How do you know if you've had a miscarriage?

Still a taboo subject, due to fear and obviously sadness, miscarriage (which we prefer to call a stopped pregnancy) is nevertheless intrinsically linked to pregnancy. Because one in ten women worldwide has already been affected, it is time and necessary to open up the conversation about this sensitive topic. To better cope with it if you are affected (yourself or your loved ones), to recognize it if it happens, to know the steps for your mind and body if you have just experienced one, and especially to know how to bounce back, at your own pace, here are some key points.

What is a miscarriage?

A miscarriage defines a sudden and involuntary interruption of pregnancy that occurs between 1 and 22 weeks of amenorrhea. There are nevertheless differences in stopped pregnancies, depending on when or how they manifest. It is important to differentiate them, as the management approaches are not the same and will need to be adapted.

1. Spontaneous miscarriage (called FCS in medical abbreviation)

In the case of a spontaneous miscarriage, the embryo is naturally expelled by the uterus.

2. Early miscarriage

An early miscarriage occurs during the first trimester of pregnancy (before the 14th week of amenorrhea).

3. Late miscarriage

Also sometimes still called "late abortion", a miscarriage is considered late if it occurs between the third and fifth month of pregnancy (after the 14th week of amenorrhea). A pregnancy termination beyond the first five months (i.e., 22 weeks after the date of the last menstrual period) will be called fetal death.

4. Isolated miscarriage

A miscarriage is qualified as isolated if the pregnant woman has only experienced one, as opposed to recurrent miscarriages (a woman under 40 who has already had three consecutive early miscarriages). These recurrent miscarriages are, however, much less frequent: 1.9% of women have two, and this figure even drops to 0.7% for those who have had three. Remember that a miscarriage in no way predicts your ability to have a baby later.

How to tell if you are having a miscarriage? The signs

When you are pregnant, and perhaps even more so if it is a first pregnancy, it is not always easy to understand your body's signs and know if and when you should "worry", because everything is changing inside! If you have had a positive pregnancy test and then bleeding appears, it is normal to wonder and fear a miscarriage. To identify the symptoms of a stopped pregnancy, watch carefully for:

• The sudden absence of pregnancy signs you were experiencing (nausea, breast pain, vomiting, etc.)
• Heavy bleeding (often with bright red blood clots)
• Severe pelvic pain (pulling sensations in the back or pelvic area are normal, but if they intensify or persist, this can be an alert)
• Contractions (regular and painful) or abdominal cramps
• Fever and chills: check with a healthcare professional to ensure this is not a sign that the gestational sac is expelling the fetus

Some pregnancies can also be interrupted without particular signs. In case of doubt or anxiety, if you feel that something is not right, consult a doctor, gynecologist or midwife urgently. Sudden blood loss/vaginal bleeding, intense pain (in the lower abdomen, abdomen or back) or loss of consciousness should be immediate warning signs.

How not to confuse miscarriage and menstruation?

At first glance, it can seem difficult to distinguish an early miscarriage from the main signs of menstruation, especially during the first months or weeks of pregnancy, when it has not yet been confirmed. Here are some elements to help you differentiate the two:

• Heavy (and long) bleeding: Vaginal bleeding related to a miscarriage is often more abundant and prolonged than usual menstrual periods. To give you a reference, they may require using more than two sanitary pads per hour, while normal periods usually only require one per hour.
• Presence of blood clots or tissue: During a miscarriage, the expulsion of blood clots or embryonic tissue is often observed. This is not the case during menstruation.
• Blood of a different color: Menstrual bleeding often starts with a brownish tint before turning red. Miscarriage bleeding, on the other hand, can be bright red from the start.
• Intense abdominal pain: Although menstrual cramps are common during periods, abdominal pain related to a miscarriage is generally more intense. It can even be accompanied by back pain or severe pelvic pain.
• Disappearance of pregnancy symptoms: If bleeding is associated with a sudden disappearance of pregnancy signs (nausea, tender breasts, fatigue), this may indicate a miscarriage.

What to do in case of miscarriage or doubt

When a miscarriage occurs, medical consultation can be essential to assess the situation and determine the best course of action. Depending on the stage of pregnancy and how the expulsion unfolds, several options are possible:

Natural expulsion: In cases of early miscarriage, the body can naturally eliminate embryonic tissue. This expulsion is often accompanied by abdominal cramps and bleeding that can last several days. Medical monitoring is then necessary to ensure that the uterus has completely emptied and that no residual tissue risks causing complications.

Medication: If expulsion does not occur spontaneously, medical treatment with misoprostol may be prescribed. This medication induces contractions and promotes evacuation within 12 to 24 hours. In some cases, a second dose may be prescribed. Doctors tend to favor this approach for early miscarriages, as it avoids surgical intervention. Once the process is complete, a follow-up ultrasound checks that the uterus is empty.

Curettage: When the pregnancy is more advanced (generally after 10 weeks of pregnancy) or in case of incomplete miscarriage, surgical treatment becomes necessary. This involves an intra-uterine aspiration performed under local or general anesthesia to remove any remaining tissue. The procedure is quick and reduces the risk of infection or hemorrhagic complications.

If in doubt, do not wait to ask for help. Consult a doctor, midwife or gynecologist: they will be able to confirm the situation with an ultrasound or a blood test. And if your symptoms worsen (heavy bleeding, intense pain, fever or malaise), go to the emergency room without hesitation. This allows for the most appropriate care.

Last important point: after a stopped pregnancy, it is normal to have vaginal bleeding for several days. It is strongly recommended not to use tampons or menstrual cups, which could increase the risk of infection.

The same goes for sexual intercourse: it is advisable to wait a few weeks before resuming it.

After a miscarriage: what you need to know

Grieving your perinatal loss

The trauma that a spontaneous, late, or isolated miscarriage can cause in pregnant women should not be underestimated. A stopped pregnancy, regardless of the number of weeks it occurred, is a loss. The WHO refers to perinatal grief when parents lose their baby between 22 weeks of amenorrhea and the 7th day after birth, but in all cases, it is a bereavement for both partners, during which feelings are confused and mixed (emptiness, sadness, disappointment, and sometimes even guilt). Even if the temptation to remain alone is strong, it is important to confide in your loved ones, seek psychological support, and talk about it with your partner, who is also suffering and often feels helpless. However, if your grief lasts or paralyzes you for too long, do not hesitate to seek support from a therapist or even join support groups if you feel the need to feel understood. In France, it is estimated that there are 200,000 miscarriages per year, so you are not alone. Loved ones can be present, but may not always find the right words or have the necessary empathy if they have not gone through this difficult experience.

Requesting sick leave for miscarriage if necessary

According to Ameli, since January 1, 2024, you can obtain sick leave without a waiting period for miscarriage. To benefit from it, it's simple: your doctor can prescribe paid sick leave from the first day. Also know that if you prefer that your employer not know the medical reason for your absence, you can request regular sick leave, with a waiting period.

Allow yourself time to heal

We often wonder how long a miscarriage lasts. The truth is, there is no exact answer, as every woman will experience this ordeal differently. But one thing is certain: to recover and be able to consider a new pregnancy as calmly as possible, time plays an important role. It allows both the body and heart to gradually recover. Even if you are the only one who knows when you will be ready, it is recommended to wait at least a few menstrual cycles before trying to get pregnant again.

A past pregnancy interruption will not prevent you from having a normal future pregnancy. Remember to check with your gynecologist that your period has returned (some women may develop "psychogenic amenorrhea," a psychological blockage of menstruation) following your stopped pregnancy.

Preparing for a new pregnancy when you feel ready

Did you know that female fertility can be temporarily higher in the cycles following a stopped pregnancy? We explain why in our article Why are we more fertile after a miscarriage.

If you are considering a new pregnancy, you need to prepare both your mind and body to experience this joyful event again. Time often softens the trauma and dispels the fear that it will happen again.

If you are pregnant again (congratulations!), do not hesitate to have early follow-up ultrasounds (the first one as soon as possible) to check that everything is going well. And take care of yourself, of course!

What can be the causes and risks of a miscarriage?

It is legitimate to want to understand what happened and to wonder if one "did something wrong". But this is often a source of guilt for pregnant women who feel responsible, wrongly. Spontaneous miscarriage affects about 15% of pregnancies, or about 23 million cases each year worldwide. It is therefore a phenomenon that is unfortunately as frequent as it is misunderstood, and whose cause is generally not identified. A mother can be in good health and still experience a stopped pregnancy.

Causes of miscarriage

• Chromosomal abnormalities of the fetus that prevent it from developing correctly: this concerns the vast majority of cases. The chromosomes have a problem and/or are not well distributed, or embryonic development (nervous system, heart, etc.) presents dysfunctions. A stopped pregnancy is in this case an appropriate response from the body, which understands that the embryo will not be viable.
• A fall or an accident: a significant shock (or blows) can cause placental abruption.
• An ectopic pregnancy (in the majority of cases).
• Polycystic ovary syndrome (PCOS), which can increase the risk of miscarriage.
• The presence of an infection in the pregnant woman: toxoplasmosis, rubella, listeriosis, etc.
• Maternal health problems: coagulation problems, hormonal imbalances, uterine fibroids, uterine malformations (such as a septate uterus), or autoimmune diseases, chronic diseases, etc. In the case of recurrent stopped pregnancies, further research is needed to find if there is a medical cause.

Risk factors

• Age: as with fertility, age plays against women in the risk of stopped pregnancy; it would be around 12% at 25 years old, and could reach 50% around 42 years old.
• Alcohol or drug consumption during pregnancy (especially heroin, cocaine and amphetamines).

Key steps to know if you are having a miscarriage

1. Identification of signs: Note the presence of pelvic cramps or unusual bleeding that differs from your usual cycles.
2. Biological verification: Even if you have already had a positive pregnancy test, a new analysis of the pregnancy hormone (hCG) by blood test may show a drop in the level.
3. Imaging examination: A vaginal ultrasound or pelvic ultrasound is performed by a professional to check for cardiac activity.
4. Diagnostic consultation: The medical team analyzes whether the uterus is empty or if intervention is necessary (medication or curettage).
5. Recovery follow-up: Monitor the return of your menstrual cycle and take the time needed for emotional and physical recovery.

Summary table on how to tell if you are having a miscarriage

Frequently asked questions about how to tell if you are having a miscarriage

What is a silent miscarriage?
This is a situation where the embryo's heart activity has stopped, but the body has not yet initiated expulsion, thus causing no immediate bleeding.

How to distinguish between a miscarriage and an ectopic pregnancy?
Only a pelvic ultrasound can confirm if the embryo is properly positioned. An ectopic pregnancy often manifests with pain on one side and is an emergency.

What is the main cause of early pregnancy loss?
In the majority of cases, it is an accidental chromosomal abnormality that prevents the normal development of the embryo.

How long after can the menstrual cycle return?
The menstrual cycle generally resumes between 4 and 8 weeks after the complete evacuation of the uterus.

Can you have a miscarriage without pain?
Yes, particularly during an early or silent miscarriage, where physical symptoms can be very subtle or absent at first.

This article is for informational purposes only and does not constitute medical advice. If in doubt or experiencing suggestive symptoms, consult your doctor, midwife, or go to the emergency room promptly.