Early miscarriage is common, and almost never something you caused

Around one in five recognised pregnancies ends in miscarriage, and the true figure including very early losses that are never detected is higher still. The overwhelming majority occur in the first trimester.

It is one of the most common experiences in reproductive life and one of the least discussed, which leaves most people who go through it convinced it is rare and that they did something wrong.

What actually causes it

The single largest cause of first-trimester loss is chromosomal abnormality in the embryo — an error occurring at fertilisation or in the earliest cell divisions. Studies of tissue from early losses find abnormalities in a majority of cases.

These are random events. They are not caused by anything either parent did, and they are not usually inherited. The frequency rises with maternal age because the proportion of eggs with chromosomal errors rises with age, which is the mechanism behind the age-related increase in miscarriage rates.

Less commonly: uterine abnormalities, untreated thyroid disease, poorly controlled diabetes, antiphospholipid syndrome, and cervical insufficiency in later losses.

What does not cause it

This list matters, because people search for a reason and find one in whatever they happened to do that week.

Exercise, including vigorous exercise, does not cause miscarriage in an otherwise normal pregnancy. Nor does sex. Nor does lifting something heavy, having an argument, a stressful week at work, a cup of coffee, a glass of wine before you knew, flying, or a hot bath.

Stress does not cause miscarriage. This is worth stating flatly, because it is one of the most common self-blaming beliefs and there is no good evidence for it.

Smoking, heavy alcohol use and cocaine do increase risk, and are worth addressing — but the timing of a specific loss is still overwhelmingly likely to be chromosomal.

What it looks like and what happens next

Bleeding in early pregnancy is common and does not always mean miscarriage; a substantial proportion of pregnancies with first-trimester bleeding continue normally. Any bleeding should be assessed, mainly to exclude ectopic pregnancy, which is a medical emergency.

Once loss is confirmed, there are three management options, and where there is no infection or heavy bleeding they are broadly equivalent in outcome:

• Expectant — waiting for it to complete naturally, which can take days to a few weeks
• Medical — misoprostol, sometimes with mifepristone
• Surgical — a short procedure to empty the uterus

The choice is largely about what you can tolerate: how long you can bear to wait, whether you can manage significant bleeding and pain at home, and whether being physically finished matters to you. It is a legitimate preference, and you should be offered a choice rather than assigned one.

Recurrent loss

Investigation is usually offered after two or three consecutive losses, depending on the guideline and your age.

The workup typically includes antiphospholipid antibody testing, thyroid function, a pelvic ultrasound or hysteroscopy to look at uterine structure, and sometimes karyotyping of both parents or of the pregnancy tissue.

The honest and difficult fact: in around half of recurrent loss cases, no cause is found. That is deeply unsatisfying and it is not the same as no hope — the majority of couples with unexplained recurrent loss go on to have a successful pregnancy.

Progesterone supplementation has evidence specifically for women with recurrent miscarriage who have early pregnancy bleeding, which is a narrower group than the people it is commonly given to.

Trying again

Most guidance is that there is no medical need to wait beyond one normal cycle, provided you are physically recovered and hCG has returned to baseline. Older advice to wait three months has not held up.

Emotionally, the timeline is entirely individual and does not need to match anyone's expectations.

Grief after early loss is frequently disenfranchised — people are told it was early, that it was not really a baby, that at least they know they can conceive. Studies find rates of clinically significant depression and anxiety after miscarriage that are substantial and that persist for months. A subsequent pregnancy is often accompanied by considerable anxiety rather than relief. Both are normal, and both are reasons to ask for support rather than evidence of overreaction — how to tell a bad week from something that needs help.

Keeping a record, for the next time

Two practical things.

First, if you are trying again, knowing your own cycle — when you ovulate, how long your luteal phase is, when hCG cleared — makes the next pregnancy easier to date and easier to monitor. Dating from an assumed day 14 is a common source of unnecessary alarm at an early scan, and ovulation moves more than people expect.

Second, if losses recur, a dated record of each pregnancy and each cycle is exactly what an early pregnancy unit will want, and it is very hard to reconstruct afterwards.

Naked holds that record alongside how you are actually doing — because the months after a loss have their own pattern, and being able to see that the anxiety is easing, slowly, is worth something when it does not feel like it is.

None of this makes it smaller. It is not a small thing. But it is also, almost always, not something you caused.