Miscarriage, the spontaneous loss of a pregnancy before the 20th week, is a common and often emotionally challenging experience for those who endure it.

While the majority of miscarriages occur due to genetic abnormalities that are unavoidable, the management and treatment of miscarriage aim to ensure the physical wellbeing of the individual, address any underlying causes, and provide emotional support.

A miscarriage generally occurs for reasons outside your control and nothing can be done to prevent or stop it from happening. Any treatment you have will be aimed at avoiding heavy bleeding and infection. Recurrent miscarriage, also known as recurrent pregnancy loss (RPL), is defined as two or more consecutive pregnancy losses and affects a smaller subset of individuals, presenting additional emotional and medical complexities.

Understanding the causes, treatment options, strategies for prevention, management, and relevant statistical information about miscarriages can provide crucial support and guidance for those affected.

  • General Miscarriage Rates: Miscarriage is relatively common, with estimates suggesting that 10-20% of known pregnancies end in miscarriage, though the actual number may be higher since many occur before a pregnancy is clinically recognised.
  • Age-Related Risk: The risk of miscarriage increases with maternal age, from about 10-15% in women under 35, and up to 50% in women aged 40 and above.
  • Recurrent Miscarriage Rates: Recurrent miscarriage affects about 1% of couples trying to conceive.

Managing Your Miscarriage

  • It is usual to have pain and bleeding after a miscarriage. It will feel similar to a period and will usually stop within two weeks. You can take ordinary painkillers for the pain. Your next period will usually come in four to six weeks after a miscarriage.
  • See a doctor or attend a hospital emergency department if you have strong pain and bleeding (stronger than period pain), abnormal discharge, (especially if it is smelly), or fever. These symptoms may mean that you have an infection or that tissue has been left behind.
  • Try and avoid vaginal sex until the bleeding stops and you feel comfortable.
  • Use sanitary pads until the bleeding stops (do not use tampons).
  • All contraceptive methods are safe after a miscarriage.
  • See a GP in four to six weeks for a check-up.

Cause of Miscarriage

The causes of recurrent miscarriage are diverse, and in many cases, a specific cause may not be identified. Known factors include:

  • Genetic or Chromosomal Abnormalities: A significant proportion of miscarriages are due to chromosomal abnormalities in the embryo.
  • Anatomical Issues: Uterine anomalies, such as a septate uterus or fibroids, can interfere with the implantation and growth of the embryo.
  • Hormonal Imbalances: Conditions like polycystic ovary syndrome (PCOS), thyroid disorders, and luteal phase defects can affect pregnancy sustainability.
  • Immune System Disorders: Some women may develop antibodies that attack the developing embryo or experience blood clotting disorders that affect placental blood flow.
  • Lifestyle Factors: Smoking, excessive alcohol consumption, obesity, and extreme caffeine intake can increase the risk of miscarriage.
  • Infections: Certain bacterial and viral infections can compromise pregnancy.
  • Environmental Toxins: Exposure to certain environmental pollutants and toxins may be linked to increased miscarriage risk.

Treatment Options

Expectant management of miscarriage, also known as “wait and see” is an approach where medical intervention is delayed, allowing the body to naturally expel pregnancy tissue after a miscarriage has been diagnosed. This option is typically considered for early miscarriages, particularly when the miscarriage is incomplete, but the body is beginning to process the loss naturally.

How it works
When a miscarriage is diagnosed, especially in cases where the miscarriage is incomplete (meaning not all pregnancy tissue has passed from the uterus), expectant management gives the body time to pass the remaining tissue on its own. The process can vary in duration, typically ranging from a few days to a few weeks. Healthcare providers will offer guidelines on monitoring symptoms and recognising signs of complications that would necessitate immediate medical attention.

Advantages of expectant management

  • Natural Process: Many individuals prefer expectant management because it allows the body to complete the miscarriage process naturally, without medical interventions like medication or surgery.
  • Avoids Procedures: It eliminates the risks associated with medical or surgical management, such as infection or uterine scarring.
  • Emotional Closure: For some, experiencing the physical process of miscarriage provides a sense of emotional closure, helping them to grieve and process the loss.


Considerations and risks
While expectant management is a viable option for many, it’s not suitable for everyone. Factors influencing the decision may include the duration of the pregnancy, the level of bleeding and discomfort experienced, and individual health considerations. Risks associated with expectant management include:

  • Heavy Bleeding: There’s a risk of heavy or prolonged bleeding, which can be distressing and, in rare cases, may require emergency treatment.
  • Incomplete Miscarriage: If the miscarriage does not complete naturally, medical or surgical intervention may eventually be needed to prevent infection or other complications.
  • Emotional Distress: The waiting and uncertainty can be emotionally challenging for some, making it important to have adequate support and access to counselling services if needed.


What to expect
During expectant management, individuals may experience symptoms similar to a heavy menstrual period, including bleeding and cramping. The severity and duration of these symptoms can vary. Healthcare providers will advise on what symptoms to monitor, such as signs of infection (e.g., fever, foul-smelling discharge) or excessive bleeding, which would require prompt medical attention.

Follow-up care
Follow-up care is an essential component of expectant management to ensure that the miscarriage has been completed without complications. This may involve ultrasound scans and/or blood tests to confirm that all pregnancy tissue has passed from the uterus. Healthcare providers will also offer guidance on physical recovery, emotional support resources, and discussions about future pregnancies when the individual is ready to consider this.

Medical management of miscarriage is a treatment option that uses medication to facilitate the expulsion of pregnancy tissue from the uterus after a miscarriage has been diagnosed. This approach is particularly relevant for early miscarriages or when an incomplete miscarriage has occurred, meaning not all pregnancy tissue has naturally passed from the body.

How it works
Medical management typically involves the use of a medication called misoprostol, either alone or in combination with mifepristone. Misoprostol causes the uterus to contract and expel pregnancy tissue through the vagina. It is administered orally or vaginally, and the process of miscarriage usually begins within a few hours to a few days after taking the medication.

Advantages of medical management

  • Non-Surgical Option: It offers an alternative to surgical intervention, avoiding the risks associated with anaesthesia and the procedure itself, such as infection or uterine scarring.
  • Privacy and Comfort: This method can be completed in the privacy of one’s home, allowing for a more personal or intimate experience during this difficult time.
  • Effectiveness: Medical management is generally effective in completing the miscarriage, with success rates varying but generally high, especially in early pregnancy.


Considerations and risks

  • Bleeding and Pain: Medical management often results in heavy bleeding and cramping, more intense than a menstrual period. Pain management with prescribed or over-the-counter pain relievers is an important consideration.
  • Incomplete Miscarriage: There is a possibility that not all pregnancy tissue will be expelled, requiring further treatment, either with additional medication or surgical intervention.
  • Emotional Impact: The process can be emotionally challenging, and the physical experience of passing the pregnancy tissue can intensify feelings of loss and grief.


What to expect
Individuals can expect to experience bleeding and cramping, which may begin within a few hours after taking the medication. The intensity of these symptoms can vary widely. Passing large blood clots or tissue is common during this process. Healthcare providers will offer guidance on managing pain and what symptoms to monitor, such as signs of infection or excessive bleeding that would necessitate medical attention.

Follow-up care
Follow-up care is critical to ensure that the miscarriage has been completed and to address any complications. This typically involves a follow-up visit with a healthcare provider, who may perform an ultrasound or order blood tests to confirm that all pregnancy tissue has been expelled and that the uterus is clear.

Surgical management of miscarriage is a medical intervention used to remove pregnancy tissue from the uterus following a miscarriage. This approach is considered when a miscarriage is incomplete, meaning some pregnancy tissue remains in the uterus, or when there’s a need to expedite the process due to heavy bleeding, infection risk, or for emotional reasons. The primary methods include dilation and curettage (D&C) and vacuum aspiration.

Surgical procedures for miscarriage

  • Dilation and Curettage (D&C): This procedure involves dilating the cervix and then using a curette (a spoon-shaped instrument) to scrape the lining of the uterus and remove pregnancy tissue. D&C is typically performed under general anaesthesia or sedation in a hospital.
  • Vacuum Aspiration: Also known as suction aspiration, this method involves using gentle suction to remove pregnancy tissue from the uterus. Vacuum aspiration can be performed under local anaesthesia in a clinic setting and is considered less invasive than D&C, with a generally quicker recovery time.


Advantages of surgical management

  • Prompt Resolution: Surgical management quickly clears the uterus of pregnancy tissue, which can be crucial in cases of heavy bleeding or infection.
  • High Success Rate: These procedures have a high success rate in completely removing pregnancy tissue, reducing the need for additional treatment.
  • Control: Unlike expectant or medical management, surgical options provide control over the timing of the procedure, which can be a significant consideration for emotional or physical reasons.


Considerations and risks
While surgical management is generally safe, as with any procedure, there are potential risks:

  • Infection: There’s a small risk of infection, which can typically be managed with antibiotics.
  • Scarring: Rarely, procedures can lead to scarring of the uterine lining (Asherman’s syndrome), which can affect future fertility and pregnancy.
  • Anaesthesia Risks: Though minimal, there are always risks associated with anaesthesia, ranging from minor reactions to more severe complications.

What to expect
Preparation for surgical management of a miscarriage includes fasting if general anaesthesia is to be used. Post-procedure, patients might experience cramping and light to moderate bleeding for a few days. Pain relief medication can be used to manage discomfort. Most individuals can resume normal activities within a few days, although heavy lifting and inserting anything into the vagina, including tampons, should be avoided for a period to reduce infection risk.

Follow-up care
Follow-up care is crucial after surgical management to ensure complete recovery and address any complications. This usually involves a post-operative visit to check for signs of infection, ensure the uterus is returning to its normal state, and discuss any needed emotional support or planning for future pregnancies.

Recurrent Miscarriages

A very small number of couples experience recurrent miscarriage, which will often require a more thorough investigation.

Diagnostic Approaches

A thorough evaluation is essential for identifying the cause(s) of recurrent miscarriages. This may include:

  • Genetic Testing: Both partners may undergo genetic testing to identify chromosomal issues.
  • Hormonal Assessments: Tests to check for thyroid disorders, progesterone levels, and other hormonal imbalances.
  • Anatomical Evaluations: Ultrasound, hysteroscopy, or laparoscopy can identify uterine anomalies or other structural issues.
  • Blood Tests: To detect autoimmune disorders or blood clotting issues.

Treatment Options

Treatment for recurrent miscarriage depends on the identified causes, but may include:

  • Corrective Surgery: For anatomical issues like fibroids or a septate uterus, surgical intervention can often correct these problems.
  • Genetic Counselling and Assisted Reproductive Techniques (ART): For genetic issues, IVF with preimplantation genetic testing (PGT) may be recommended to select embryos without genetic abnormalities.
  • Hormonal Therapy: Progesterone supplementation in early pregnancy can help in cases of hormonal imbalance.
  • Anticoagulation Therapy: For women with certain blood clotting disorders, low-dose aspirin or heparin can improve pregnancy outcomes.
  • Immunotherapy: Although controversial and not widely recommended without clear evidence of benefit, treatments like intravenous immunoglobulin (IVIG) may be considered in specific cases of immune-related miscarriage.
  • Lifestyle Modifications: Advice on weight management, quitting smoking, and reducing alcohol and caffeine intake.

Future Attempts at Pregnancy After Miscarriage

Medical opinions on the best time to try for another pregnancy after a miscarriage have varied. Historically, it was often recommended to wait for a certain number of menstrual cycles before attempting to conceive again, typically one to three cycles. However, recent studies suggest that conceiving soon after a miscarriage does not increase the risk of subsequent miscarriages and may even be associated with higher rates of successful pregnancies. Ultimately, the timing should be based on individual health, emotional readiness, and the advice of a healthcare provider.

Planning and preconception care
When you are ready to try again, preconception care can help optimise your health for a future pregnancy:

  • Folic Acid Supplementation: Starting or continuing folic acid supplementation is recommended to decrease the risk of neural tube defects in the developing foetus.
  • Preconception Checkup: A visit to a healthcare provider for a preconception checkup can help address any health concerns and provide guidance on preparing for a healthy pregnancy.
  • Tracking Fertility: Understanding your menstrual cycle and tracking ovulation can help in timing intercourse for conception.


The risk of another miscarriage after a single loss is generally low and similar to the overall miscarriage risk in the general population, which is about 10-20%. However, the risk may be higher in individuals with underlying medical conditions or those who have experienced multiple miscarriages.

Emotional Support Recommended

The emotional toll of recurrent miscarriages can be profound, leading to feelings of grief, anxiety, and depression. Support from counselling, support groups, and mental health professionals specialising in reproductive health can be invaluable. Comprehensive care for recurrent miscarriage includes not only medical interventions but also emotional and psychological support to help couples navigate their journey.

Dr Rozen’s Approach to Miscarriage

Understanding the statistics related to miscarriage and recurrent miscarriage can offer some perspective. While specific success rates for treatments can vary based on the underlying cause, it is encouraging to know that with appropriate intervention, about 60-70% of women with miscarriages go on to have successful pregnancies.

Get in touch with our friendly team.

Dr Genia Rozen is a Melbourne gynaecologist and fertility specialist with 10+ years of experience dedicated to fertility medicine.

She holds a Masters of Reproductive Medicine (MRMED) degree and undertook three years of sub-specialising training in Fertility and Reproductive Medicine at the Royal Women’s Hospital in Melbourne. She is affiliated with Genea Fertility who are recognised leaders in advanced reproductive laboratory services.

Please get in touch if you have a question or wish to book an appointment.