Recurrent Miscarriage: Causes, Symptoms, and Treatment
Pregnancy loss has become a common medical complication affecting women across the globe. A topic that has remained unspoken for a long time, recurrent pregnancy loss, is a painful experience that affects the emotional well-being of families expecting to conceive.
At The Evewell, we acknowledge all kinds of fertility journeys, and sadly for some of our patients, recurrent miscarriage is one of them that requires profound courage and strength.
The heartache and uncertainty that accompany this path can be overwhelming, and our team are here to support and accompany anyone experiencing this.
We asked Dr Ewa Goncikowska, fertility consultant and gynaecologist at The Evewell West London, to explore the topic of recurrent miscarriage.
What is recurrent miscarriage?
Recurrent (or frequent) miscarriage is defined as three or more consecutive pregnancy losses that occur before the 24th week of pregnancy. This experience can feel like an isolating one, but please remember that you are not alone. Many women grapple with similar challenges, and we are here to provide understanding, care, and hope.
What causes recurrent miscarriage?
The causes of recurrent miscarriage are varied and can include hormonal imbalances, structural issues in the uterus, infections, genetic anomalies, autoimmune disorders, and advanced maternal age.
Sometimes, the cause remains elusive, which can bring its own form of frustration and sadness.
Some of the possible causes of recurrent miscarriage include:
- Genetic cause – Age-related decline in egg quality results in higher numbers of embryos with chromosomal abnormalities. About 2-5% of couples may also have inherited genetic abnormalities which results in abnormal embryos.
- Blood clotting disorders (thrombophilia) – Antiphospholipid syndrome (APS) is the most common treatable clotting disorder in women with recurrent miscarriage. APS can affect the blood flow to the womb and consequently embryo implantation.
- Uterine abnormalities – Structural anomalies (eg. septate, bicornuate uterus) affect the shape of the womb cavity in which the baby grows.
- Cervical incompetence – Cervical dilatation and rupture of pregnancy membranes may cause mid-trimester miscarriages.
- Endocrine abnormalities – Poorly controlled diabetes and under- or overactivity of the thyroid gland can increase miscarriage risk.
- Immunological causes – A subset of women with recurrent miscarriages may have higher/ lower natural killer cell levels in their womb, but there is currently no consensus on what defines a normal range or type of treatment.
- Infections – Low levels of healthy bacteria (Lactobacillus) or the presence of unhealthy bacteria in the womb environment may be linked to miscarriages.
It can be challenging to identify the cause of recurrent miscarriages, and the cause is unknown in about half of cases. However, it is important that you see a specialist if you experience recurrent pregnancy loss.
Your doctor will recommend blood tests, genetic testing, and an ultrasound, to determine the cause of your recurrent miscarriage and help develop a treatment plan.
What are the symptoms of a recurrent miscarriage?
Symptoms of a miscarriage can vary depending on the stage of pregnancy. Some women may experience mild cramping and spotting, while others may experience more severe symptoms such as heavy bleeding and intense cramping.
If you experience any signs that worry you, please reach out to either a member of our team, or a healthcare professional such as your midwife, your local Early Pregnancy Unit, or call 111 immediately. We are here to help and ensure both your and your baby’s health and safety.
How to treat recurrent miscarriage?
The treatment for recurrent miscarriage will depend on the underlying cause. Your doctor may prescribe blood thinning medications if you are found to have a clotting disorder or medications for endocrine disorders. Or maybe simply careful monitoring and early interventions.
If the cause is unidentified, your doctor may recommend progesterone supplementation and closer monitoring with early pregnancy scans.
How does progesterone help with recurrent miscarriage?
One option we often explore is the use of progesterone, a hormone that can play a crucial role in maintaining pregnancy.
A large randomised controlled trial (PRISM trial) showed that women with recurrent miscarriages who experienced bleeding and were given progesterone supplementation had improved live birth rates.
This was particularly pronounced in women who had had three or more previous miscarriages.
If you have had a previous miscarriage(s) and experience bleeding, you should have a discussion with your doctor about progesterone treatment.
How to cope with recurrent miscarriages
This journey is not just a physical one, but an emotional one as well. The feelings of grief, depression, and anxiety that you might be experiencing are completely valid, and it’s important to give yourself permission to feel and express them.
Please remember that you don’t have to face these emotions alone. Reach out to counselling services, join support groups, or talk to friends and family about what you’re going through. Organisations like Tommy’s offer a miscarriage support line and information service, providing another valuable resource for you during this time.
Above all, please remember this: Your experience matters. Your feelings matter. You matter.
We are here for you. Please do not hesitate to reach out if you have any questions or need someone to share your thoughts and feelings with.
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