First Period After Loss: What to Expect

The most unwanted period is probably the period that follows a miscarriage. It’s a painful reminder of what you’ve lost and how you indeed aren’t pregnant anymore, plus — it can be triggering. Often, our doctor will tell us to expect the first period within 4-6 weeks following the physical loss, and some may warn you that it’s heavier than usual, but there’s not a lot of guidance or support offered. So today, I wanted to chat about the first period and layout all of the information that I share with my clients.

When Will Your Cycle Return?

I can’t say when it will happen, but I can give you a timeline of how recovery moves into your first cycle. As doctors say, 4-6 weeks is an expected timeframe; however, it can be longer than that. Many factors are involved with your cycle returning, and sometimes, it’s hard to gauge. Before I share with you the timeline leading up to your first period, I wanted to tell you that if your cycle doesn’t return by six weeks after your physical loss — please call your doctor. I’ll share what you can ask them and request later in this blog post.

The problematic aspect of providing a timeline is that almost everyone will experience these milestones in order but differently. Since losses at different gestations contain different hormone levels of hCG and progesterone, that can affect the timeline. For example, if someone has a loss before six weeks, their hCG may not have gotten too high, and chances are, their progesterone had already been lowering; therefore, this timeline may look different or in a sped-up timeframe. But I have had clients who experienced losses at seven weeks and 12 weeks whose recovery fell on the time timeline.

Other factors that factor into this timeline maybe if someone had to have a D&C later due to retained tissue (this timeline may even start over at that point) or if you had an ectopic pregnancy, molar pregnancy, or other complications. So while this timeline generally works for everyone — please know that there are exceptions as we are all experiencing different losses with different factors.

If You Don’t Have Your Period by Six Weeks –

Do not panic! There is a wide range of normal when it comes to miscarriage recovery. I even asked my audience on Instagram and received a lot of responses about cycles not starting until 8-12 weeks. But, again, everyone is different, and there are so many factors. I create a threshold around the six-week mark because I imagine women are feeling confused and impatient when their cycle isn’t starting, which is why I recommend calling your doctor and setting up an appointment to make sure that things are okay.

Now, if you are still bleeding six weeks after your miscarriage, that is a reason to call your doctor and ask for a vaginal ultrasound to check on your uterus. Especially if the bleeding is heavier than spotting, contains blood clots, or is painful at times.

So what do you say to your doctor and what tests do you ask for? Here’s a little rundown:

Request blood draws to check your hCG levels and progesterone levels (hCG level under five is considered “negative” and progesterone under five means that your uterine lining can shed, which ultimately begins your period). Asking to draw your estrogen levels may also be helpful as they tend to drop around when your period starts.
If you’ve had concerns about your thyroid in the past (or have a current concern), you can request a TSH blood draw to check on your levels as the thyroid can be a factor in menstrual cycle irregularities (if this was drawn since your loss, you might not need to worry about this)
An internal/vaginal ultrasound may not be a bad idea, although it can be a triggering event for so many women, not to mention it’s invasive during a vulnerable time. I added it to this list because it can give you a good picture of what’s happening in your uterus, such as the thickness of the uterine lining positioning of your cervix. Your doctor may see any pregnancy tissue left in your uterus or concerns like fibroid or polyps that may interfere with your hormone levels and your cycle starting.

Now, if you need help with language to use when reaching out to your doctor, I’ll give you an example and keep it short and sweet:

“Doctor [x], it’s been [x] weeks since my miscarriage and my cycle hasn’t returned yet. I know that this can be normal but I’m getting concerned and anxious about when it will start. After doing some research, would it be possible to come into the office and check on my hcg and progesterone levels? I’d like to make sure that they are lowering and in the right direction. If at all possible, I’d like to schedule an appointment with you to follow up after my loss and discuss what comes next. Thank you – [your name]”

What To Expect from First Period

If you’ve read any of my ebooks, blog posts, or Instagram posts, you may already know this, but I don’t sugarcoat things. The first period after loss is generally really rough on women for a few reasons: it’s physically more painful for many and triggering for some women. Now, that’s not to say that you could have your period and feel that it’s no different than any other period you’ve had. But, again, there are a lot of factors involved here, so I’ll be sharing the worst-case scenario in hopes that you are over-prepared. If your period is more manageable than expected — that is not a red flag for anything and is okay!

The first period after a miscarriage may begin with spotting, which may seem abnormal for many of you, and it’s usually a fertility red flag. However, it’s expected after the loss as you are still recovering from the loss. Just because you’ve given birth and it’s been a few weeks doesn’t mean that your body is entirely back to how it was before pregnancy. Your bleeding pattern may be a little off than the usual period, and again, that is to be expected. The bleeding will be heavier in 8/10 women’s experiences, and often there are blood clots, and it can feel triggering if you experienced blood-related trauma with your loss. My advice is to wear adult diapers and huge maxi pads, just as you probably did following your loss. If the blood clotting becomes scary or clots more significant than a quarter, you may want to reach out for medical attention as that would be considered a little abnormal even for a period after loss.

A rule of thumb that I share with my clients is the bleeding may look like your miscarriage for a day or two, but the blood clots should never be the same size as your loss experience. And as always, if you fill a pad in less than an hour, please seek medical attention ASAP. If you do have heavier bleeding, it’s usually for one or two days of your period, and then you should see the bleeding taper.

Arden’s Experience: Following my first miscarriage which occurred at home without any intervention after a missed miscarriage but my body was measuring 10 weeks pregnant, my first period arrived a month to the date. The bleeding started as one day of spotting and two days of heavy bleeding followed by 3-4 more days of spotting. This wasn’t a usual period of mine as I didn’t usually have spotting and my period would be over by day four or five.

What About The Second, Third, or Fourth Period?

Everything we just discussed above can happen during subsequent periods. However, if you are experiencing irregular or abnormal-feeling periods after three cycles – reach out to your doctor and ask them the same questions that are mentioned above. The truth is, pregnancy changes your body and can change your cycle, no matter if you were pregnant for four weeks, five months, or nine months. If you feel like something is off, it’s completely justified to see your doctor. I’m also happy to work with you and help troubleshoot or brainstorm questions or concerns to go to your doctor about. To learn more about booking 1:1 calls with me, click here.

Disclaimer: this blog post is not intended to take the place of medical advice and results/experiences may vary. When in doubt, reach out to your doctor with any questions or concerns that you have. Arden & The Miscarriage Doula is a place of emotion, physical, and psychological support where we help women pinpoint areas of concern but never provide a diagnoses.