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Miscarriage, the loss of a pregnancy that’s in the uterus, is common. It happens in about 1 in 10 women who know they’re pregnant. But many people don’t know what to expect afterward.

The vast majority of miscarriages happen in the first trimester, before 13 weeks of pregnancy. Most occur before 10 weeks. In this article, I’ll discuss the treatment options for first-trimester miscarriage, also called early pregnancy loss. Second-trimester miscarriage usually requires different treatments.

Here’s what to know about care and recovery.

There are three main treatments for early pregnancy loss. The goal for all three is to remove any pregnancy tissue left in the uterus. There are two nonsurgical treatments: expectant management (letting the tissue pass on its own) and medication. The third treatment is a surgical procedure called dilation and curettage (also known as D&C or suction curettage).

In many cases, patients can choose the option they prefer.

Expectant management is giving your body time to pass the tissue on its own. This doesn’t involve medication or surgery. Some women choose this because it’s the most natural option, but it is more unpredictable than other treatments.

Most women pass the tissue within 2 weeks of a miscarriage diagnosis, but it can take longer. If it takes too long, your ob-gyn may recommend medication to start the process. (Once the process starts and cramping and bleeding begin, most of the tissue passes within a few hours. More on that below.)

Sometimes, the body doesn’t pass all the tissue. When this happens, another treatment is recommended, usually a D&C. Expectant management is most likely to work when you already have some bleeding and cramping. This means your body has begun the process of passing the tissue.

Medication works faster and is more predictable. Some women choose medication that helps their body remove any leftover tissue. These drugs are absorbed through the cheek in the mouth or through the vagina. Cramping or bleeding usually starts within a few hours. Most women pass the tissue within 48 hours and don’t need any other treatment. (Some women may still not pass all the tissue and may need a surgical procedure.)

Medication gives you more control over the timing of the tissue passing. And it’s often quicker than waiting for the tissue to pass on its own.

Some women like to take the medication in the morning, so the process doesn’t start overnight. And some women like to have a support person, such as a friend or family member, with them when they take the medication.

You’ll have a similar experience whether the tissue passes on its own or you take medication. You’ll have bleeding and cramping that are heavier than your normal period. The pregnancy tissue may look like large blood clots, or it may look white or gray. It does not look like a baby. The process can be painful, and ob-gyns may prescribe medication to help with this discomfort. Your ob-gyn may also suggest over-the-counter pain medication. Talk with your ob-gyn about pain relief options.

Most of the tissue passes within 2 to 4 hours after the cramping and bleeding start. Cramping usually stops within a day. Light bleeding or spotting can go on for 4 to 6 weeks. Two weeks after the tissue passes, your ob-gyn may do an ultrasound exam or other tests to make sure all the tissue has passed.

A D&C is the most predictable treatment. During a D&C, your ob-gyn passes a small tool through the cervix and into the uterus to remove the tissue. Some women choose this option because they want a faster, more certain treatment. And if you’re already bleeding heavily, it’s the safest option.

Some ob-gyns do D&Cs in an operating room using general anesthesia, which means you’ll be asleep. Some offer a form of pain relief called sedation, where you will be awake but comfortable. Others do the procedure in a normal exam room, with an injection of drugs that block pain in a specific area. Women often have some bleeding and intense cramping during a D&C. They usually have little discomfort afterward.

Light spotting or bleeding can last up to a month. An antibiotic is prescribed to prevent infection. Other complications are rare, and most women don’t need any follow-up appointments.

Whichever option you choose, call your ob-gyn if you have very heavy bleeding, a fever, or feel unwell. Dangerous bleeding and infection are a risk of all treatments, but these problems are rare. Call your ob-gyn right away if you have any of these symptoms:

  • Your bleeding soaks through more than two large pads in an hour for 2 hours or more. This much bleeding is dangerous and needs immediate care.

  • You have a temperature higher than 100 °F.

  • You have chills, severe pain, or any other symptoms that concern you.

Physical recovery is usually quick. Most women resume their regular activities a day or two after they pass the tissue or have a D&C. For some, nausea and other pregnancy symptoms stop before their ob-gyn diagnoses a miscarriage. For others, these symptoms go away a few days after the tissue passes.

To keep your infection risk low, don’t put anything into your vagina for a week—no douching (which is never a good idea at any time), vaginal sex, tampons, or menstrual cups. You can use pads to absorb the bleeding. Most women have their first period about 2 weeks after any spotting or light bleeding ends, which is usually about 2 to 3 months after you pass the tissue or have a D&C.

People have different emotional reactions. Some women feel sadness or grief. Others may feel relief. Some may feel a mixture of emotions. All these feelings are normal, and it’s important to allow yourself time to process them.

Talking about these feelings with friends, family, your ob-gyn, or a mental health professional can help. If you feel depressed or are thinking of hurting yourself, tell your ob-gyn or another doctor right away. Support groups and resources, such as Share Pregnancy & Infant Loss Support, may be helpful too.

Miscarriage isn’t your fault. Women often worry that they somehow caused their miscarriage. This is not the case. Physical activity, stress, and sex don’t cause miscarriages. Most happen because the pregnancy wasn’t developing normally. Often, the egg or sperm develops with more or fewer chromosomes than normal, which can lead to miscarriage. This is a random event that you cannot control.

Most women can have a healthy pregnancy after a miscarriage. Talk with your ob-gyn if you have concerns. Your ob-gyn can help ease your fears, answer any questions, and talk about preparing for your next pregnancy.

Published: June 2022

Last reviewed: June 2022

Copyright 2022 by the American College of Obstetricians and Gynecologists. All rights reserved. Read copyright and permissions information.

This information is designed as an educational aid for the public. It offers current information and opinions related to women's health. It is not intended as a statement of the standard of care. It does not explain all of the proper treatments or methods of care. It is not a substitute for the advice of a physician. Read ACOG’s complete disclaimer.

About the Author
Rebecca H. Cohen, MD, MPH
Dr. Rebecca Cohen

Dr. Cohen is an obstetrician–gynecologist who specializes in contraception and abortion services. She is an assistant professor of obstetrics and gynecology who practices at the University of Colorado. She is a fellow of the American College of Obstetricians and Gynecologists.