A miscarriage is the loss of a pregnancy before 20 weeks of gestation. It happens in roughly 10 to 20 percent of recognized pregnancies, with the wide range depending on how early the pregnancy was detected. The vast majority occur in the first trimester, and many happen before a person even realizes they’re pregnant.
Why Miscarriages Happen
Nearly half of all first-trimester miscarriages are caused by chromosomal abnormalities in the embryo. These are random errors that occur when the egg and sperm combine, resulting in an embryo with too many or too few chromosomes. The most common type is an extra copy of a single chromosome (called a trisomy), which accounts for about 54 percent of chromosomally abnormal miscarriages. Other patterns include an embryo with an entirely extra set of chromosomes or a missing sex chromosome. These errors are not inherited and are not something either parent caused.
For the other half of miscarriages, the cause is often never identified. Known risk factors include maternal age, certain health conditions, and lifestyle factors. At age 35, the risk of miscarriage is about 20 percent. By 40, it climbs to 33 to 40 percent. At 45, it ranges from 57 to 80 percent. This steep increase is largely because chromosomal errors in eggs become more common with age.
Smoking increases miscarriage risk, as does heavy alcohol or caffeine intake and use of drugs like cocaine. Being significantly underweight or overweight is also linked to higher risk. Conditions like uncontrolled diabetes, thyroid disorders, and certain uterine abnormalities can play a role as well.
What a Miscarriage Feels Like
Vaginal bleeding is the most common symptom, though bleeding in early pregnancy can happen for other reasons and doesn’t always mean a miscarriage is occurring. The bleeding may start light and become heavier, sometimes with clots or tissue passing from the vagina. Cramping in the lower abdomen, similar to period cramps or more severe, typically accompanies the bleeding. Some people also experience back pain.
Other signs include a sudden gush of fluid from the vagina (even without pain or bleeding), fever, or a noticeable loss of pregnancy symptoms like nausea and breast tenderness. Some people describe it as simply not “feeling pregnant” anymore.
Not all miscarriages produce obvious symptoms. In a missed miscarriage, the embryo has stopped developing but hasn’t been expelled from the uterus. There may be no bleeding or cramping at all. These are typically discovered during a routine ultrasound when no heartbeat is detected.
Types of Miscarriage
Doctors classify miscarriages based on what’s happening physically, and the terminology can be confusing if you hear it in an exam room without context.
- Threatened miscarriage: Bleeding and cramping are present, but the cervix remains closed and the pregnancy may still be viable. Some threatened miscarriages resolve, and the pregnancy continues normally.
- Inevitable miscarriage: Bleeding and cramping are present and the cervix has begun to open. At this point, loss of the pregnancy cannot be prevented.
- Incomplete miscarriage: Some pregnancy tissue has passed, but some remains in the uterus. Bleeding and cramping continue.
- Complete miscarriage: All pregnancy tissue has passed. Bleeding and cramping taper off, and the cervix closes on its own.
- Missed miscarriage: The embryo has stopped developing but the body hasn’t begun to expel it. There are usually no symptoms, and it’s found on ultrasound.
How a Miscarriage Is Confirmed
Diagnosis typically involves a combination of ultrasound and blood tests. On ultrasound, a doctor looks for a heartbeat, the size of the gestational sac, and whether the embryo is measuring on track for its age. In very early pregnancies where an ultrasound is inconclusive, blood levels of a pregnancy hormone called hCG are measured. In a healthy pregnancy, hCG levels roughly double every two to three days. Levels that plateau, rise too slowly, or drop signal that the pregnancy is not progressing. A missed miscarriage shows significantly lower hCG levels compared to a viable pregnancy at the same stage.
Sometimes a single test isn’t enough to confirm a miscarriage, and you may need to return in 48 to 72 hours for a repeat blood draw or ultrasound. This waiting period can be agonizing, but it exists to avoid misdiagnosis in very early pregnancies where timing can be uncertain.
Treatment Options
Once a miscarriage is confirmed, there are three main approaches, and in many cases you’ll have a choice among them.
Expectant management means letting the miscarriage happen on its own without medical intervention. Your body will eventually expel the pregnancy tissue through cramping and bleeding. Once the process begins, most of the tissue passes within a few hours. The downside is unpredictability: in a large clinical trial, about 44 percent of people who chose expectant management ultimately needed a surgical procedure because the tissue didn’t fully pass on its own. Nearly half had unplanned hospital visits.
Medical management uses medication to prompt the uterus to expel the tissue. This speeds up the process compared to waiting, but it still involves significant cramping and bleeding at home. In the same trial, about 36 percent of people who received medication still needed a surgical procedure to complete the process.
Surgical management is a brief procedure where a doctor removes the pregnancy tissue using gentle suction, performed under anesthesia. It’s the most predictable option, with a completion rate of about 89 percent on the first attempt. It carries a small risk of infection or injury to the uterus, but serious complications are uncommon.
None of these approaches is medically superior to the others in terms of long-term outcomes. The choice often comes down to personal preference: whether you want the process to happen naturally, whether you want it to be faster, or whether you want the certainty of a procedure.
Physical Recovery
After a miscarriage, bleeding and spotting can continue for several days to a couple of weeks regardless of which treatment path you take. Your first period typically returns about two weeks after the spotting stops, which for most people works out to roughly two to three months after the miscarriage.
Physically, the body recovers relatively quickly. Hormone levels return to their pre-pregnancy baseline within a few weeks, though lingering pregnancy symptoms like breast tenderness may take a bit longer to fade. Emotional recovery is a different timeline entirely and varies enormously from person to person.
Chances of a Healthy Pregnancy Afterward
A single miscarriage does not meaningfully reduce your chances of having a healthy pregnancy in the future. Most people who miscarry go on to have successful pregnancies. Even after three consecutive miscarriages, the risk of losing the next pregnancy is about 29 percent, meaning there is still roughly a 70 percent chance of carrying to term. That number drops only after six or more consecutive losses, where the risk of another miscarriage climbs to about 53 percent.
Research on women with unexplained recurrent miscarriage found that supportive care alone, without any medication, led to excellent pregnancy outcomes. This is important context because it means that for many people, repeated miscarriage is a matter of probability rather than an underlying condition that prevents pregnancy. That said, after two or three consecutive losses, testing for treatable causes like blood clotting disorders, hormonal imbalances, or uterine structural issues becomes worthwhile, since identifying and addressing these can further improve the odds.