What happens within your body when experiencing a miscarriage?
Approximately 23 million pregnancies worldwide result in miscarriage annually. Despite its prevalence, miscarriage remains a topic shrouded in taboo. The ordeal can be isolating and, for some, emotionally distressing. Misconceptions surrounding miscarriage contribute to the stigma, causing many individuals to blame themselves for the loss. Nevertheless, the majority of miscarriages are unavoidable and stem from factors outside of an individual's influence. These occurrences are a result of the intricate nature of pregnancy, which necessitates precise coordination between the fertilized egg and the uterus. In reality, out of every three fertilized eggs, only one will develop into a live birth. Therefore, it is essential to delve deeper into the physiological processes that take place within the body during the initial 12 weeks of pregnancy, a period in which the majority of miscarriages occur. Pregnancy is sustained by various hormones, including progesterone and estrogen produced in the ovaries, as well as human chorionic gonadotropin (hCG) released by the fertilized egg. In the initial phase of each menstrual cycle, estrogen levels rise, followed by an increase in progesterone. These hormones communicate with the uterine lining to improve its blood supply and thicken its mucosa, creating the necessary conditions for the development of an early pregnancy. If an unfertilized egg reaches the uterus, the levels of these hormones naturally decrease, leading to contractions and the shedding of the uterine lining during menstruation. However, if the egg is fertilized, the outer layer starts producing hCG. This hormone travels to the ovaries, promoting the continuous release of progesterone and estrogen, which stops menstruation. hCG also attaches to receptors on the uterine lining to prevent the rejection of the fertilized cell mass during implantation. This critical stage is where complications can arise, with up to one-third of fertilized eggs failing to attach properly, often going unnoticed during a seemingly normal menstrual period. Successful attachment is just the beginning for fertilized eggs, as they must navigate further challenges once embedded in the uterine lining, guided by their own DNA as they grow rapidly. Chromosomal abnormalities can lead to irregular development or halt embryo growth completely. While some mistakenly attribute their miscarriage to factors such as stress, exercise, vaccination, or past use of birth control, the majority are actually caused by genetic issues or other health factors beyond a person's control. Some pregnancy losses result in few, if any, noticeable physical symptoms. In other cases, hCG levels decrease, followed by a drop in progesterone, leading to bleeding and cramping. In either scenario, there are three treatment options, two of which are also used for induced abortion procedures when patients choose to terminate a pregnancy. The first option is the "watch-and-wait" method, where a person waits for pregnancy hormones to drop further, allowing the pregnancy tissue to be released with the shedding uterine wall. This approach is effective up to 90% of the time, but it can involve several weeks of unpredictable pain and bleeding. Others may choose option two, which involves taking the pills mifepristone and misoprostol in sequence. The first pill works hormonally by blocking progesterone receptors, while the second mimics a molecule that induces labor, stimulating uterine contractions and causing the cervix to soften and dilate. After taking the second pill, the process typically takes 1 to 6 hours.