For many women, miscarriage is one of the worst events of their lives. It is painful physically, emotionally, spiritually. Pregnancy loss is a worst fear realized, and the mourning process is complicated, in part because it may be suffered in silence.
Is this you? If so, I’m so sorry you are going through this. You are not alone. At least 10% of pregnancies may end in miscarriage. This can feel like a scary statistic, but an important counterpoint is the low chance of it happening again. Studies show that only 5% of women will have 2 consecutive miscarriages, and only 1% will have 3 or more. The likelihood is that your next pregnancy will be a baby.
What does it mean to have a miscarriage?
Just like so much else in medicine, we have multiple names for the same entity. We use early pregnancy loss (EPL) or spontaneous abortion (Sab) as other interchangeable terms for miscarriage; they all signify a spontaneous pregnancy loss before 20 weeks.
We further subdivide miscarriage into a chemical or clinical loss. Chemical means that it is early, found typically either with a urine or blood hCG test. Clinical is when the pregnancy is noted on ultrasound and then unfortunately passes.
The diagnosis of pregnancy and its location is complex: we use your last menstrual period, if you know when you ovulated, hCG levels, and ultrasound to deduce the health of the pregnancy.
Your doctor will discuss with you specifics on management of a miscarriage. Please continue the monitoring and to get immediate care if you are having any worrisome symptom.
The question you can’t stop thinking about — why did this happen?
Feeling guilty about doing (or not doing) almost everything you can think of is common, so it’s important to specify what isn’t the cause for miscarriage:
- typical exercise
- lifting objects
- sleeping habits
- usual diets
Though this needs to be tailored to your circumstances (which is why it’s always good to check in with your doctor!), certain conditions may contribute to pregnancy loss:
- a random chromosomal error within the embryo.
- The majority of the time in the 1st trimester
- This doesn’t increase the chance it will happen in a future pregnancy
- a cause in the uterus
- a change in the shape of the uterus
- an easily removed benign tissue overgrowth, such as an endometrial polyp or uterine fibroid
- issues with the reproductive microbiome or a subacute inflammation in the lining of the womb called chronic endometritis
- hormonal imbalances
- thyroid or prolactin abnormalities — these can be corrected and the risks of miscarriage will then decrease
- PCOS (polycystic ovary syndrome) may be associated with an increased risk of miscarriage
- certain medical conditions, such as
- uncontrolled diabetes
- possible associations with autoimmune diseases
- extremes of weight
- maternal age
- mainly due to age and egg quality’s intertwined impacts
- certain medications, such as
So, when can I try again?
You may begin trying to conceive. This can be as early as with the next cycle. One study showed there was no increase in risk of another miscarriage when the interval between pregnancies was even less than 3 months.
However, the physical healing from miscarriage is but one facet. Talking with your partner to decide when you are emotionally ready helps you both move forward together. And grief is complicated; it’s okay to wait if you need more time. Please seek help if you need it.
Ways to optimize fertility naturally
Environmental factors that you can work on include:
- quitting smoking
- decreasing alcohol and caffeine
- decreasing plastics, fragrances, and pesticide exposure (eating organic foods is an easy way to impact this)
- taking a prenatal vitamin and considering other tailored supplements
Diet changes may also improve not only your cardiovascular health, but are suggested to have beneficial effects on fertility:
- Plant based
- Decrease processed foods & sugars
- “Good” fats
- Decrease red meats
- Consider decreasing gluten
There are many different emotions involved in coping with this loss, and there is no one right way. Seeking support, obtaining the knowledge to process what happened and deciding on a path that you feel peace with are all important components to healing. Know that hope exists and that you are loved.
I am a USC-trained Reproductive Endocrinology & Infertility physician with a boutique practice in Orange County, CA. I am also a Fellow in Integrative Medicine at the Andrew Weil Center at the University of Arizona, a FEMM Fellow at the Reproductive Health Research Institute, and serve as Associate Clinical Faculty at UC Irvine. My goal is to radically reimagine my field by focusing on whole body methods to identify the root cause and heal reproductive issues, like fertility, miscarriage, and abnormal cycles. I do this through integrative medicine practices coupled with traditional REI techniques, all while avoiding aggressive procedures. I’m grateful to have been selected for multiple years running as a Southern California Super Doctor and Rising Star, Orange County Physician of Excellence, and Top Doc in Pasadena. I am a Healthcare Task Force member for Life Perspectives, a leader in education, research, expertise and support after reproductive loss; serve on the Advisory Board for Pre-Health Shadowing, a non-profit that makes discovery of different medical specialties accessible to students; and have been an invited guest at multiple conferences and podcasts as well as an author of book chapters and multiple articles. I am excited to use an integrative medicine lens to educate about women’s issues!