Spontaneous miscarriage refers to a condition that is caused when the body aborts a fetus within 20 weeks of gestation. As your body heals it may take time for your menstrual cycle to return to normal. Your first period after your miscarriage should occur four weeks after the hCG levels return to zero. Many examinations only measure these levels until the hCG levels fall below 5, so it can be difficult to determine when exactly normal bleeding can be expected. You should not use the timing based on when you found out about the miscarriage as your basis for evaluating your heal time, but when the natural miscarriage began. Your doctor will help you determine the difference so you can work together to see how your health is progressing.
Possible Symptoms of First Period after Miscarriage
Noting the symptoms that accompany your bleeding will help you determine if your body is healing from the miscarriage properly. There are multiple scenarios which can occur as your body works to recover.
Most Common Symptoms
Bleeding from a miscarriage will often slow within a week, though random spotting may still occur for a week after the regular bleeding ends. By the time you finish spotting, your hCG levels should reach zero. You may also see a brown or yellow discharge emanating from the vagina. This is a natural cervical mucus that is no cause for alarm. Your period will typically come late due to your body's attempts to return hormones to their normal levels. In some cases your period may come as late as seven weeks after the miscarriage.
At this point a fertility monitor may claim you are ovulating, but this is typically a false reading. In most cases you will not ovulate during the first cycle following a miscarriage. You may experience pregnancy symptoms such as abnormal body temperature or late period that can lead to a false impression during this time period. As your body works to return to its normal cycle it is common to see a fluctuation in symptoms.
Less Common But Normal Symptoms
In less common cases, your bleeding may end rather quickly aside from the occasional spotting. Then one or two weeks later your bleeding will start again. This new bleeding may be heavy and accompanied by pain and cramping. The second onset of bleeding should not last for more than a few days before you resume spotting. This should not be mistaken for your period unless at least 20 days have passed, allowing adequate time for your hormone levels to reset.
This second round of bleeding is caused by a portion of the placenta that clung to the uterus during the miscarriage. Because this remained in place your body continued to nourish it with blood, producing pregnancy hormones until it tore loose. Now the cycle must begin again so your body can fully recover from the incident. Though this can be emotionally difficult to manage, it is not a physically dangerous condition.
If your bleeding or spotting carries on for several weeks without fully stopping, you may have an issue that is impeding your recovery. If you alternate between spotting and heavy bleeding, and your hCG levels still remain high you may still have a piece of tissue that needs to pass. If this goes on for a significant amount of time, your doctor can prescribe medication that will help you pass this tissue so your cycle can begin again.
Those who are still dealing with spotting after several weeks but have relatively low hCG hormones may be dealing with a hormone imbalance that is not allowing your body to return to its normal cycle. Your doctor may provide a dose of progesterone that will force your body to act as though it has just finished its menstrual cycle. After this drug leaves your system you should have a normal period that will allow your cycle to return to normal. If you are still having trouble with spotting at this point you may need to temporarily use birth control pills to help regulate your hormones.
If you are dealing with extremely heavy bleeding two weeks after the miscarriage you may have a problem that requires medical attention. You may also notice large portions of black tissue in with the blood. In addition from the concern that you may become ill from the loss of blood, you may see hCG levels that are 500 or higher.
There are two explanations for this type of reaction. You may have a partial molar pregnancy, a condition that can cause your body to exhibit higher hCG levels and bleeding symptoms for months. You will not be able to get pregnant until you manage to clear these hormones from your system completely.
You may also have a portion of tissue that has become lodged in the reproductive system that will not clear on its own. This may require D&C or methotrexate treatments to kill the tissue. You will need to work with your doctor to determine the best method of removing this tissue to reduce the risk of infection or hemorrhaging.
Approximately two to six weeks after your miscarriage, you will need to have a follow up examination to access your condition. At this point, your cervix will still be open and you will be very tender. Taking an anti-inflammatory before your appointment can help lessen your discomfort.
During your initial appointment you will be given the opportunity to ask questions, but you may not have many tests done. It may also be emotionally taxing to go through this process, so be prepared for the emotional turmoil this examination may cause. Try to go to an appointment during a gynecology time period so you do not have to sit in a room with expecting mothers or bring along someone you trust for emotional support.
Tips for Sex
Sex should be avoided in the time period shortly after the miscarriage. Your cervix will still be open, making you very susceptible to pain and infection. Do not try to have sex or conceive until you have had a regular period. Take things slowly at first to determine what you can handle. You may need to have sex a few times before the pain eventually stops.