Recurrent miscarriage

Recurrent miscarriage means having 2 or more miscarriages before 20 weeks of pregnancy. Your healthcare team may also use the term 'recurrent pregnancy loss'.

In Australia, a miscarriage is when a pregnancy ends naturally before 20 weeks.

Recurrent miscarriage can be intensely emotional and can lead to many different feelings such as:

• grief
• guilt
• anger
• anxiety
• depression

You are not to blame, and you do not need to carry this burden. Be gentle with yourself and allow space for your emotions. Support is available, and you deserve care and kindness as you move through this experience. You are not alone. Unfortunately, pregnancy loss is common, and in many situations of recurrent miscarriages, there is no clear reason. Most miscarriages are not caused by anything you did or didn't do — they are often due to factors outside your control, such as genetic or medical reasons that no one could have prevented.

The cause of most recurrent miscarriage can't be found. In some cases, it may be linked to:

• genetic or chromosomal conditions
• a health condition such as diabetes or thyroid problems, polycystic ovary syndrome (PCOS) or blood clotting conditions
• uterus (womb) shape or problems such as fibroids and scarring
• immune conditions such as antiphospholipid syndrome
• infections such as bacterial vaginosis
• older maternal age

Lifestyle factors (for example, smoking or heavy alcohol use) may also play a role, but many miscarriages happen when people take good care of their health.

If you have had 2 or more miscarriages, your doctor may recommend tests such as:

• blood tests to check hormones, thyroid gland function, clotting or immune factors
• chromosome (genetic) testing for you and your partner
• pelvic ultrasound
• testing pregnancy tissue (if available) from a miscarriage

These tests can help guide treatment, though sometimes the cause remains unknown.

Recurrent miscarriage is diagnosed when you have 2 or more miscarriages before 20 weeks of pregnancy. Your doctor will review your pregnancy history and may order tests to look at possible causes or risks.

Treatment for recurrent miscarriages depends on many things. Here are some examples:

• If blood tests show you have hormone or thyroid problems, your doctor may prescribe medicines.
• If you have clotting or immune conditions, low-dose aspirin or blood-thinning medicines may help.
• Surgery may help correct some uterus conditions.
• Your healthcare team may recommend lifestyle advice such as stopping smoking, reaching a healthy weight or managing medical conditions if this is affecting your pregnancy.

Even when no cause is found, supportive care and early and frequent monitoring in pregnancy can make a difference.

Even after recurrent miscarriage, most pregnancies are successful. Around 1 in 5 people may experience another miscarriage, but most do not.

Experiencing repeated pregnancy loss can be physically and emotionally painful.

Care for yourself physically

After a miscarriage, you may bleed for up to 2 weeks. It is best to use sanitary pads rather than tampons to avoid infection.

Pregnancy symptoms such as nausea and tender breasts will go away gradually.

It's important to rest and to be kind to yourself.

If you have any ongoing bleeding or other physical symptoms that worry you, see your doctor.

Care for yourself emotionally

It is common to feel many different emotions, and at different times you may feel grief, sadness, guilt, anger or shock. There is no right or wrong way to feel.

Recurrent miscarriages can lead to ongoing stress, depression or anxiety. People who experience recurrent pregnancy loss may feel the emotional impact for longer than people who experience one miscarriage, and it can affect how they cope in later pregnancies.

Recurrent miscarriages may also affect your relationship. You and your partner may cope in different ways. You do not need to go through this alone — support services are available to help you, and your partner.

When to seek mental health support

It can take many weeks to return to your normal daily activities — work, relationships and hobbies — after a miscarriage. If your feelings of sadness, anxiety or guilt become overwhelming, or last for weeks, speak with your doctor. They can refer you to a support group, a counsellor or psychologist.