What happens in your body during a miscarriage?

Each year, approximately 23 million pregnancies worldwide end in miscarriage. Despite its prevalence, miscarriage remains a taboo topic, often leaving individuals feeling isolated and emotionally traumatized. Misconceptions about miscarriage contribute to the stigma, causing many to unjustly blame themselves for the loss. However, the majority of miscarriages are unpreventable and occur due to factors beyond a person’s control. Pregnancy is a complex process requiring precise coordination between the fertilized egg and the uterus. In reality, only one out of every three fertilized eggs results in a live birth. To understand this better, let's explore what occurs in the body during the first 12 weeks of pregnancy, a period when most miscarriages happen.

Pregnancy is sustained by several hormones: progesterone and estrogen from the ovaries, and human chorionic gonadotropin (hCG) produced by the fertilized egg. In the first half of the menstrual cycle, estrogen levels rise, followed by an increase in progesterone. These hormones signal the uterine lining to enhance its blood supply and thicken its mucosa, creating a supportive environment for early pregnancy. If the egg is unfertilized upon reaching the uterus, hormone levels drop, leading to uterine contractions and the shedding of the lining during menstruation. Conversely, a fertilized egg begins producing hCG, which prompts the ovaries to continue releasing progesterone and estrogen, thereby halting menstruation. hCG also prevents the uterine lining from rejecting the fertilized egg as it implants.

At this stage, many fertilized eggs fail to properly attach for reasons not fully understood, often passing unnoticed during a normal menstrual period. Properly implanted eggs face further challenges, as their growth is guided by their own DNA. Chromosomal abnormalities can disrupt development or halt embryo growth entirely. Miscarriages are commonly attributed to genetic issues or other uncontrollable health factors, rather than stress, exercise, vaccination, or past birth control use.

Miscarriage symptoms can vary; some individuals experience few physical signs, while others may see a drop in hCG and progesterone levels, leading to bleeding and cramping. There are three treatment options for miscarriage: the watch-and-wait method, medication, and vacuum aspiration. The watch-and-wait method allows pregnancy hormones to drop naturally, enabling the body to shed the uterine lining. This approach is effective 90% of the time but can involve unpredictable pain and bleeding over several weeks.

Alternatively, medications mifepristone and misoprostol can be used sequentially. Mifepristone blocks progesterone receptors, while misoprostol induces uterine contractions and cervical dilation. This process typically takes 1 to 6 hours and can be managed privately at home. The third option, vacuum aspiration, involves a healthcare provider numbing the cervix and using a thin tube connected to a syringe-like device to remove the pregnancy tissue. Treatment choice depends on medical history, timeline, expectations, and personal preferences, with all three methods proving safe and effective.

However, untreated or incomplete miscarriages can lead to serious infections and hemorrhage. The treatments for miscarriage are also used in induced abortion care, which can complicate access and legality in certain areas. Additionally, over half the world’s population lacks access to essential reproductive healthcare services.

While pregnancy experiences vary widely, the loss of a pregnancy can be devastating and overwhelming for many. During such a difficult time, it is crucial for individuals to receive compassionate care and support, and to have access to life-saving treatments.

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