What happens in your body during a miscarriage?

Globally, around 23 million pregnancies

end in miscarriage each year. Despite how common it is, miscarriage

is still considered a taboo subject. The experience can feel isolating,

and for some, emotionally traumatizing. And myths about miscarriage

add to the stigma, leading many to blame themselves

for the loss. However, most miscarriages

are unpreventable and caused by factors

beyond a person’s control. They happen because pregnancy

is a complex process, which requires careful choreography

between the fertilized egg and uterus. In fact, of every three eggs

that are fertilized, only one progresses to a live birth. So, let’s take a closer look at what

happens in the body during the first 12 weeks of pregnancy, when a majority of miscarriages occur. Pregnancy is maintained

by several hormones: progesterone and estrogen,

produced within the ovaries, and human chorionic gonadotropin, or hCG,

sent out by the fertilized egg. During the first half of each

menstrual cycle estrogen levels increase, followed by an increase in progesterone. These hormones signal to the uterine

lining to enhance its blood supply and thicken its mucosa, creating the conditions needed

for an early pregnancy to grow. If an egg arrives at the

uterus unfertilized, these hormone levels naturally drop, triggering contractions and the shedding

of the uterine lining in menstruation. Yet, if the egg arrives fertilized,

its outermost layer begins producing hCG. This hormone travels to the ovaries

and stimulates the continued release of progesterone and estrogen, halting menstruation. hCG also binds to receptors

on the uterine lining to prevent it from rejecting

the fertilized cell mass as it embeds. This is a stage where things

often go awry. For reasons that are not fully understood, as many as one third of fertilized eggs

fail to properly attach, passing undetected in a normal-seeming

menstrual period. And implantation is only the first hurdle

for fertilized eggs that do properly attach. Once burrowed in the uterine lining, the rapidly dividing fertilized egg’s

own DNA guides its growth. Chromosomal abnormalities can therefore

cause irregular development, or stop embryo growth entirely. While many mistakenly believe their

miscarriage was caused by factors like stress, exercise, vaccination,

or past birth control use, a vast majority are in fact caused

by these genetic issues or other health factors

beyond a person’s control. Some pregnancy losses lead to few, if any,

noticeable physical symptoms. In other cases, hCG levels drop,

followed by a decrease in progesterone, causing bleeding and cramping. In either situation,

there are three treatment options— two of which are also used

for induced abortion procedures, when patients choose to end a pregnancy. The first of the three options is

what’s commonly known as the “watch-and-wait” method. A person waits for pregnancy hormones

to drop further, allowing the pregnancy tissue to be

released with the shedding uterine wall. This approach works up to 90% of the time, but it can involve several weeks

of unpredictable pain and bleeding. Others may opt for option two, taking the pills mifepristone

and misoprostol in sequence. The first works hormonally,

by blocking progesterone receptors, and the second mimics a molecule

which induces labor, stimulating uterine contractions and

causing the cervix to soften and dilate. After taking the second pill,

the process normally takes 1 to 6 hours. It’s often safely self-managed,

and can be done privately at home. The third possible treatment option

is known as vacuum aspiration. During this five-minute procedure,

the healthcare provider numbs the cervix, then places a thin tube connected

to a syringe-like device to remove the pregnancy tissue. Treatment choice is often based

on the pregnant person’s medical history, timeline, expectations,

and personal preferences, and all three methods have proven

to be safe and effective. However, without the medication

or vacuum aspiration options, an untreated or an incomplete miscarriage

can lead to life-threatening infections and hemorrhage. And because they are the same treatments

used in induced abortion care, they can be harder to access

and even criminalized in some areas. Beyond this, over half the world’s

population lacks access to reliable basic healthcare, including these essential

reproductive health services. While pregnancy means different

things to different people at different points in their lives, for many, losing a pregnancy can be

devastating and overwhelming. During this difficult time, everyone deserves to be met

with care and support, and to have access to these

life-saving treatments.