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    Miscarriage: Should I Have Treatment to Complete a Miscarriage?

    Miscarriage: Should I Have Treatment to Complete a Miscarriage?

    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Miscarriage: Should I Have Treatment to Complete a Miscarriage?

    Get the facts

    Your options

    • Wait to see if your body completes the miscarriage on its own.
    • Take medicine to complete the miscarriage.
    • Have surgery to complete the miscarriage.

    Key points to remember

    • There is no treatment that can stop a miscarriage after it has started. The goal of treatment is to prevent an infection and the loss of too much blood. These problems are most likely to occur when the uterus does not completely empty. (This is called an incomplete miscarriage.)
    • For many women, the body completes the miscarriage on its own. If you decide not to treat your miscarriage, see your doctor. He or she will watch you closely during the time you wait for the miscarriage to complete.
    • If you have heavy bleeding or infection during a miscarriage, you will likely need surgery to empty your uterus.
    • Medicine makes the uterus squeeze and empty. Medicine takes longer than a procedure to empty your uterus, and it can cause pain and side effects.
    • Surgery has risks, including infection and a possible hole (puncture) or scarring in the uterus.
    • Using medicine or waiting for the uterus to empty on its own doesn't always work. If medicine, waiting, or both don't empty the uterus after several weeks, you may need surgery.
    FAQs

    What is a miscarriage?

    A miscarriage is the loss of a pregnancy during the first 20 weeks. (After 20 weeks, pregnancy loss is known as a stillbirth.) The risk of miscarriage increases as a woman ages.

    The loss of a pregnancy can be very hard to accept. You may wonder why it happened or blame yourself. But a miscarriage is no one's fault. You can't prevent it.

    Common signs of a miscarriage can include:

    • Vaginal bleeding.
    • Pain in the belly, lower back, or pelvis.
    • Passing fetal tissue from the vagina.

    Bleeding may be light or heavy, and it may be constant or come and go. It can sometimes be hard to know if light bleeding is a sign of miscarriage. But if you have pain along with bleeding, the chance of a miscarriage is high.

    What should you do if you are or might be miscarrying?

    Call your doctor or nurse-midwife right away if you have symptoms of a miscarriage. Getting medical advice and care can lower your chance of any problems from the miscarriage. Your doctor or nurse-midwife will check to see if you:

    • Might be losing too much blood or getting an infection.
    • Could have an ectopic pregnancy , which can be deadly. You may need emergency surgery to remove the embryo or fetus .
    • Are at risk for Rh sensitization , which may be dangerous to a fetus in your next pregnancy. If your blood type is Rh-negative, you will probably need treatment.

    How is a miscarriage treated?

    There is no treatment to stop a miscarriage. For many women, the body completes the miscarriage on its own. There are several treatments to help complete a miscarriage. Depending on your condition, you may be able to choose:

    • Watchful waiting (known as expectant management), which means that you see your doctor and he or she watches you closely during the time you wait for the miscarriage to complete on its own.
    • Medicine to complete the miscarriage, known as medical management.
    • Surgical treatment, such as dilation and curettage (D&C) , to complete the miscarriage.

    If your doctor or nurse-midwife is sure that your first-trimester or early second-trimester miscarriage is complete and all tissue has passed from your uterus, the bleeding is likely to taper off within about a week. Unless you have a fever or heavy bleeding, you will not need treatment. But your doctor or nurse-midwife may want to see you sometime during the next month.

    Compare your options

    Compare

    What is usually involved?









    What are the benefits?









    What are the risks and side effects?









    Take medicine Take medicine
    • You take pills that empty your uterus.
    • You can be at home.
    • After several hours, you will have bleeding and cramps as the medicine starts to work. The miscarriage may take days or weeks to end.
    • It completes a miscarriage more quickly than waiting.
    • You don't have the risks from surgery or anesthesia.
    • It causes cramping and bleeding. You may have more cramping than if the miscarriage ended on its own.
    • It doesn't work as well for second-trimester miscarriages.
    • It can cause side effects such as:
      • Pain.
      • Nausea.
      • Vomiting.
      • Diarrhea.
    • You still may need surgery if the medicine doesn't complete the miscarriage.
    Have surgery Have surgery
    • It's the quickest way to complete a miscarriage.
    • You could have less bleeding than with medicine or no treatment.
    • You may have pain (but for a shorter time than with medicine).
    • Possible risks include:
      • A reaction to the anesthesia.
      • An infection.
      • A hole (puncture) or scarring in the uterus.
    Have no treatment Have no treatment
    • You talk to your doctor to see if it's okay to wait for the miscarriage to end on its own.
    • You can be at home.
    • It could take days or weeks for the miscarriage to end.
    • You see your doctor to make sure that the miscarriage is over.
    • You don't have the risks from medicine or surgery.
    • You may have to wait weeks for the bleeding to end.
    • You still may need medicine or surgery if the miscarriage doesn't complete on its own.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about miscarriage treatment

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    When I learned that I was having a miscarriage, I couldn't bear the thought of it. I knew right away that I needed to get through the physical process of the miscarriage as quickly as possible. This way, I could begin to emotionally cope with my loss, rather than suffering through the extra days of waiting for the miscarriage to end. I asked my doctor to do a D&C right away.

    Claire, age 26

    I actually didn't have a choice about having a D&C when I miscarried, because I was bleeding so heavily. I think that I would have chosen to let my body miscarry on its own, but my nurse-midwife said that this was an urgent situation. I'm just grateful that I came through it as well as I did.

    Lucero, age 38

    It was late in my first trimester when my doctor told me that I had started a miscarriage, probably a couple of weeks before. She said that this is called an "incomplete miscarriage," and that I had some choices. I could wait a little longer for bleeding to start, I could have a D&C, or I could take a medicine that would make the miscarriage progress. Either way, I'd have to have an Rh immunoglobulin injection, because my blood is Rh-negative. I can't stand the idea of surgery, and I felt I had to do something, so I chose the medicine. While I was taking it, I felt miserable. I had stomach pain and nausea. My husband had to take care of me for a few days. The treatment worked. And after I bled for a couple of weeks, the miscarriage was done. I also saw a counselor a few times. She really helped me out with recovering emotionally from my miscarriage.

    Dao, age 28

    My doctor is experienced with using medicine to treat miscarriage. And as a nurse, I'm familiar with the drugs used. So I felt comfortable with choosing this kind of treatment for ending a miscarriage.

    Jennifer, age 36

    When I began to bleed during my 10th week, I went in to see my doctor. She examined me and told me that I might be miscarrying, but we'd have to wait to see for sure. That was a terrible time. A couple of days later, it was clear that I was miscarrying, because I was passing some tissue. My doctor told me that I could have a D&C or let the miscarriage happen on its own. I decided that the natural course of things was best for me. After a couple of weeks, the bleeding tapered off. It took me a while before I was ready to try to get pregnant again, and I met with a counselor to help me get through those first few months. I think it helped me, though, to have gone through the slower process of physically and emotionally losing the pregnancy.

    Renna, age 30

    When my doctor told me that I was miscarrying, I told him that I really didn't want a D&C. He agreed, saying that he prefers a "watch and wait" approach with a miscarriage. He said that he hardly ever uses surgery or medicine to treat a miscarriage anymore?only if it's requested or if there are complications. I did have to have an Rh immunoglobulin injection because I'm Rh-negative and the fetus could have been Rh-positive. Well, unfortunately, a day later, I started to bleed heavily. I went right in to get checked, and my doctor said that I was going to lose too much blood if he didn't do a D&C. After the D&C, I had light bleeding for a week or so, which apparently is normal.

    Anna, age 35

    What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    I would rather take medicine or have surgery than wait for the miscarriage to end on its own.

    Not important
    Somewhat important
    Very important

    I want to avoid surgery if I can.

    Not important
    Somewhat important
    Very important

    I would rather wait and let nature takes its course.

    Not important
    Somewhat important
    Very important

    I'm concerned about the pain and side effects from medicine or surgery.

    Not important
    Somewhat important
    Very important

    It would be harder for me emotionally to wait for the miscarriage to end on its own.

    Not important
    Somewhat important
    Very important

    My other important reasons:

    Not important
    Somewhat important
    Very important

    Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Taking medicine

    NOT taking medicine

    Leaning toward
    Undecided
    Leaning toward

    Having surgery

    NOT having surgery

    Leaning toward
    Undecided
    Leaning toward

    Waiting for the miscarriage to end

    NOT waiting

    Leaning toward
    Undecided
    Leaning toward

    What else do you need to make your decision?

    Check the facts

    1.

    If I have a miscarriage, I will have to get treatment with medicine or surgery.

    • True Sorry, that's not right. A miscarriage often completes on its own.
    • False That's right. A miscarriage often completes on its own.
    • I'm not sure It may help to go back and read "Get the Facts." A miscarriage often completes on its own.
    2.

    I may need to have surgery even if I wait or take medicine.

    • True You're right. You may need surgery if waiting or medicine doesn't work.
    • False Sorry, that's not right. You may need surgery if waiting or medicine doesn't work.
    • I'm not sure It may help to go back and read "Get the Facts." You may need surgery if waiting or medicine doesn't work.
    3.

    If I have heavy bleeding or an infection, surgery is my best choice.

    • True You're right. You may need surgery if you have heavy bleeding or an infection.
    • False Sorry, that's not right. You may need surgery if you have heavy bleeding or an infection.
    • I'm not sure It may help to go back and read "Get the Facts." You may need surgery if you have heavy bleeding or an infection.

    Decide what's next

    1.

    Do you understand the options available to you?

    2.

    Are you clear about which benefits and side effects matter most to you?

    3.

    Do you have enough support and advice from others to make a choice?

    Certainty

    1.

    How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure
    3.

    Use the following space to list questions, concerns, and next steps.

    Your Summary

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

    Your decision

    Next steps

    Which way you're leaning

    How sure you are

    Your comments

    Your knowledge of the facts

    Key concepts that you understood

    Key concepts that may need review

    Getting ready to act

    Patient choices

    Credits

    Credits
    Credits Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology
    You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

    Miscarriage: Should I Have Treatment to Complete a Miscarriage?

    Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
    1. Get the facts
    2. Compare your options
    3. What matters most to you?
    4. Where are you leaning now?
    5. What else do you need to make your decision?

    1. Get the Facts

    Your options

    • Wait to see if your body completes the miscarriage on its own.
    • Take medicine to complete the miscarriage.
    • Have surgery to complete the miscarriage.

    Key points to remember

    • There is no treatment that can stop a miscarriage after it has started. The goal of treatment is to prevent an infection and the loss of too much blood. These problems are most likely to occur when the uterus does not completely empty. (This is called an incomplete miscarriage.)
    • For many women, the body completes the miscarriage on its own. If you decide not to treat your miscarriage, see your doctor. He or she will watch you closely during the time you wait for the miscarriage to complete.
    • If you have heavy bleeding or infection during a miscarriage, you will likely need surgery to empty your uterus.
    • Medicine makes the uterus squeeze and empty. Medicine takes longer than a procedure to empty your uterus, and it can cause pain and side effects.
    • Surgery has risks, including infection and a possible hole (puncture) or scarring in the uterus.
    • Using medicine or waiting for the uterus to empty on its own doesn't always work. If medicine, waiting, or both don't empty the uterus after several weeks, you may need surgery.
    FAQs

    What is a miscarriage?

    A miscarriage is the loss of a pregnancy during the first 20 weeks. (After 20 weeks, pregnancy loss is known as a stillbirth.) The risk of miscarriage increases as a woman ages.

    The loss of a pregnancy can be very hard to accept. You may wonder why it happened or blame yourself. But a miscarriage is no one's fault. You can't prevent it.

    Common signs of a miscarriage can include:

    • Vaginal bleeding.
    • Pain in the belly, lower back, or pelvis.
    • Passing fetal tissue from the vagina.

    Bleeding may be light or heavy, and it may be constant or come and go. It can sometimes be hard to know if light bleeding is a sign of miscarriage. But if you have pain along with bleeding, the chance of a miscarriage is high.

    What should you do if you are or might be miscarrying?

    Call your doctor or nurse-midwife right away if you have symptoms of a miscarriage. Getting medical advice and care can lower your chance of any problems from the miscarriage. Your doctor or nurse-midwife will check to see if you:

    • Might be losing too much blood or getting an infection.
    • Could have an ectopic pregnancy , which can be deadly. You may need emergency surgery to remove the embryo or fetus .
    • Are at risk for Rh sensitization , which may be dangerous to a fetus in your next pregnancy. If your blood type is Rh-negative, you will probably need treatment.

    How is a miscarriage treated?

    There is no treatment to stop a miscarriage. For many women, the body completes the miscarriage on its own. There are several treatments to help complete a miscarriage. Depending on your condition, you may be able to choose:

    • Watchful waiting (known as expectant management), which means that you see your doctor and he or she watches you closely during the time you wait for the miscarriage to complete on its own.
    • Medicine to complete the miscarriage, known as medical management.
    • Surgical treatment, such as dilation and curettage (D&C) , to complete the miscarriage.

    If your doctor or nurse-midwife is sure that your first-trimester or early second-trimester miscarriage is complete and all tissue has passed from your uterus, the bleeding is likely to taper off within about a week. Unless you have a fever or heavy bleeding, you will not need treatment. But your doctor or nurse-midwife may want to see you sometime during the next month.

    2. Compare your options

    Take medicine Have surgery
    What is usually involved?
    • You take pills that empty your uterus.
    • You can be at home.
    • After several hours, you will have bleeding and cramps as the medicine starts to work. The miscarriage may take days or weeks to end.
    What are the benefits?
    • It completes a miscarriage more quickly than waiting.
    • You don't have the risks from surgery or anesthesia.
    • It's the quickest way to complete a miscarriage.
    • You could have less bleeding than with medicine or no treatment.
    What are the risks and side effects?
    • It causes cramping and bleeding. You may have more cramping than if the miscarriage ended on its own.
    • It doesn't work as well for second-trimester miscarriages.
    • It can cause side effects such as:
      • Pain.
      • Nausea.
      • Vomiting.
      • Diarrhea.
    • You still may need surgery if the medicine doesn't complete the miscarriage.
    • You may have pain (but for a shorter time than with medicine).
    • Possible risks include:
      • A reaction to the anesthesia.
      • An infection.
      • A hole (puncture) or scarring in the uterus.
    Have no treatment
    What is usually involved?
    • You talk to your doctor to see if it's okay to wait for the miscarriage to end on its own.
    • You can be at home.
    • It could take days or weeks for the miscarriage to end.
    • You see your doctor to make sure that the miscarriage is over.
    What are the benefits?
    • You don't have the risks from medicine or surgery.
    What are the risks and side effects?
    • You may have to wait weeks for the bleeding to end.
    • You still may need medicine or surgery if the miscarriage doesn't complete on its own.

    Personal stories

    Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

    Personal stories about miscarriage treatment

    These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

    "When I learned that I was having a miscarriage, I couldn't bear the thought of it. I knew right away that I needed to get through the physical process of the miscarriage as quickly as possible. This way, I could begin to emotionally cope with my loss, rather than suffering through the extra days of waiting for the miscarriage to end. I asked my doctor to do a D&C right away."

    ? Claire, age 26

    "I actually didn't have a choice about having a D&C when I miscarried, because I was bleeding so heavily. I think that I would have chosen to let my body miscarry on its own, but my nurse-midwife said that this was an urgent situation. I'm just grateful that I came through it as well as I did."

    ? Lucero, age 38

    "It was late in my first trimester when my doctor told me that I had started a miscarriage, probably a couple of weeks before. She said that this is called an "incomplete miscarriage," and that I had some choices. I could wait a little longer for bleeding to start, I could have a D&C, or I could take a medicine that would make the miscarriage progress. Either way, I'd have to have an Rh immunoglobulin injection, because my blood is Rh-negative. I can't stand the idea of surgery, and I felt I had to do something, so I chose the medicine. While I was taking it, I felt miserable. I had stomach pain and nausea. My husband had to take care of me for a few days. The treatment worked. And after I bled for a couple of weeks, the miscarriage was done. I also saw a counselor a few times. She really helped me out with recovering emotionally from my miscarriage."

    ? Dao, age 28

    "My doctor is experienced with using medicine to treat miscarriage. And as a nurse, I'm familiar with the drugs used. So I felt comfortable with choosing this kind of treatment for ending a miscarriage."

    ? Jennifer, age 36

    "When I began to bleed during my 10th week, I went in to see my doctor. She examined me and told me that I might be miscarrying, but we'd have to wait to see for sure. That was a terrible time. A couple of days later, it was clear that I was miscarrying, because I was passing some tissue. My doctor told me that I could have a D&C or let the miscarriage happen on its own. I decided that the natural course of things was best for me. After a couple of weeks, the bleeding tapered off. It took me a while before I was ready to try to get pregnant again, and I met with a counselor to help me get through those first few months. I think it helped me, though, to have gone through the slower process of physically and emotionally losing the pregnancy."

    ? Renna, age 30

    "When my doctor told me that I was miscarrying, I told him that I really didn't want a D&C. He agreed, saying that he prefers a "watch and wait" approach with a miscarriage. He said that he hardly ever uses surgery or medicine to treat a miscarriage anymore?only if it's requested or if there are complications. I did have to have an Rh immunoglobulin injection because I'm Rh-negative and the fetus could have been Rh-positive. Well, unfortunately, a day later, I started to bleed heavily. I went right in to get checked, and my doctor said that I was going to lose too much blood if he didn't do a D&C. After the D&C, I had light bleeding for a week or so, which apparently is normal."

    ? Anna, age 35

    3. What matters most to you?

    Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

    I would rather take medicine or have surgery than wait for the miscarriage to end on its own.

    Not important
    Somewhat important
    Very important

    I want to avoid surgery if I can.

    Not important
    Somewhat important
    Very important

    I would rather wait and let nature takes its course.

    Not important
    Somewhat important
    Very important

    I'm concerned about the pain and side effects from medicine or surgery.

    Not important
    Somewhat important
    Very important

    It would be harder for me emotionally to wait for the miscarriage to end on its own.

    Not important
    Somewhat important
    Very important

    My other important reasons:

    Not important
    Somewhat important
    Very important

    4. Where are you leaning now?

    Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

    Taking medicine

    NOT taking medicine

    Leaning toward
    Undecided
    Leaning toward

    Having surgery

    NOT having surgery

    Leaning toward
    Undecided
    Leaning toward

    Waiting for the miscarriage to end

    NOT waiting

    Leaning toward
    Undecided
    Leaning toward

    5. What else do you need to make your decision?

    Check the facts

    1. If I have a miscarriage, I will have to get treatment with medicine or surgery.

    • True
    • False
    • I'm not sure
    That's right. A miscarriage often completes on its own.

    2. I may need to have surgery even if I wait or take medicine.

    • True
    • False
    • I'm not sure
    You're right. You may need surgery if waiting or medicine doesn't work.

    3. If I have heavy bleeding or an infection, surgery is my best choice.

    • True
    • False
    • I'm not sure
    You're right. You may need surgery if you have heavy bleeding or an infection.

    Decide what's next

    1. Do you understand the options available to you?

    2. Are you clear about which benefits and side effects matter most to you?

    3. Do you have enough support and advice from others to make a choice?

    Certainty

    1. How sure do you feel right now about your decision?

    Not sure at all
    Somewhat sure
    Very sure

    2. Check what you need to do before you make this decision.

    • I'm ready to take action.
    • I want to discuss the options with others.
    • I want to learn more about my options.

    3. Use the following space to list questions, concerns, and next steps.

    Credits
    By Healthwise Staff
    Primary Medical Reviewer Sarah Marshall, MD - Family Medicine
    Specialist Medical Reviewer Femi Olatunbosun, MB, FRCSC - Obstetrics and Gynecology

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