Disclaimer: I am not a women’s health professional. This post contains information from my own experiences, observations, and years of research through infertility and recurrent miscarriage. Provided here is information, advice, and encouragement I would share with a friend experiencing an early miscarriage. Always do your own research and consult a trusted health professional when necessary according to your own judgment. Full disclaimer here.
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I’m so sorry you’re here reading this. I’m sending you a big, fat hug and lots of love right now.
I’ve had five miscarriages between 2015 and 2019. They all happened a little differently and at different gestational ages, but here I’m going to focus on the three that happened right around 4 weeks gestation. Your circumstances and feelings will be different from mine, but for starters, here are 12 things to know about your 4-week miscarriage:
You were pregnant for two weeks
Since women’s cycles vary so greatly, doctors typically count pregnancy from that first day of your last period. This means if you are 4 weeks along, you’ve actually been pregnant for 2 weeks. If you have been trying to conceive for a while, you may know this already.
In case you don’t or you’re newer to TTC, “4 weeks pregnant” means you actually ovulated (and conceived) 2 weeks ago. About 2 weeks after your period starts and about 2 weeks before your next one is due, you ovulate. This is about the time the sperm meets the egg and cells begin to divide into what is called a blastocyst (or early embryo), which then implants into your uterus around 1 week after ovulation (when you were 3 weeks pregnant.)
If you took a home pregnancy test around the day your period was due and got a positive result, then you are 4 weeks along and have been pregnant for 2 weeks.
It is a real pregnancy
You’re going to hear many people online or in person refer to your pregnancy as a “chemical pregnancy.” This is currently the technical, medical term for a very early miscarriage that was never confirmed by a doctor either by bloodwork or by ultrasound. The term “chemical pregnancy” makes it sound like the sperm got close to the egg and accidentally sent out pregnancy signals but were flushed out with your regular period.
You might even see your positive home pregnancy test result referred to as a “false positive.”
THIS IS MISLEADING AND UNTRUE.
If you’re reading this, I’m going to assume you’ve ruled out possible causes of a false positive home pregnancy test (like certain medical conditions, evaporation lines, or certain fertility drugs.) I believe you when you say you’ve had a miscarriage.
If you are quite in tune with your body like I was after years of infertility, you may have noticed pregnancy symptoms before your positive pregnancy test. I don’t know if Spidey signals are sent out the moment the sperm meets the egg or if some babies implant incredibly early, but I have documentation to show that I began experiencing pregnancy symptoms at 5 dpo (days past ovulation) with both of the babies I miscarried at 4 weeks.
Whether or not this was your experience, know that your pregnancy was real. The sperm met the egg, implanted, and began to form a baby. Ultrasound picture or not, your pregnancy and your loss are real.
Your baby counts
In a perfect world, your baby would have continued growing, but for some unknown reason, he or she didn’t. That is so sad and wrong and unfair. I’m so sorry for your loss and the lack of answers to the many questions you must have.
You may have stumbled across this post searching for how you’re supposed to feel after such an early loss.
The truth is, that is totally up to you, and however you feel is valid. If you do feel some sense of relief that the loss happened early, that is valid too. You don’t have to feel devastated by your 4-week loss, even if you love and wanted your baby. Feel whatever you need to feel for as long as you need to feel it, and honor your baby in whatever way feels right for you.
It might be very painful
You may read online or hear from medical professionals that an early miscarriage (particularly around 4 weeks) is “just like a period,” or, “like a heavy period.” In reference to very early miscarriages, you may even read or hear something along the lines of, “the actual miscarriage rates are thought to be higher than estimated because many women may miscarry early and not realize it.”
This may be true for some women, but I definitely, DEFINITELY would have realized I was miscarrying at 4 weeks 3 days, positive pregnancy test or not. I was surprised when this miscarriage was just like my miscarriage at 7 weeks: heavy bleeding and cramps that had me curled up on the couch for the first few days. While my period is on the heavier end at 5-6 days, the bleeding of my first 4-week miscarriage lasted for 2 weeks followed by 2 more weeks of messed up hormones.
It might be surprisingly painless
This was the case for me with my second 4-week miscarriage. I don’t know if it was because I had given birth to two full-term babies or because my hormones were slightly suppressed due to breastfeeding, but I had no pain and very little cramping with my miscarriage that happened before 4 weeks. The bleeding also only lasted about 4 days.
It’s incredible what a difference 5 days gestation can make in your miscarriage experience!
It might happen before 4 weeks
Never in my years on the online infertility and miscarriage forums did I ever read that this was a possibility!
I thought the TWW (two-week wait) was a safe zone in which you wait for your period to either come or not come and that the earliest you could possibly miscarry was the day your period was due, in which case the miscarriage may present itself as a regular period.
I never knew or considered that my body would reject my baby before my period was even due and was so disheartened when this happened to me.
Since the dawn of time– well, since the dawn of me tracking my cycle (sometime in 2014), my period has come 14 days after my ovulation. Regardless of the time between my CD 1 (cycle day 1) and ovulation, my next period has always started 14 days later. Through trying to conceive, post-partum cycles, breastfeeding, and post-miscarriage cycles, this phase of my cycle (the luteal phase) has always been the most predictable part of my cycle. (This seems to be the general consensus from other women.)
Well, my second 4-week miscarriage began at 12dpo, 2 days before my period was even due. That’s 3 weeks 5 days gestation. This one did present as a regular period, which was physically a relief but emotionally discouraging because I felt like even my own body didn’t validate my loss.
Still, loss is loss, and my baby (and yours) counts even in this situation.
Your partner might grieve differently– or not at all
This is a tough one. We want our partners to know they cared about our babies too. Their babies. With such an early miscarriage, your partner doesn’t have a lot of time to bond with the baby or even process the reality of the pregnancy. For most guys, it all seems very abstract. That doesn’t mean he loves you any less or was any less excited about your pregnancy.
Your partner may not have the words to express his grief or even realize he is grieving. He may be extra irritable or need more time than usual to do things he enjoys like socializing, exercising, or even working.
I’ve learned to give my husband and myself time and space to work through the brunt of grief separately. For him, that’s going to work, doing projects around the house, and generally remaining distracted. For me, that’s talking to friends, going for walks, writing, and crying it out. Then we come together at the end of the day, spend time together, and calmly communicate where we are in our grief without any judgment.
When it comes down to it, I don’t need my husband to curl up in a ball and cry over the loss of our baby. I just want to know he cares. Even his, “Yeah, me too,” in response to my, “I miss our baby,” does wonders to make me feel loved and reunite us in navigating miscarriage together.
According to RWFJ, the largest philanthropy in the United States, a single pregnancy loss increases the divorce rate by 22 percent. This statistic is intimidating, but if you are prepared and proactive, you can love each other well through your miscarriage and come out stronger.
An ER visit may not be necessary
Miscarriage can be scary, especially when you don’t know what to expect!
When I called to make my first prenatal appointment for my first pregnancy, no one told me what symptoms to look out for or what to do if I experienced signs of miscarriage before my appointment. When I woke up to heavy bleeding and cramping at 7 weeks pregnant, I had no idea what to do. I called my dad who told me to go to the ER in case I needed a D&C to prevent infection.
I thought that made sense, so I went to the ER expecting to be seen by a doctor who would either stop the miscarriage or perform an emergency D&C procedure.
This was absolutely not my experience.
I had an ultrasound and a blood draw (neither of which my husband was allowed to be present for), then was stuck in a chair in a cold hallway surrounded by a bunch of other people and left to wait for hours only to be told by a nurse to follow up with my regular OB in 48 hours for a repeat blood draw.
This was not the answer or treatment I was expecting as a woman who was actively losing her baby.
It turns out there is not much– if anything– that can be done to stop an early miscarriage that has already started.
Pro tip: You’ll want to use pads instead of tampons or menstrual cups. This is for two reasons. The first reason is to monitor your bleeding and clotting through the miscarriage process. (Bleeding through a pad in less than 2 hours is generally considered excessive bleeding.) The second reason is to prevent infection, as your cervix may be more dilated than it is during your period. Click to shop nontoxic menstrual pads.
Knowing what I know now, I would have skipped the ER and called my OB office. This may not be an option if you miscarry on a day when your OB office is closed, in which case you may benefit from going to an Urgent Care or Emergency Room for the sake of documenting your miscarriage and testing your blood hCG until you can be seen by your OB. I also learned that the D&C procedure is not the standard of care for early miscarriages as my dad had led me to believe.
The American Pregnancy Association website states,
“About 50% of women who miscarry do not undergo a D&C procedure. Women can safely miscarry on their own with few problems in pregnancies that end before 10 weeks… Choosing whether to miscarry naturally or to have a D&C procedure is often a personal choice that is best decided after talking with your health care provider.”
Ultimately, follow your intuition and do what feels right for your situation. Some symptoms, like fever, excessive bleeding, and extreme pain do indicate a complication such as an ectopic pregnancy or an infection, which would require medical attention.
ER or not, call your OB. With each of my 4-week miscarriages, I was able to complete the miscarriage process at home then follow up with my regular OB. If you already scheduled your prenatal exam before your early miscarriage happened, you may be able to keep that appointment time and wait until then to be seen, or your doctor may want to see your earlier to monitor your hCG levels throughout the miscarriage process.
If anything, having documentation of care received for a miscarriage may help you secure insurance coverage for testing if you go on to have multiple miscarriages.
You deserve care
All that being said, you absolutely deserve care, and you don’t deserve less care just because some of medical professionals don’t fully understand the physical and emotional impact of an early miscarriage. If you feel something is wrong or you want to consult a doctor about testing or how to prevent another miscarriage in the future, you deserve that. Keep searching until you find a doctor who makes you feel comfortable, validated, and heard.
Remember that insurance may not cover certain testing or treatments until an official diagnosis of “recurrent pregnancy loss,” which is typically considered two “clinical miscarriages” (loss of a pregnancy that was confirmed by the doctor’s office) in a row or three total “clinical miscarriages.”
My doctors so far have thankfully “counted” both of my 4-week miscarriages even though they didn’t fit the definition of “clinical miscarriage,” and my insurance has covered testing under a diagnosis of recurrent pregnancy loss.
You can probably TTC the next cycle (before your next period)
If you do decide to follow up with your doctor after your miscarriage, he or she may recommend waiting until after you’ve had a period to TTC again. This is usually in case you do get pregnant immediately (before the start of your first post-miscarriage period), it is easier to accurately date the pregnancy.
There are also mixed studies about whether or not conceiving the cycle after a miscarriage increases your risk of another miscarriage. Knowing this, I personally felt that if my body was ovulating, it was telling me it was ready for another pregnancy. I did TTC immediately following each of my 4-week miscarriages.
This is a very personal decision, and as with any decision, you and your partner must weigh the pros and cons and decide what is right for you. You’ll want to make sure both of you are physically and emotionally ready to try again, which may not happen the first cycle following your early miscarriage.
You may also need to wait longer if there were complications with your early miscarriage or if you had a D&C procedure.
The cycle following your miscarriage may be irregular
It can be frustrating waiting for your next period to start and for your body to get back to normal following your miscarriage. If you do decide to TTC or even just track your cycle after your miscarriage, remember that the first day of bleeding from your miscarriage is generally considered CD1, although that may not be an accurate indication of when you can expect to ovulate or start your post-miscarriage period.
In my case, I ovulated on CD23 following both my 4-week miscarriages instead of my usual CD18 ovulation. After both miscarriages, I also had what I refer to as a “psych-out” ovulation where I had all my typical ovulation symptoms including raised BBT (basal body temperature) for 3 days before my temperature dropped back down. (If you’re tracking ovulation and BBT, the general rule is to document 4 days of raised BBT in a row to confirm ovulation. I personally like to track all the way through till my next period.)
As I mentioned above, the luteal phase (after ovulation) tends to be the most reliable for many women, even if your follicular phase (the phase between your period and ovulation) is irregular. If you do manage to catch ovulation the cycle following your 4-week miscarriage, your period will likely come about 12-16 days later (whatever your typical luteal phase length is.)
When I did conceive immediately after my first 4-week miscarriage, I used an online calculator to calculate my due date based on ovulation. I then calculated my CD1 to be 14 days before my known ovulation date, even though that’s not the day I actually started bleeding for my miscarriage. (I started bleeding on August 1st but considered CD1 to be August 9th: 14 days before my ovulation 23 days post-miscarriage.) By calculating my own due date based on my known ovulation, I came closer to my son’s actual birth date than what was estimated by the first ultrasound measurement.
I don’t recommend giving your doctor false information, but giving CD1 of August 9th when the OB receptionist asked, “When was the start of your last period” saved me from having to explain my irregular post-miscarriage cycle to someone who just didn’t need to know all the details.
You are not alone
One in four women experiences a miscarriage. The statistic for recurrent pregnancy loss is lower at 1 in 100 women.
That is in no way meant to minimize your loss. That means there are other women– maybe even someone you know– who understand how you feel. Support is available. I have found the online miscarriage community on Instagram to be particularly supportive.