Every miscarriage experience is different, and there is a wide range of normal. I’ve had 4 missed miscarriages and 1 natural miscarriage. For my missed miscarriages, I’ve experienced medicated miscarriage, D&Cs, and expectant management (waiting). When I first learned I had a missed miscarriage, I was faced with a decision: wait for the miscarriage to occur naturally, use medication, or get a D&C. What helped me most, as I was deciding and figuring out what to expect, was to read the experiences of others. While I can’t predict the future, I can give a general idea of what you might expect during recovery after miscarriage. I hope this helps you through this difficult time.
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Recovery after Medicated or Natural Miscarriage
Hormones
The process your body experiences when recovering from a medicated miscarriage and a natural miscarriage are fairly similar. One difference is that with a natural miscarriage, your body may have already begun experiencing decreases in hormones associated with pregnancy. With a medicated miscarriage, it may cause a more sudden change as levels of hCG and progesterone may have been high or even increasing at the time of the medicated miscarriage.
hCG
hCG levels rise quickly in early pregnancy. hCG is responsible for your positive pregnancy test and common pregnancy symptoms. These hCG levels will not immediately drop to normal after a miscarriage, although they may already be decreasing at the time of the miscarriage. Because of this, you may still have pregnancy symptoms after your miscarriage, although they should go away quickly. You may test positive with a urine pregnancy test after your miscarriage for several weeks. In my experiences, it took roughly 3-4 weeks for hCG levels to return to normal. Your doctor may order lab work to look at your hCG level, because an hCG level that continues to remain elevated could indicate retained products of conception.
Progesterone and estrogen
In addition to hCG, progesterone and estrogen levels that increased during pregnancy are now dropping. Physical symptoms of pregnancy should begin to decrease, but the drop in these hormone levels can cause changes in mood or mental health. It also can cause a lot of fatigue. Give yourself grace as you recover and time to heal. And if you feel like your mental health is a problem, please seek treatment from your doctor or a therapist.
Bleeding and cramping
After the miscarriage, you may have some cramping as the uterus expels blood but this should stop after about a day. You may have bleeding heavier than a period or you may only have spotting. Bleeding should last 1-2 weeks, tapering off in the first few days. If you feel that the bleeding isn’t slowing down, you’re passing large clots, or the bleeding and cramping suddenly increases again, you should contact your doctor. If you are bleeding through a pad in an hour or less, then you need to contact your doctor immediately and likely head to the ER. Heavy bleeding like this needs to be addressed right away.
Activity restrictions
It is common for your OB or midwife to recommend 1 or 2 weeks of pelvic rest. This is to prevent infection. Pelvic rest means to not put anything in your vagina. This includes use of tampons or menstrual cups and vaginal sex. If you have a fever or signs of infection, you should call your provider right away. You should also hold off on exercise until your OB gives you the go ahead, especially high intensity exercise.
Ovulation and first period after miscarriage
Ovulation usually occurs somewhere between 2 and 6 weeks after miscarriage. That’s a big range, so if you are not ready to become pregnant again make sure you are using some form of birth control during this time. Sometimes you may have an anovulatory cycle after miscarriage, meaning a cycle where you don’t ovulate.
When your period returns after miscarriage, it may be heavier than normal or with more intense symptoms. Your cycles should begin to become more regular again after 1-2 cycles. If your menstrual cycles do not return to normal, or you are concerned about heavy bleeding, please contact your provider. I waited a long time assuming that my heavy periods would get better, but really I should have just spoken up sooner. My midwife was able to recommend supplements that helped me have better regulated cycles again and I felt much better.
If you are experiencing heavy periods, consider these strategies for surviving heavy periods after miscarriage.
Trying to Conceive after miscarriage
When to try to conceive after miscarriage is a personal question that needs to be taken on a case by case basis. Evidence has shown that you don’t need to wait to begin trying to conceive again, but there are some exceptions. For example, trying to conceive should be delayed if you will be undergoing testing, such as tests for blood clotting or thyroid hormones. In this case, if an issue is identified, you would want to wait to try to conceive until you have a treatment plan in place with your provider.
Personally, I believe that this should be a topic you discuss with your OB or midwife. And if you or your spouse are not emotionally ready to start trying to conceive, no problem. Take your time and do not feel pressured.
What if there are retained products of conception?
Retained products of conception (RPOC) are placental or fetal tissue that remain in the uterus after the miscarriage. RPOC can be found with palpation during an exam or via ultrasound, as well as other tests. If hCG levels continue to remain elevated in the weeks following miscarriage, this can also indicate RPOC.
It is possible that RPOC will pass naturally over the days after the miscarriage, as happened in my latest miscarriage. I had cramping, bleeding, and passing clots occur 2 days after I had miscarried. RPOC could also be treated with medication to pass the remaining tissue, or with a D&C. Your provider may have specific recommendations for you, or you may be able to make a decision based on your preferences. If you are having heavy bleeding, a D&C may be necessary. If RPOC is not removed, you are susceptible to infection, at risk of heavy bleeding or hemorrhage, and your pregnancy hormone levels may remain elevated longer.
Recovery after D&C
Recovery after D&C is typically easier and more predictable than with a medicated or natural miscarriage. Bleeding or spotting is often lighter and will likely stop in less than 1 week. Some people do experience pain, but I can say that I personally did not have pain after either of my D&Cs. I was back to normal activity (with caution) in 1-2 days.
With a D&C, you will still go through the hormonal changes we discussed above, as the levels of pregnancy hormones drop. hCG levels drop, causing a decrease in physical symptoms of pregnancy. Progesterone and estrogen levels drop as well, causing changes in mood and mental health. Please seek help if you need it. Also consider taking a bit more time off work if you need it for emotional or mental health, even if you are physically ready to return. Your body is going through a lot of changes that can’t be seen from the outside.
As with natural or medicated miscarriage, your provider will recommend 1-2 weeks of pelvic rest to prevent infection. As mentioned above, do not put anything in your vagina. This includes use of tampons or menstrual cups and vaginal sex. Hold off on exercise, especially high intensity exercise and heavy lifting, until cleared by your provider. And if you are experiencing fever or signs of infection, you should call your provider right away.
Return to work
Physically, many people can be ready to return to work within a week. After a D&C, you might even be physically ready to return earlier. But there is the emotional component to consider too. Like I mentioned above, there are hormonal changes occurring in your body, and at the same time, you are grieving. I have found the most peace when I was able to take extra time off (2-4 weeks) before returning. Then I was in a better place emotionally with more stable moods to take on the demands of my job. Here are a few considerations when deciding when to return to work
It may be better to wait until after your follow up appointment
With my first missed miscarriage, I chose a medicated miscarriage. I had never had a miscarriage before, but I felt that everything had gone as it should. I returned to work, grieving but believing it was all over. Then, at my follow up appointment, it was found that I had retained products of conception (RPOC). So I had to explain that at work, take more time off for another round of medication. I returned to work again, then I started to have heavy bleeding and pass large clots. Ultimately I needed a D&C and another absence from work.
If I was financially able to take more time off, for the rest of my miscarriages I chose to stay off of work until my follow up appointment or at least until lab work was done to indicate that the miscarriage was complete.
Job requirements
If you are working from home, and your job doesn’t involve a lot of customer service or demands of social interaction, it may be easier to return more quickly to work. In fact, in this case work may provide a good distraction. On the other hand, you may have a job that is physically demanding and/or involves a lot of interaction with clients, customers, or management. In this kind of environment, you may need more time off before you are physically and emotionally ready to return.
Working in healthcare, my job involved heavy lifting and I had to be “on” 100% of the day as I worked with patients and families with little chance for a break. Remember that first miscarriage I mentioned where I returned too early? I was so exhausted I could barely get through my day. Even when I was physically ready to return, I still needed a bit more time to really be emotionally ready. There were 3 pregnant women at work with due dates close to mine, and it was hard to handle. Add in the nosy patients who always ask how many children you have and if you plan to have more, and I was at a breaking point.
If I had waited a bit longer, to allow myself to grieve and allow my hormones to regulate more, I would have had an easier time returning to work. And that’s exactly what I did during my other 3 miscarriages. I took extra time and allowed myself the healing I needed.
What if I don’t have paid time off and can’t afford to be off any longer?
If you can’t take time off work, ask about bereavement time. Some companies will give a few days of bereavement time for a miscarriage. It isn’t much but it’s better than nothing.
When you need to return, look for support where you can find it. Returning to life while still grieving and healing takes so much strength, and even if others don’t understand, I do and so do the other women who have experienced miscarriage too. Try sharing your story with a trusted coworker. I have worked in 2 different places when I was going through miscarriages, and in both places, as I shared my story, several women who experienced miscarriage shared their stories with me and surrounded me with love and support. They gave me comfort and affirmation, and helped out in practical ways that made my work day easier to get through.