Miscarriage: It’s more common than you think

For all the talk about babies we hear, not much discussion happens about the less-cute aspects of reproductive health. One of the most overlooked: miscarriage. Miscarriage is a common part of the reproductive cycle. It happens in all mammals who experience pregnancy. Still, it can bring with it a diversity of emotions from grief, to anxiety to relief.

Miscarriage occurs in roughly 1 in 5 detected pregnancies (1). The miscarriage rate is closer to 1 in 3 when accounting for undetected pregnancies (or over 2 in 3 if you include fertilized eggs that don’t implant in the uterus)(2, 3, 4). Miscarriage is not caused by the actions, behaviors, or even the body of the pregnant person in the majority of cases.

Despite this, there is still a lot of confusion, silence and misinformation around the topic. Public figures like Priscilla Chan have spoken about the isolation they felt throughout their own miscarriage experiences. Healthcare services do not always provide resources for social or emotional impacts miscarriage can have. Understanding what miscarriage is and why it happens is an important step in removing the stigma around it.

A late period may actually be a miscarriage

A miscarriage is a pregnancy that ends in the first 20 weeks, but most happen within the first eight weeks (5). Miscarriage can even happen before a pregnancy is detected.

In people having unprotected intercourse, it is not uncommon for an irregular cycle to be due to a miscarriage, before someone even knows they are pregnant (4, 6).

Because a miscarriage can happen around the same time someone expects their period, it can be mistaken for menstruation.

Not all fertilized eggs lead to pregnancy

When a sperm meets an egg in the fallopian tube, it can become fertilized. If this happens, the fertilized egg then grows and develops a bit, before it can implant in the uterus. Many fertilized eggs don’t make it past this stage — they don’t start to develop at all, or they cannot implant. In these cases, a person doesn’t become pregnant and the menstrual cycle continues as usual.

Miscarriage is most often random

The majority of miscarriages happen for the same reason that most fertilized eggs do not lead to pregnancy — “chromosomal abnormalities.” This is when there is a problem in the genes of the egg, the sperm or in the two together. These problems are usually caused by normal, random mistakes that happen when cells divide — not because there is a larger problem in the genes of either parent. Miscarriage is the way the body handles these situations after an egg has implanted.

Between 5 and 7 of every 10 early miscarriages are caused by these chromosomal abnormalities in the embryo (7, 8). In many of these cases, an embryo never starts to develop at all.

A miscarriage can also be caused by a medical condition in the pregnant person. This can be hormonal condition such as polycystic ovary syndrome, a thyroid disorder or a physical issue in the uterus, from a condition such as uterine fibroids or endometriosis (9, 10, 11, 12). Miscarriage can also be caused by things like infections, exposure to certain environmental toxins, high stress and behaviors like drinking alcohol (13, 14).

After an early pregnancy stops, the inner tissue of the uterus, along with any new tissue that has grown, usually sheds by itself via the vagina. By the time bleeding occurs, the pregnancy has already ended, meaning an early miscarriage cannot be ‘stopped’ by stopping bleeding or other symptoms such as cramping

The majority of people who’ve had one, two and even three unexplained miscarriages can go on to have a healthy pregnancy (15, 16).

You can be fertile immediately after a miscarriage

It can take anywhere from a few hours to several weeks for the blood and tissue from a miscarriage to completely expel from the uterus. If a miscarriage happens within the first eight weeks of pregnancy, it usually takes 4–6 weeks for menstruation to return (17).

It is possible to be fertile again immediately after a miscarriage, meaning a person can become pregnant even before their menstruation returns.

Emotions can vary

Up to 1 in 2 people will experience significant emotional symptoms in the weeks and months following a miscarriage (18). Anxiety, sadness, grief and depression are common feelings that can last weeks or months. Other people may feel relief, if they did not wish to be pregnant.

While medical services can be great at treating the body, they are not always equipped to address emotions as comprehensively. Some people will need to seek out help for strong emotions that last, and become overwhelming.

Acknowledging a painful loss can be a helpful tool in emotional recovery (19).

Some people choose to bury the tissue, for example, or take time away from regular life activities to grieve.

Knowing your options can help

Most miscarriages do not necessarily need intervention and can be medically managed with a process called “watchful waiting” (20, 21). Some people may choose intervention to have some control over the experience, and/or they would like it to be over more quickly. Others may have intervention because they are at risk of a complication, or because a miscarriage didn’t complete on it’s own. Depending on timing, interventions include an aspiration procedure to remove the uterine contents, or a pill to help shed it more quickly.

Contact a healthcare provider if you think you may be having a miscarriage. They will ask you some questions, and make sure everything is okay. Some people may need a blood test. In certain cases a miscarriage doesn’t complete on it’s own, requiring treatment. If you experience sharp pain, dizziness, fever or shoulder pain, go to the doctor or emergency room to rule out complications like ectopic pregnancy.

Tracking bleeding patterns and other symptoms with Clue during and/or after a miscarriage can help provide a record of how things are changing. It may also help spot when something might be off, or when a miscarriage may need further treatment. If you are concerned about your cycle or any symptoms, talk to a healthcare professional.

Remember, you can make sure a miscarriage (or other anomalous cycles) won’t affect Clue’s predictions (and your statistical averages) by excluding any irregular cycles later on..

Understanding how common miscarriage really is, and why it happens, can help to shape and inform decision-making and emotional process. And the more we are able to talk about it, the more we will weaken problematic cultural stigma.

References

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  2. Wilcox AJ, Weinberg CR, O’Connor JF, Baird DD, Schlatterer JP, Canfield RE, Armstrong EG, Nisula BC. Incidence of early loss of pregnancy. New England Journal of Medicine. 1988 Jul 28;319(4):189–94.
  3. Zinaman MJ, Clegg ED, Brown CC, O’Connor J, Selevan SG. Estimates of human fertility and pregnancy loss. Fertility and sterility. 1996 Mar 31;65(3):503–9.
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  15. Li W, Newell-Price J, Jones GL, Ledger WL, Li TC. Relationship between psychological stress and recurrent miscarriage. Reproductive biomedicine online. 2012 Aug 31;25(2):180–9.
  16. Rai R, Regan L. Recurrent miscarriage. The Lancet. 2006 Aug 18;368(9535):601–11.
  17. Donnet ML, Howie PW, Marnie M, Cooper W, Lewis M. Return of ovarian function following spontaneous abortion. Clinical endocrinology. 1990 Jul 1;33(1):13–20.
  18. Lok IH, Neugebauer R. Psychological morbidity following miscarriage. Best Practice & Research Clinical Obstetrics & Gynaecology. 2007 Apr 30;21(2):229–47.
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