You know a miscarriage means the loss of your pregnancy. And you probably know it causes pain and bleeding. But what’s actually going on in your body? Here’s a guide to what happens…

Your pregnancy hormones drop 

A miscarriage is when the baby in your womb dies, or the pregnancy doesn’t develop, at any time before 24 weeks. Most miscarriages happen in the first trimester. Pregnancy hormone levels can plateau or start to drop, often before you know anything’s wrong. Sometimes, the loss of pregnancy symptoms – such as tender breasts and morning sickness – are a clue you’re miscarrying. But be aware some women don’t have noticeable pregnancy symptoms in the first place, and that in itself isn’t a sign there’s anything wrong with the pregnancy. 

The hormone drops can also have an impact on your emotions. Obviously, miscarrying can bring a mix of very difficult feelings anyway. But the hormonal changes can exacerbate this. 

You start to bleed

All women worry about bleeding in the early stages of pregnancy but it isn’t necessarily a cause for concern, even if it seems quite heavy (although you should definitely always get it checked out). However, bleeding is the most common first sign of a miscarriage as the lining of your womb starts to break down. The amount of blood you’ll lose depends on how advanced your pregnancy was. It can start slowly and then intensify. A very early miscarriage is likely to be similar to a heavy period. 

After around six weeks, you might pass large clots as there will be more pregnancy tissue to lose. Depending on how far the pregnancy got, some of these clots may be as large as an orange. You might be able to see the gestational sac, and even a tiny foetus, which some women find really upsetting. It’s worth nothing, though, that even if you miscarry at around 12 weeks, the pregnancy might have stopped developing several weeks previously, which means there won’t be so much tissue expelled.

Bleeding can go on for up to two weeks, though it’s likely to get lighter during this time. Use absorbent sanitary pads, never tampons, as your cervix and uterus are partly dilated during and after a miscarriage, so there’s a risk of infection. 

You have cramps

Again, some women notice mild cramps during early pregnancy as a result of the womb expanding and ligaments stretching. This is nothing to worry about. You might also have abdominal pain for completely unrelated reasons. But cramping can be a sign of miscarriage. Even with an early miscarriage, you may have quite severe cramps, like bad period pain. This happens because your uterus contracts as it pushes out pregnancy tissue. You can take painkillers to help but speak to your doctor if you’re in a lot of pain. The cramps shouldn’t last too long. Later in the second trimester, you will probably need to go to hospital as the process will be more like a form of labour.

When you have a missed or incomplete miscarriage

Sometimes, the pregnancy stops developing but the body doesn’t expel the tissue. You may continue to ‘feel’ pregnant and may have no sign anything’s wrong. You might only know you’ve had a miscarriage when you go for your scan, which can be shocking and upsetting. 

It’s also possible to have an incomplete miscarriage, where your body expels some of the pregnancy tissue but not all of it. With both missed and incomplete miscarriages, your body would eventually expel all the tissue. But you may decide, along with your healthcare team, that you would like treatment to speed up the process. You can read more about miscarriage treatments here.