If you’ve heard the term miscarriage, you probably know that it means the loss of a pregnancy before 20 weeks’ gestation. Miscarriage is something that no one wants to think about during early pregnancy, but 10-20% of all known pregnancies end in miscarriage. Being able to recognize miscarriage symptoms and knowing what to do next can help you be more prepared in case one happens.

Symptoms of a miscarriage

A miscarriage can happen suddenly or gradually, which means that you may not notice any particularly early symptoms of a miscarriage. But no matter how fast it happens, key symptoms include:

  • Pink, red or brown vaginal bleeding or spotting
  • Cramps or pain in the lower abdomen
  • Passing tissue or blood clots from the vagina

Every miscarriage is different. The heaviest bleeding and cramps may be over within a few hours, but bleeding could continue off and on for as long as three weeks. And although most people experience cramps, a miscarriage isn’t always painful.

Both vaginal spotting and mild cramps are common during early pregnancy, so it’s possible to have a miscarriage and not know it. This is why you should call your care provider if you experience any of the above symptoms once you’ve confirmed your pregnancy.

When do miscarriages happen?

Most miscarriages happen during the first trimester, which is the first 12 weeks of pregnancy. If you’re not tracking your menstrual cycle or fertility, it’s possible to mistake an early miscarriage for a period. And although miscarriages can still happen after the first trimester, the chances drop significantly – to around 3-4%. It’s also possible to have a pregnancy loss after 20 weeks, but this is referred to as a stillbirth. It’s treated differently and is much less common than a miscarriage.

Will a pregnancy test be negative after a miscarriage?

It takes time for your hormones to return to their pre-pregnancy levels after a miscarriage. The amount of the pregnancy hormone human chorionic gonadotropin (hCG) may still be high enough to trigger a positive result on a pregnancy test for several weeks after a miscarriage.

What causes miscarriages?

One of the most important things to know about miscarriages is that they’re often caused by things that you have no control over, including:

  • Chromosomal abnormalities: This is when a fertilized egg has too many or too few chromosomes. Chromosomal abnormalities account for around half of all miscarriages and are usually random. They can either prevent the embryo from developing or from forming in the first place.
  • Uterine or cervical issues: In some cases, conditions related to the uterus or cervix can interfere with embryo development and lead to miscarriage. This includes conditions that create growths or scar tissue in the uterus like endometriosis, pelvic inflammatory disease, and cervical insufficiency – which is when the cervix opens too early, typically in the second trimester.
  • Infections: Untreated sexually transmitted infections (STIs) can cause you to miscarry. It’s important to get tested for STIs before you get pregnant, as you can have an infection without symptoms. You may also miscarry if you become infected with listeriosis, which is a type of food poisoning. This is why it’s recommended that you avoid eating certain foods during pregnancy.

In addition to the above, there are other factors that can increase your risk of miscarriage and other pregnancy complications . These risk factors include:

  • Age: Pregnancy after age 35 comes with a higher risk of miscarriage. This is because as you age, eggs with extra or missing chromosomes become more common.
  • Environmental exposure: Working around or otherwise being exposed to radiation, toxins or contaminants.
  • Health conditions: Certain health conditions, like autoimmune disorders, thyroid disorders, severe diabetes and being over- or underweight.
  • Lifestyle choices: Smoking, drinking alcohol and using drugs.
  • Previous miscarriages: Having two or more miscarriages in a row can be a sign that you have a higher chance of miscarrying in general.

What does NOT cause a miscarriage

Physical activity and sex have not been linked to miscarriage. But if you’re ever unsure about whether something is safe to do during your pregnancy, talk to your care provider.

Some studies have shown that stress or high caffeine intake during pregnancy may increase miscarriage risk. More research is needed, but it’s recommended that you try to manage your stress as best you can, and keep your daily caffeine intake below 200 milligrams.

What to do if you have a miscarriage

Again, if you notice potential symptoms of a miscarriage, call your care provider. They will want to confirm the miscarriage and make sure that you aren’t at risk for heavy blood loss or infection. This is usually done with a pelvic exam and an ultrasound.

Miscarriages frequently resolve on their own without any need for treatment. It may take a few days to pass all of the tissue, and you may have moderate bleeding that lightens over the course of a couple weeks. Seek immediate medical treatment if you have heavy bleeding that does not lighten, fever, weakness or other signs of infection.

Medical treatment for a miscarriage

There’s no treatment that can stop a miscarriage. Instead, miscarriage treatment focuses on preventing excessive blood loss and infection, which can happen if the uterus isn’t completely cleared of tissue. Once a miscarriage has been confirmed, options for treatment may include:

  • Medication: Medication can be used to speed up the passing of pregnancy tissue.
  • Surgery: If there’s leftover tissue in the uterus or signs of heavy blood loss or infection, a minor surgery called dilation and curettage (D&C) may be performed. In a D&C, the cervix is dilated so that the remaining tissue can be gently removed. This option can also be chosen based on preference.

Tips for recovering from a miscarriage

  • To prevent infection, avoid putting anything in your vagina during a miscarriage, and for two weeks afterwards. This means avoiding sexual intercourse and using pads instead of tampons.
  • If you’re having painful cramps during or after a miscarriage, take acetaminophen – follow the label instructions.
  • Your iron levels may drop as a result of the bleeding. To offset this and support your body’s blood production, eat a healthy diet that’s high in iron and vitamin C. Iron can be found in red meat, shellfish, beans and leafy green vegetables. Vitamin C can be found in citrus fruit, kiwis, bell peppers and many other vegetables.
  • A miscarriage can be an emotionally difficult time, and there’s no right or wrong way to feel. It’s common to experience a variety of emotions, including mood swings, grief, anger and loneliness. Talk with family, friends or a counselor if you’re feeling overwhelmed or need support after a pregnancy loss.
  • Be kind to yourself. The physical and emotional toll of a miscarriage can be draining. It’s okay to take a step back from your regular activities if you need to rest and recuperate.
  • Once your miscarriage has been confirmed, go to any recommended follow-up appointments, and report new or worsening symptoms to your care provider as soon as possible.

Can you avoid a miscarriage?

After a miscarriage, it’s normal to wonder if you could have done anything differently. Remember, a miscarriage is rarely anyone’s fault, and there’s no sure way to prevent one from happening. That said, there are a few healthy lifestyle choices you can make to minimize your risk:

  • If you smoke, drink alcohol or use drugs, quit as soon as possible.
  • Get tested for STIs.
  • Talk to a medical professional about any health conditions you haven’t had treatment for.
  • Stick to any treatment plans or other methods you’ve already been given for managing health conditions.
  • Get enough physical activity.
  • Eat a balanced diet.

Keep your risk low

If you aren’t pregnant yet, one of the best things you can do to minimize your risk of miscarriage and other complications is to make a preconception appointment. This is an opportunity for your care provider to review your medical and lifestyle histories, and make recommendations that can give your pregnancy the healthiest possible start.

And if you’re already pregnant, stick to your prenatal appointment schedule. Your prenatal appointments ensure that you and your little one are getting all the care you need. Plus, these appointments give your care team the chance to catch signs and symptoms of complications before they affect your pregnancy.

Make a preconception appointment or a prenatal appointment.