks, your doctor may suggest another scan if you’re still bleeding, or bleeding hasn’t started. You may need some treatment. Your doctor will help you to understand what to expect, and discuss what might be best for you.
While you are bleeding, you’ll need to wear sanitary pads until it stops. Don’t use tampons as these increase your risk of infection. Contact your hospital if:
- you develop a fever or a vaginal discharge that smells bad – you may have an infection
- the bleeding becomes very heavy
- you’re finding the symptoms too difficult to cope with
Medicines
Medicines can speed up the process of miscarriage. You may have tablets to swallow, or a vaginal pessary. You’re likely to have period-like cramps and very heavy bleeding with these medicines. Both will be more than with a normal period. You’re also likely to pass some clots. Bleeding can continue for up to three weeks.
The medicines may make you feel sick and cause diarrhoea. So your doctor may offer you painkillers and medicines to stop you feeling sick. Read the patient information leaflet that comes with your medicine. Always ask your doctor or a pharmacist if you need advice.
Sometimes, these treatments don’t work and you need surgery. Your doctor will ask you to do a pregnancy test three weeks after you take the medicine. If it’s positive or if your bleeding is hard to manage, speak to your doctor for advice.
Surgery
Surgery can remove any remaining pregnancy tissue from your womb. There are two main procedures.
- Surgery in an operating theatre under general anaesthetic, so you’ll be asleep.
- Vacuum removal (aspiration) in an outpatient clinic with a local anaesthetic.
With local anaesthetic, you’ll be awake, but the anaesthetic will help to block feeling from your cervix as it opens. You may have cramping pains during the procedure – your doctor will give you painkillers or ‘gas and air’.
If you have a rhesus negative blood group, your doctor will offer you an injection after surgery. This is an anti-D rhesus injection. It stops your body forming antibodies that could harm the baby in a future pregnancy.
Having a late miscarriage
A late miscarriage happens between 13 and 23 weeks of pregnancy. If you lose a pregnancy after this, it’s called a stillbirth. Going through a late miscarriage can be devastating. Your hospital team will do all they can to support you.
You’ll usually need to go through the process of labour and deliver your baby. This can happen naturally or you may need to take medicines to start (induce) labour. You can see and hold your baby after the delivery if you would like to. There’s no right or wrong decision – it’s up to you.
Afterwards, you may have bleeding and tummy cramps like period pain. This may last for several weeks. You’ll probably feel very tired and emotional.
In some circumstances, you may need a surgical procedure under anaesthetic. This could be to remove pregnancy tissue remaining in the womb, for example.
After a miscarriage
Physical effects
It may take several weeks for the physical effects of a miscarriage to clear and you may feel tired and run down. Your periods should return to normal within about six weeks.
If you’ve had a late miscarriage, your breasts may be painful and produce milk. You can take over-the-counter painkillers. If you feel very uncomfortable, speak to your GP or midwife. They may be able to prescribe medicines to stop milk production.
Emotional impact
Everyone reacts differently to having a miscarriage and there’s no right or wrong way to feel. A miscarriage can be devastating. The grief you feel can be just as intense as after any other type of loss. It’s also normal to feel shocked, angry, or numb.
Some people feel guilty when they have a miscarriage. But it’s very unlikely that it happened because of something you did or didn’t do. You can’t prevent the things that most often cause miscarriages.
It can be a difficult time for your partner too, and it’s important that you both get the support you need. You should have a follow-up appointment with your GP or other health professional. They can talk things through with you. They may refer you for counselling or tell you where you can get further support.
Your baby
If you had a late miscarriage, your hospital may offer to carry out a post-mortem on your baby. This is to try to find out what caused the miscarriage. It’s your decision whether to have this done. It isn’t always possible to find a reason. But a post-mortem may provide information that can help if you get pregnant in the future.
There’s no legal requirement to have a burial or cremation when a baby dies before 24 weeks of pregnancy. But your hospital may offer you this option. Of course, you can make your own private arrangements if you prefer.
Trying again
You may decide you want to try again for a baby straight after your miscarriage. Or you may feel you need more time to recover. There’s no right or wrong – it’s important that you do what’s right for you and your partner. Having one miscarriage doesn’t necessarily mean you’ll have another. There’s a good chance you’ll have a successful pregnancy in future.
It’s best to wait until your bleeding stops before you have sex again. You may want to wait until you’ve had a period before you try to get pregnant again. This makes it easier to work out how many weeks pregnant you are if you get pregnant straightaway.
If you’ve had tests to try to find out why you’re having miscarriages, it’s a good idea to wait until you get the results.
Otherwise, if you feel physically and emotionally ready, there’s no medical reason why you need to wait. If you don’t want to get pregnant, you’ll need to start using contraception straightaway.
Prevention of miscarriage
If there is a medical cause for your miscarriage, treating it may help to prevent another. For example, antiphospholipid syndrome (APS) can be treated with medicines.
If you have a weakened cervix, your doctor may suggest a cervical stitch. The cervix usually stays tightly closed during pregnancy. But if you have a weak cervix, it can start opening as your baby grows bigger, causing a miscarriage. In a cervical stitch procedure, your doctor puts a strong stitch or tape around your cervix to help keep it closed. Your doctor will remove the stitch when you’re around 37 weeks pregnant, ready for you to give birth.
You can’t prevent most other causes of miscarriage. But there are some things you can do that may help to reduce risk.
- Smoking in pregnancy is harmful to you and your baby and increases miscarriage risk – so try to give up if you smoke.
- Limit or stop drinking alcohol completely when planning a pregnancy. During pregnancy, it’s safest not to drink at all.
- Don’t use illegal drugs if you’re pregnant or planning to become pregnant.
- Avoid foods known to increase the risk of miscarriage (unpasteurised dairy products, soft and blue cheeses, and raw or undercooked meat).
- Maintain a healthy weight before and during your pregnancy.
Try to eat a healthy balanced diet when planning a pregnancy, including folic acid and iron. These don’t affect miscarriage risk but they will help to keep you and your baby healthy in a future pregnancy.
The first sign of a miscarriage is bleeding from your vagina. You may have anything from light spotting to very heavy bleeding that goes on for several days. You might have cramping and backache too.
For more information, see our section on symptoms of miscarriage.
You probably won’t need to go to hospital after a miscarriage. They usually happen naturally, in their own time. But you may need to go to hospital for a scan if you’re still bleeding after two weeks.
For more information, see our section on management of miscarriage.
You may not need any treatment for a miscarriage. But if you do, it could be medicines to help it along. Or a procedure to remove any remaining tissue from your womb afterwards.
For more information, see our section on management of miscarriage.
A miscarriage can be devastating for both you and your partner. It’s important that you get the support you need. You’ll have a follow-up appointment with your GP or other health professional. They can talk things through with you. They may suggest counselling, or tell you where you can get further support.
For more information, see our section on after a miscarriage.
Depression
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