Most of the time, bleeding is the first sign of a miscarriage. However, a miscarriage can occur without bleeding, or other symptoms may appear first.
Many women prefer the term pregnancy loss to miscarriage. Pregnancy loss is most common within the first weeks of pregnancy, and the risk steadily declines as the pregnancy progresses.
It is important to remember that pregnancy symptoms shift over time. These changes do not always signal a pregnancy loss.
Anyone who believes that they have lost a pregnancy, with or without bleeding, should seek medical attention.
Pregnancy losses do not always involve bleeding. In fact, a woman may not experience any symptoms and only learn of the loss only when a doctor cannot detect a heartbeat during a routine ultrasound.
Bleeding during pregnancy loss occurs when the uterus empties. In some cases, the fetus dies but the womb does not empty, and a woman will experience no bleeding.
Some doctors refer to this type of pregnancy loss as a missed miscarriage. The loss may go unnoticed for many weeks, and some women do not seek treatment.
According to the American Pregnancy Association, most losses occur within the first 13 weeks of pregnancy. While an estimated 10–25 percent of all recognized pregnancies end in a pregnancy loss, a loss in the second trimester is very rare.
Some women have no external symptoms of pregnancy loss. When the loss occurs early on, a woman may have few signs of pregnancy, which can make identifying the loss more difficult.
It is normal to experience changes in pregnancy signs over time, particularly in the transition from the first to the second trimester. These changes do not usually indicate the loss of the pregnancy.
Some warning signs of a pregnancy loss without bleeding include:
- a sudden decrease in pregnancy signs
- pregnancy tests that show a negative result
- nausea, vomiting, or diarrhea
- back pain
If the pregnancy has advanced, fetal movement may noticeably slow or stop.
Most women seek treatment for a pregnancy loss when they experience bleeding. When there is no bleeding, a doctor may only diagnose a loss during a routine scan.
A doctor may also suspect a loss because of other indications, such as a drop in the levels of pregnancy hormones or an unusual decrease in other pregnancy signs.
Blood tests can determine the levels of hormones, which can help to assess the likelihood of a pregnancy loss. To conclusively diagnose a loss, a doctor must perform an ultrasound to check for a heartbeat.
The heartbeat does not develop until 6.5–7 weeks of gestation, so the absence of a heartbeat before this time does not indicate a loss.
To confirm a pregnancy loss, a doctor may choose to perform scans on multiple days.
To determine the reason for a loss, a doctor may also recommend genetic testing, further ultrasound scans, or blood testing.
The goal of treatment is to remove the fetus and tissue from the uterus and to prevent complications, such as a uterine infection. There is a variety of treatment options available, and a doctor or midwife will be able to advise on the best option.
When pregnancy loss occurs without bleeding, it is often safe to wait for a few weeks before seeking treatment, because the uterus may empty on its own.
When this occurs, a woman can expect bleeding that involves passing the tissue. This usually lasts for less than a week, and cramping may accompany it.
If the uterus does not empty, or if a woman does not want to wait, the most common treatment options are:
- medication that encourages the release of the fetus
- a surgical procedure called dilation and curettage
A doctor may recommend pain medication to reduce associated cramping. Over-the-counter varieties are often effective. If they do not work, a doctor can prescribe something stronger.
In rare cases, pregnancy loss leads to a uterine infection, which requires treatment.
Therapy and support groups can help. Some women might also benefit from using antianxiety or antidepressant medications.
Many women worry that they are responsible for the loss of their pregnancies. In most cases, this is untrue, and the loss is outside of a person's control.
The most common cause of a pregnancy loss is a chromosomal abnormality that would have made it impossible for the baby to survive.
Less common causes include:
The recovery time associated with a pregnancy loss depends on many factors, including how far along the pregnancy was.
For most women, the time to physically recover is relatively short. Women who undergo surgical removal of the fetus may experience no physical symptoms after any associated bleeding has stopped.
Those who experience complications, such as a uterine infection, can expect a longer recovery time.
However, the emotional effects of a pregnancy loss can last much longer. Some women grieve for a lifetime. Others feel better after conceiving another baby.
There is no standard timeline, no right way to grieve, and no right way to feel about a pregnancy loss.
Many women find that talking to loved ones, joining a support group, and meeting with a therapist who specializes in pregnancy loss helps.
Following a pregnancy loss, many women worry that they will be unable to become pregnant again. However, losses are common and the issues responsible often do not recur.
There is no right way to respond to the loss of a pregnancy. Many people need time to grieve, while others want to try again right away.
Likewise, losses can occur in many ways. Some involve no physical symptoms, while others are painful and require surgery.
Working with trusted healthcare providers can help a woman to deal with the physical and emotional effects of a pregnancy loss.