First Period After Miscarriage: What to Expect

Miscarriage is not, as many people assume, a singular event that begins and ends at defined times. Some women describe both miscarriage and the ensuing recovery as a lengthy process that involves extended emotional and physical challenges.

The grieving associated with miscarriage can last several months. Physically, the first period after a miscarriage may be different from what you usually experience. It can be unusually heavy and cause more discomfort than typical menstruation or be unusually light but with severe emotional distress.

Common Concerns

Unusual menstrual symptoms after a miscarriage can be alarming for those who don’t know what to expect. While these issues vary from one person to the next, the following concerns are especially common:

Late periods. Many women return to their regular cycle four weeks after having a miscarriage, but for some women, menstruation may be delayed even longer.

The timing for the first period after a miscarriage largely depends on when the miscarriage becomes “complete.” A miscarriage is complete when the uterus has shed all tissues from the pregnancy. This process can occur naturally, but a dilation and curettage (D&C) procedure may be required. In a D&C, the tissue is surgically removed from the uterus.

After a miscarriage, tissue fragments can remain in your uterus for days or even weeks. The remaining tissue can cause bleeding to pick up again after it appears to have tapered off. The sooner all placental tissue (source of nutrients and oxygen for a baby in the womb) is gone, the sooner your menstrual cycles will return to normal.

Women who were nearing the end of the first trimester or already in the second trimester at the time of miscarriage may take longer to return to “typical” menstruation due to elevated levels of a pregnancy hormone called human chorionic gonadotropin (hCG).

Heavy flow. Regardless of when your first period after miscarriage takes place, it is likely to be heavier than usual. Your body won’t have ovulated during the past cycle, so the endometrial lining (lining of the wall of the uterus) may be thicker. This leads to a heavier flow and may also cause your period to last longer than usual.

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Some women experience menstrual clotting for the first time during their initial post-miscarriage period. This is normal and won’t necessarily continue for future periods. Pain as well as other menstrual symptoms, such as acne, food cravings, and tiredness, can also be more significant for the first few post-miscarriage periods.

Given the severity of post-miscarriage periods, some women choose to take a few days off of work to rest and recuperate.

Severe cramps can be managed with help from over-the-counter medications like ibuprofen or acetaminophen. You can also use a heating pad or hot water bottle to ease painful cramps. 

Light flow. While many women experience a heavier than usual flow after a miscarriage, others discover that their period is actually lighter. Despite this, other menstrual symptoms may still be more severe than usual. 

If you have an abnormally light flow after a miscarriage, monitor your cycle closely for a month or two. Contact your physician if your period still seems unusually light after this time.

While a light period is usually harmless after a miscarriage, it can sometimes be a sign of Asherman’s syndrome. This condition occasionally happens after a D&C and may involve scarring of the uterus.

Hormonal fluctuations. Many women also have major hormonal fluctuations during their first period after miscarriage. These fluctuations may lead to significant emotional distress and symptoms, which sometimes resemble postpartum depression. 

The hormonal changes from your first post-miscarriage period may contribute to mental health issues. Nearly one in five women may develop symptoms of major depression or anxiety after miscarriage.

Although many women find that their emotional distress eases significantly after the first post-miscarriage menstrual cycle, for some women, symptoms of depression and anxiety last much longer.  If these symptoms continue for more than a month or two after a miscarriage, they could be a sign of a larger problem and should be addressed as soon as possible. 

If you’re worried about your mental health after a miscarriage, consider tracking both emotional and physical changes and meeting with a physician six to eight weeks after the loss.

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Physical readiness to conceive. The first real period after miscarriage signals that you are physically capable of getting pregnant again. If you don’t feel ready, emotionally or physically, to try for a baby so soon after your miscarriage, you may want to ask your doctor about birth control. 

Depending on the severity of the miscarriage, it may be preferable to wait for a few cycles before you try to get pregnant again. This provides more time for physical and emotional recovery and the opportunity to track ovulation. Keep in mind that getting an early period after a miscarriage doesn’t necessarily mean that you have ovulated already.

WebMD Medical Reference Reviewed by Dan Brennan, MD on March 10, 2021

Sources

SOURCES:
American Family Physician: “Common Treatments for Miscarriage.”

Forbes: “Conceiving After Miscarriage: How Long Should You Wait?”

Harvard Health Publishing: “Miscarriage What is It?”

Human Reproduction: “Asherman’s Syndrome: it may not be all our fault.”

Jezebel: “The Never-Ending Miscarriage: What Really Happens When You Lose a Pregnancy.”

John Hopkins Medicine: “Dilation and Curettage (D&C).”

March of Dimes: “Miscarriage.”

Mayo Clinic: “Menorrhagia (heavy menstrual bleeding).”

Mayo Clinic: “Menstrual Cramps.”

MyHealth Alberta: “Miscarriage: Care Instructions.”

Obstetrics and Gynecology: “Predicting the Decline in Human Chorionic Gonadotropin in a Resolving Pregnancy of Unknown Location.”

The Primary Care Companion For CNS Disorders: “Depression and Anxiety Following Early Pregnancy Loss: Recommendations for Primary Care Providers.”

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