While there are many things that can lead to a miscarriage, polycystic ovary syndrome (PCOS) is linked to a higher rate of early miscarriage and complications during pregnancy. The loss of a baby, whether at birth or in the weeks or months afterward, is no less significant or heartbreaking than the loss of another person. It can bring months to years of despair and disappointment to women and their partners. It is important to learn how to best approach this difficult time.

Recovering from a Miscarriage

The term miscarriage, medically known as spontaneous abortion, refers to the loss of pregnancy before 20 weeks.¹ If the fetus fails to thrive after 20 weeks, the term “stillbirth” is used instead. Recurrent miscarriage—losing three or more pregnancies in a row—can affect 1 in 100 women.²

Several studies revealed that polycystic ovaries (PCO) are one of the most commonly identified ultrasound abnormalities among women with recurrent miscarriage.^3,4 However, a recent study concluded that having polycystic ovaries is not predictive of pregnancy loss in women with recurrent miscarriage.⁵

Although PCOS is linked to infertility and miscarriage, it can be managed if diagnosed and treated promptly. Talk to your PCOS care team about recurrent miscarriage and how to reduce your risk.

What are the Symptoms of a Miscarriage?

The most common sign of miscarriage is vaginal bleeding or spotting. But light vaginal bleeding is also common in early pregnancy, so bleeding alone doesn’t always mean you are having a miscarriage. If any bleeding occurs during pregnancy, contact your obstetrician, midwife, or nurse practitioner immediately. 

Other symptoms of miscarriage include:¹

• Light or heavy vaginal bleeding that may have blood clots or other tissue
• Pain in the back, abdomen, or pelvic area
• A discharge of fluid from the vagina
• Early pregnancy signs, such as breast tenderness or nausea, are reduced

Remember that not all miscarriages will have symptoms. Some failed pregnancies appear as just a heavy period. In some instances, a miscarriage is only revealed during a pregnancy visit. 

How Often Do Miscarriages Happen?

Pregnancy loss is not a rare phenomenon. It is much more common than many people imagine. The overall miscarriage risk is between 17 and 22 percent.⁶ About one in four women experience miscarriage of some kind. More than half of these pregnancies are lost without the women even realizing that they have conceived. 

Your risk of miscarriage drops as the pregnancy progresses. After the first trimester, the chances of miscarriage fall to only about 2 percent. Miscarriage rates start to decline between six to 10 weeks. But for women in their late 30s to early 40s, miscarriage risk remains high up to week 12.⁷ 

Risk of miscarriage by pregnancy week⁸

• 6 weeks – 9.4%
• 7 weeks – 4.6%
• 8 weeks – 1.5%
• 9 weeks – 0.5%
• 10 weeks – 0.7%

Another study found that miscarriage risk doubles for women who took more than a year to get pregnant compared to those who conceived within three months.⁹

What To Do After a Miscarriage

Consult your doctor if you are experiencing symptoms of a miscarriage. You will be referred to a specialist for tests. An ultrasound scan may be requested to check if you’re having a miscarriage. An ultrasound can identify a non-viable pregnancy even before symptoms like vaginal bleeding and abdominal cramps occur.¹⁰ 

Once a miscarriage is confirmed, your doctor or midwife will discuss your treatment options. You may not require treatment if there’s no pregnancy tissue left in your womb. Alternatively, you can choose to wait for the tissue to pass naturally. This is called expectant management. Your doctor may also prescribe medications or recommend surgical removal through dilatation and curettage (D&C).

Miscarriage Treatments: What to Expect

Expectant Management (no treatment)

• Waiting for pregnancy tissue to pass without intervention may take days or as long as three to four weeks, depending on the stage of the fetus or embryo.
• You may experience heavy bleeding and strong cramps during this period.
• If the miscarriage occurs in the second trimester, the bleeding period may be longer.
• If you are experiencing heavy bleeding, severe pain, or signs of infection, you will need medical assistance.

Treatment with Medicine

• It is possible to speed up the process of passing pregnancy tissue using medications. 
• In an incomplete miscarriage (bleeding has begun but some pregnancy tissue remains), misoprostol is usually given to encourage the passing of pregnancy tissue within a few hours up to a few days. Occasionally, though, it can take up to two weeks.
• There are instances when medication is not recommended, such as when there is heavy bleeding or signs of infection. 
• This medicine may cause side effects, including nausea, vomiting, and diarrhea. 
• You may take over-the-counter pain relievers for cramping or pelvic pain. 

Surgical Treatment (curette)

• Dilatation and curettage is a minor operation that usually requires general anesthesia.
• The whole procedure may take less than 15 minutes, but you will need to stay in the hospital for up to five hours. 

Self-Care After a Miscarriage

Pregnancy loss is a devastating experience. It can be emotionally and physically draining. It is normal to feel frustrated and scared of trying for another pregnancy. Most women resort to self-blaming; some go into a vicious cycle of self-doubt and self-loathing. 

After repeated losses, your self-esteem can take a nosedive. It can be difficult to find support from friends or family, particularly if nobody else in your circle has experienced pregnancy loss. 

But, you are not alone in your suffering. 

Opening up and learning about other people’s experiences can help you and your partner to understand and make sense of what you are going through. Joining a support group may provide comfort, empathy, and validation to many sufferers of a lost pregnancy. 

Before you decide to try for another baby, give yourself the chance to heal emotionally and physically. Your focus should be shifted from blaming yourself or your body to improving the health of your future pregnancies. Ask your healthcare team for guidance.

Sources:

1. Harvard Health Publishing. Miscarriage. Harvard Health. https://www.health.harvard.edu/a_to_z/miscarriage-a-to-z. Published February 2019.‌
2. NHS Choices. Overview –  Miscarriage. https://www.nhs.uk/conditions/Miscarriage/. Published 2019.‌
3. Sagle M, Bishop K, Ridley N, et al. Recurrent early miscarriage and polycystic ovaries. BMJ. 1988;297(6655):1027-1028. doi:10.1136/bmj.297.6655.1027‌
4. Clifford K, Rai R, Watson H, Regan L. Pregnancy: An informative protocol for the investigation of recurrent miscarriage: preliminary experience of 500 consecutive cases. Human Reproduction. 1994;9(7):1328-1332.doi:10.1093/oxfordjournals.humrep.a138703‌
5. Rai R, Backos M, Rushworth F, Regan L. Polycystic ovaries and recurrent miscarriage—a reappraisal. Human Reproduction. 2000;15(3):612-615. doi:10.1093/humrep/15.3.612‌
6. García-Enguídanos A, Calle ME, Valero J, Luna S, Domínguez-Rojas V. Risk factors in miscarriage: a review. European Journal of Obstetrics, Gynecology, and Reproductive Biology. 2002;102(2):111–119. doi:10.1016/s0301-2115(01)00613-3‌
7. Cohen-Overbeek TE, den Ouden M, Pijpers L, Jahoda MGJ, Wladimiroff JW, Hop WCJ. Spontaneous abortion rate and advanced maternal age: consequences for prenatal diagnosis. The Lancet. 1990;336(8706):27–29. doi:10.1016/0140-6736(90)91528-I‌
8. Tong S, Kaur A, Walker SP, Bryant V, Onwude JL, Permezel M. Miscarriage risk for asymptomatic women after a normal first-trimester prenatal visit. Obstetrics and gynecology. 2008;111(3):710-714. doi:10.1097/AOG.0b013e318163747c‌
9. Maconochie N, Doyle P, Prior S, Simmons R. Risk factors for first trimester miscarriage-results from a UK-population-based case-control study. BJOG: An International Journal of Obstetrics & Gynaecology. 2007;114(2):170-186. doi:10.1111/j.1471-0528.2006.01193.x‌
10. Lemmers M, Verschoor MAC, Kim BVeronica, Hickey M, Vazquez JC, Mol BJ, Neilson J. Medical treatment for early fetal death (less than 24 weeks). Cochrane Database of Systematic Reviews 2019, Issue 6. Art. No.: CD002253. DOI: 10.1002/14651858.CD002253.pub4