In the UK, around 1 in 5 pregnancies ends in miscarriage. Miscarriage refers to the loss of a pregnancy before 24 weeks. Whether you have an early or late miscarriage, it takes time to heal physically and emotionally.
Here, we’ll discuss the symptoms, risk factors and causes of miscarriage, as well as types of miscarriage, how miscarriage is managed and what recovery involves.
First, it helps to understand some of the words used when describing what happens during a miscarriage.
Embryo, foetus and other terms
During pregnancy, the fertilised egg is called an embryo. The process of the embryo attaching to the inner lining of the womb (also known as the uterus) is called implantation.
Soon after implantation, a sac develops around the embryo called a gestational sac. In a healthy pregnancy, the gestational sac continues to grow until around week 10.
The gestational sac starts to shrink after week 10 and is replaced by another sac called the amniotic sac.
After around 8 weeks, the embryo enters another phase of development and is called a foetus.
Types of miscarriage
Miscarriage or pregnancy loss before 24 weeks can occur in different ways. Broadly, miscarriage can be grouped into early miscarriage and late miscarriage.
Early miscarriage happens within the first 12 weeks of pregnancy, while late miscarriage happens during weeks 13–24 of pregnancy. A missed miscarriage — where miscarriage happens without any symptoms — usually occurs within the first 12 weeks but can happen later.
Early miscarriage can be grouped into anembryonic pregnancy, chemical pregnancy, ectopic pregnancy and molar pregnancy. If you have 3 or more early miscarriages, this is called recurrent miscarriage — in between these miscarriages, you may have pregnancies that lead to the live birth of babies.
Anembryonic pregnancy
In the past, this was also called a blighted ovum. Although this term can be upsetting, it’s still sometimes used in a medical setting.
An anembryonic pregnancy is a type of miscarriage that happens soon after implantation. The embryo stops developing and is absorbed by the body. This occurs during the first 12 weeks of pregnancy. Although the embryo has been lost, the gestational sac (the sac that grows around the embryo soon after implantation) remains and pregnancy symptoms can continue.
Chemical pregnancy
This type of miscarriage occurs within the first 5 weeks of pregnancy. You are unlikely to have any pregnancy symptoms as the embryo is lost so early.
The embryo is often lost soon after implantation and before the pregnancy is known. However, increasingly sensitive over-the-counter pregnancy tests mean that more women are now aware of when they have a chemical miscarriage.
Ectopic pregnancy
In the UK, around 1 in 80 pregnancies is ectopic. An ectopic pregnancy can never lead to the live birth of a baby.
In the vast majority of cases, it happens when the embryo implants in a fallopian tube instead of in the womb. The embryo cannot be moved into the womb and, therefore, cannot survive.
Some people may not experience any symptoms, and in these cases, an ectopic pregnancy is often only detected during a routine 12-week ultrasound scan. Once detected, if the embryo is not lost naturally, treatment is needed to end the ectopic pregnancy.
Molar pregnancy
A molar pregnancy is a rare type of pregnancy that does not produce an embryo. Around 1 in 600 pregnancies in the UK is a molar pregnancy. It’s caused by a problem during fertilisation of the egg, which causes abnormal cells to grow, instead of a healthy embryo.
As with an ectopic pregnancy, symptoms do not always occur, and in these cases, it is often only detected during a routine 12-week ultrasound scan. Once detected, treatment is needed to end the molar pregnancy.
Late miscarriage
A late miscarriage refers to pregnancy loss between 13–24 weeks of pregnancy. When a pregnancy is lost after 24 weeks, it’s called a stillbirth.
There are many different causes of late miscarriage. It often triggers premature labour and birth. In cases where this does not happen, labour usually needs to be artificially started using medications or a medical procedure (induced labour).
Missed miscarriage
A missed miscarriage refers to a miscarriage that happens without any symptoms. After the miscarriage, you may still experience pregnancy symptoms as the hormones responsible for these symptoms can take weeks to return to normal levels.
A missed miscarriage is usually only detected during a routine ultrasound scan. How the miscarriage is managed will depend on the stage of development the embryo or foetus reached.
Symptoms of a miscarriage
A miscarriage does not always cause symptoms; when this happens, it is called a missed miscarriage.
When symptoms occur, the most common symptoms are vaginal bleeding, pain and unusual vaginal discharge.
Vaginal bleeding
Vaginal bleeding doesn’t always mean you’re having a miscarriage, but it should always be investigated.
The extent of vaginal bleeding during miscarriage can vary. The blood can be bright or dark and may or may not contain blood clots. Vaginal bleeding can be:
- Spotting — red, pink or brown spots of blood on your underwear or toilet paper when you wipe yourself
- Light bleeding — red, pink or brown patches of blood, which may need the use of a sanitary pad
- Heavy bleeding — red blood that soaks through a sanitary pad
You should seek urgent medical help if you notice any amount of vaginal bleeding during pregnancy. You can call your maternity unit, an early pregnancy centre or 111 for urgent advice on what to do next.
Pain
Miscarriage can cause abdominal pain and cramps, which can be constant or come and go. Pain usually occurs in the lower part of the tummy and is caused by the womb, which is a large muscle, contracting in waves.
Abdominal pain during miscarriage is often described as feeling like a contraction during labour or severe period pain.
An ectopic pregnancy often causes abdominal pain on one side. If the fallopian tube containing the ectopic pregnancy bursts, the internal bleeding can irritate your diaphragm. This, in turn, can cause pain to spread to the tip of your shoulder.
As with vaginal bleeding, if you experience abdominal pain or shoulder pain during pregnancy, you should seek urgent medical help.
Unusual vaginal discharge
Miscarriage can cause a sudden gush of fluid from your vagina due to the amniotic sac (the fluid-filled sac surrounding the developing baby) bursting.
It can also cause white, grey or pink lumps of stringy tissue to pass out of your vagina. The tissue may be parts of the placenta and/or gestational sac or amniotic sac.
You may also pass blood clots from your vagina.
You should seek urgent medical help if you notice any unusual vaginal discharge during your pregnancy.
Miscarriage causes and risk factors
The exact cause of miscarriage is not always known. However, in some cases, a cause can be identified. Known causes of miscarriage include:
- A one-off error in a gene in the egg or sperm that forms the embryo — this accounts for around half of all miscarriages
- An abnormally shaped womb or large fibroids in the womb — both conditions can cause late miscarriage
- An error in a gene in the mother or father — this is rare
- Antiphospholipid syndrome in the mother — an autoimmune condition that causes excessive blood clotting and can cause early or late miscarriage
- Cervical weakness — weakness in the neck of the womb that causes it to open too early in pregnancy, which can lead to a late miscarriage
- Inherited blood clotting disorders eg factor V Leiden and protein S deficiency
Your risk of miscarriage increases with age and with previous miscarriages. It’s also higher if it took over a year for you to conceive and if you’re pregnant with more than one baby (eg twins, triplets, etc).
Other risk factors for miscarriage include:
- Being overweight or obese
- Having a previous miscarriage
- Infections — this includes chlamydia, listeria, Toxoplasma gondii and parvovirus
- Poorly controlled diabetes
- Polyendocrine metabolic ovarian syndrome (PMOS), which was previously called polycystic ovary syndrome (PCOS)
Lifestyle factors also increase your risk of miscarriage eg drinking alcohol while pregnant, and smoking.
Common misconceptions about miscarriage causes
Research into the causes of miscarriage has shown that certain factors once thought to increase the risk are unlikely to cause miscarriage in most cases.
These include moderate exercise, working full-time, eating spicy food, experiencing everyday stress, heavy lifting, living near electricity pylons or mobile phone masts, and having sex.
Getting pregnant soon after a miscarriage or giving birth is also not thought to increase your risk of miscarriage.
Diagnosing miscarriage
To diagnose a miscarriage, a doctor will ask you about your pregnancy, symptoms, medical history and any past pregnancies.
They may also suggest that you have a blood test, urine test, and/or an ultrasound scan of your womb and surrounding pelvic tissues.
If you have started to have a miscarriage, it cannot be stopped. However, you will be given appropriate care and treatment to manage your miscarriage. Your doctor will discuss your options with you, so you can make an informed decision.
Miscarriage treatment
Early miscarriage treatment
If you have an early miscarriage, your body may recover naturally by passing the tissue and embryo or foetus out of your vagina. It can take up to 2 weeks for this process to complete.
However, in some cases, you may need treatment to help your body pass the tissue and embryo or foetus. This may involve taking medication and resting at home or being monitored in hospital for 1–2 days.
In other cases, it may involve an invasive procedure where a small tube is passed through your vagina into your womb to remove the tissue and embryo or foetus using gentle suction. You will be given a local or general anaesthetic for this procedure, and you may need to stay overnight in hospital.
Late miscarriage treatment
Late miscarriage treatment usually involves going through labour and having a vaginal delivery. If you don’t naturally go into labour, you’ll be given medication to induce labour either as an oral tablet or a vaginal pessary.
After taking this medication, you can go home and come back to hospital after 36–48 hours. You’ll then be given further medication every couple of hours to stimulate contractions until you give birth. You may need to stay in hospital overnight.
Recovering from a miscarriage
A miscarriage can be a very traumatic experience, and you’ll need to give yourself time to heal physically and emotionally. It’s important to note that most women who experience miscarriage go on to have a healthy pregnancy.
Physical recovery
Your physical recovery can take days or weeks, depending on how far through your pregnancy your miscarriage occurred. You can speak to your care team about when you can return to work and other physical activities.
You may experience abdominal pain, cramping, vaginal bleeding and fatigue for up to 2 weeks. Although it’s common to experience these symptoms, if you’re concerned, your symptoms are not getting better, or they're getting worse, contact your GP or maternity team immediately.
You should not have sex again until your symptoms have gone away to avoid the risk of infection.
It can take a few weeks for your hormones to return to normal, and around 4–8 weeks before you have a period.
Emotional recovery
Miscarriage can cause a wide range of emotions. You may feel angry, anxious, shocked and/or a deep sadness and grief. You may also feel numb, lonely or isolated, and your self-esteem and confidence may be affected.
Dealing with the emotional impact of a miscarriage is different for everyone, with emotions changing from day to day. Some only feel the impact months after a miscarriage, while for others it’s immediate.
There’s no right or wrong way to deal with a miscarriage. However, it usually helps to seek support from friends, family, support groups and/or health professionals. In England, you can apply for a baby loss certificate — formalising the loss in this way can be helpful for some people.
Not everyone feels comfortable talking about their experience of miscarriage. You may find it easier to talk to a counsellor or support group member rather than a friend or family member, or vice versa. Focus on what works for you and remember that there’s no pre-set timeframe for your emotional recovery.
Can I prevent miscarriage?
Although you can reduce your risk of miscarriage by not drinking or smoking during pregnancy and managing any pre-existing health conditions, you can’t reduce your risk of miscarriage to zero.
Miscarriage often occurs without a known cause, even when you do everything you can to reduce your risk of miscarriage.
Getting pregnant again after a miscarriage
Choosing to become pregnant again after a miscarriage can feel like a big decision and can come with feelings of anxiety as well as hope. It’s important to speak to your care team to make sure you get the right help to support your pregnancy medically as well as emotionally.
If you’ve had a late miscarriage or 3 or more early miscarriages, your NHS care team may offer you tests to try to identify a cause. If a cause is identified and it can be treated, your care team will provide appropriate treatment and support.
You can try to conceive once your miscarriage symptoms have stopped. Although you may start having periods again after 4–8 weeks, it can take several months before your periods return to what is normal for you.
Where to find support after a miscarriage
If you’ve had a miscarriage, speak to your GP about where you can find support. This may include counselling and local support groups. You can also look to support services provided by UK charities such as Miscarriage UK and the pregnancy and baby charity Tommy’s.
Miscarriage FAQs
How long do you bleed after a miscarriage?
You may experience vaginal spotting or bleeding for up to 2 weeks after a miscarriage. However, bleeding should reduce over this time. If your bleeding doesn’t reduce or it continues beyond 2 weeks, see your GP.
Can stress cause a miscarriage?
There is no clear evidence that everyday stress causes miscarriage. However, stress can negatively affect your health during pregnancy by disturbing your sleep, causing headaches and increasing your blood pressure.
Does orgasm cause miscarriage in the first trimester?
No, having an orgasm does not cause miscarriage in a healthy pregnancy. Having sex also does not increase your risk of miscarriage in an uncomplicated pregnancy.
Is diarrhoea in early pregnancy a sign of miscarriage?
Diarrhoea in early pregnancy can be a sign of miscarriage; however, it can also be a symptom of pregnancy as your body adjusts to the changes in hormones. Nonetheless, if you develop diarrhoea in early pregnancy, contact your GP, midwife or early pregnancy centre for advice, and make sure you stay hydrated.
