Your body has been through trauma after a miscarriage and will need time and additional care to heal. Parsley Health physician Jaclyn Tolentino, DO and health coach Kelly Johnston, RD, weigh in on how to support your body after pregnancy loss.
If you’ve recently suffered a miscarriage, know that you’re not alone: Statistics show that up to 15 percent of pregnancies end in a miscarriage. As pregnancy loss is discussed more openly in society, the conversation often centers around the emotional and mental health implications of a miscarriage, but the physiological response your body has after a miscarriage is just as important to talk about. Your hormones were preparing for one event, and then your body pivoted in a different direction. Here’s what you need to know about caring for your body during this difficult stage and rebalancing your hormones after a miscarriage.
What can cause a miscarriage?
The first question you have is probably around why this happened. It’s not your fault—most miscarriages are caused by external factors out of your control. The most common cause of miscarriage is chromosomal abnormalities that occur in the fetus. Foodborne pathogens like salmonella are also a cause of pregnancy loss, which is why pregnant women are often instructed not to eat uncooked or undercooked eggs, meat, or fish. Other common causes of miscarriage involve mitochondrial dysfunction; Mitochondria are responsible for producing energy inside our cells, including those that will develop into a fetus. If mitochondrial cells are not working properly, it can affect the fetus’ genetic makeup, explains Jaclyn Tolentino, DO, a physician at Parsley Health in Los Angeles. You could be especially prone to mitochondrial dysfunction if you have an autoimmune disorder or other immune health issues that affect the cells in your body.
What happens to your body after a miscarriage?
Every person’s body reacts differently to pregnancy loss, so there’s no one set of miscarriage symptoms that everyone will experience. “The differentiating factors include how far along the pregnancy was, and what treatments were used to manage the miscarriage,” Dr. Tolentino says. Here are the most common signs and symptoms after miscarriage.
Cramping and bleeding
You may experience some uncomfortable cramping and bleeding after a miscarriage as the uterus contracts to expel blood and tissue it’s been holding onto. Don’t be alarmed if the bleeding is heavier than your usual menstrual bleeding, Dr. Tolentino says. This is normal, increased cramping and bleeding after miscarriage is one of the most prevalent symptoms. “The severity and duration of the bleeding can vary among individuals, but it should taper off within a few days,” Dr. Tolentino says. It’s important to stay in contact with your healthcare provider during this time to discuss any ongoing symptoms, especially if bleeding doesn’t seem to be slowing down.
The hormonal changes that occur after a miscarriage really depend on how far along you were, and therefore how your hormones adapted during your pregnancy. These are some of the major hormones at play, how they change during pregnancy, and what effect they have on your body, Dr. Tolentino explains.
- hCG: Human chorionic gonadotropin, or hCG, is the hormone pregnancy tests look for in your urine to determine whether or not you’re pregnant. This hormone is produced by cells that will eventually form the placenta and stimulates the corpus luteum—a collection of hormone-producing cells that form in the ovaries—to produce progesterone. In early pregnancy, hCG levels rise rapidly, increasing every two to three days and likely contributing to many of the unpleasant symptoms associated with early pregnancy like nausea and vomiting.
- Estrogen: Estrogen and progesterone are two of the most prominent hormones during early pregnancy. Estrogen levels quickly rise during the first trimester to help the fetus develop, supporting the transfer of nutrients, formation of blood vessels, milk duct development and more.
- Progesterone: Progesterone increases exponentially during the first few months of pregnancy, causing ligaments and joints to loosen and, eventually, allowing the uterus to expand as the fetus grows. Starting from its production in the ovaries and placenta, progesterone prepares the uterine lining for implantation, and then continues to support the endometrium to create the ideal environment for the fetus.
During and after a miscarraige, these hormones that once rose rapidly will begin to fall. Some hormones, like hCG, should eventually become undetectable while others, like estrogen and progesterone, will reset to their pre-pregnancy levels. Along with physical side effects, this drastic shift can intensify emotions associated with the trauma you recently experienced, Dr. Tolentino explains. As your hormones begin to balance after a miscarriage, the symptoms of early pregnancy, like nausea or tenderness in your breasts, will begin to subside. But for some people, the impact of these dramatic hormonal shifts on your emotions and mental health will be more prominent. “Changing hormone levels can also have a big impact on emotions, and it’s not uncommon to experience symptoms such as fatigue, anxiety, insomnia, depression, or irritability,” Dr. Tolentino explains.
Managing emotional and psychological symptoms after miscarriage is just as important as monitoring physical symptoms. It can take anywhere from two to six weeks for these physical symptoms to fully subside, though the mental toll of a loss can be different for everyone, says Dr. Tolentino. During this time, it’s important for your physician to monitor these levels and check-in on your mental and emotional health.
Symptoms of anxiety and depression
Heightened anxiety and depression are especially common during this time period, and both can affect your physical health. “Depression, anxiety, and stress can be manifested physically, in the form of mood shifts, insomnia, and a weakened immune system,” says Kelly Johnston, MS, RD, a health coach at Parsley Health in New York City.
As discussed earlier, after a miscarriage, once elevated levels of estrogen and progesterone take a sudden plunge contributing to big mood swings—comparable to the extreme emotional changes you’d experience with a severe case of PMS. This plunge of hormones, paired with the sadness and grief of pregnancy loss, can compound the feelings of fatigue, anxiety, depression, insomnia, and irritability that often accompany miscarriage.
To fuel symptoms of anxiety and depression further, while female hormones plummet after pregnancy loss, the stress hormone cortisol skyrockets—boosting systemic inflammation, contributing to insomnia and decreased immune health. Independent of other factors, elevated cortisol levels trigger anxiety—keeping the body in its fight or flight response and making relaxation difficult to achieve.
Return to a normal menstrual cycle
“Most women will experience a return to their normal menstrual cycles within 1 to 2 cycles after a miscarriage,” Dr. Tolentino points out. And, you may start ovulating and be able to conceive again sooner than you’d think, she adds. “The body can begin ovulating again as early as 2 to 3 weeks post-miscarriage, and up to 6 weeks after a miscarriage. It’s important to use contraceptives, in the form of barrier protection, if you are not trying or are advised to wait until trying to become pregnant again,” says Dr. Tolentino.
Healing after miscarriage
“Parsley doctors like myself support the body’s healing mechanisms after an impactful event such as miscarriage in several ways: by supporting the patient’s needs in addition to working alongside her OB/GYN, and by focusing on mechanisms to aid hormone balance, healing, immune regulation, and the body’s physiological ‘reset’ after miscarriage,” says Dr. Tolentino.
This supplemental care can ensure that your body is recovering and offer an additional support system with the aid of a health coach who can provide everything from helpful self-care literature and practices to nutritional tips, to frequent emotional check-ins. These are just a few ways you can focus on giving your body some extra TLC.
Include more hormone balancing foods in your diet
One dietary area of focus is on foods that can help stabilize both your mood and hormones after a miscarriage. These include probiotic-rich foods, as well as cruciferous vegetables, which can help metabolize estrogen in your intestinal tract, Johnston says. This refers to the way your body eliminates estrogen from the body, a natural and important part of your body’s proper functioning. If you’re not detoxifying hormones properly, it can lead to a buildup of excess hormones in the body that then get recirculated. So foods that promote good digestive health play an important role in hormone regulation.
Johnston also recommends eating anti-inflammatory foods such as foods rich in omega-3 fatty acids which help block inflammatory particles at the cellular level, reducing the inflammation that can make it difficult to regulate hormone levels like estrogen. For adequate intake, opt for two or more servings per week of fatty fish like salmon and mackerel, seeds, including flax and pumpkin, and nuts like walnuts.
Staying away from inflammatory foods may also help balance your hormones after a miscarriage. “Avoid foods that can be hormonally charged, like dairy, or inflammatory foods like sugar, which can throw off your hormones and inhibit the production of neurotransmitters like serotonin in the gut,” Johnston says. The way to do this is to stick to whole, fiber-filled foods, and balanced meals. Johnston adds, another source of balance comes from focusing on intuitive eating and listening to your body’s hunger cues without obsessively focusing on your diet at this time.
Support your body with supplements
Based on the symptoms you experience after miscarriage, supplements or dietary changes may be required to compensate for the changes in your body. For example, if you’re experiencing heavy bleeding, talk to your doctor about taking an iron supplement. This will help replace the iron stores that have been depleted from the miscarriage bleeding and prevent a deficiency from forming. After just a few weeks of consistent use, your iron levels should be back to normal.
There’s also a chance you may be deficient in Vitamin D, which has been linked to first trimester miscarriages. Make sure you’re getting tested for Vitamin D on your next bloodwork visit after miscarriage. If you find that your Vitamin D levels are lower than usual it may be worth considering a Vitamin D supplement.
Get back to gentle exercise
While your body is still recovering, it may not be the best time to go to HIIT classes, but healing, restorative exercise is a great place to start, especially when dealing with grief after miscarriage, explains Johnston. Your workout routine can actually be very influential in hormone regulation, as it allows you to communicate with your body and it’s endocrine system. The endocrine system is made up of glands throughout the body that are responsible for creating and releasing hormones at the proper levels—this includes estrogen, cortisol, and progesterone, among others. Regular exercise helps strengthen this system and your relationship with your body Once your OB/GYN has cleared you to exercise, this could include Pilates, yoga, walking, jogging, or gentle swimming. If getting to the gym or yoga studio seems unrealistic, Johnston suggests doing a short online yoga, Pilates, or meditation program to activate your brain and body a little bit.
If you experienced a late term miscarriage, kegel exercises can help strengthen your pelvic floor muscles with pelvic floor therapy, Johnston adds.
Engage in meditative practices
Now is the time to really focus on self-care, because your body needs it. That looks a little different for everyone. “We help people establish journaling practices, like gratitude journaling with meditation, and establishing realistic short-term healing goals,” Johnston says. Movement meditation, in the form of yoga, may help some people, while others may gravitate toward sound meditation or specific breathing techniques.
Beyond the mental benefits meditation can bring, it will also help relieve stress, bringing down your cortisol levels and helping with some of the physiological effects misscarriage may have on your hormones. Increased stress is known to speed up the enzyme aromatase, the process that converts testosterone to estrogen, contributing to hormonal imbalance.
If you struggle with getting in the right headspace for meditation, a health coach can support you with self-care and meditation book recommendations, or finding other stress management techniques that may help you.
Check-in with your health coach regularly
While Parsley Health doctors and health coaches recommend you seek out counseling or other mental health treatment after a pregnancy loss, working with a health coach can also be a nice addition to your healing journey because they’re available to you whenever you need to check-in. “In acute times of stress, we provide more regular touchpoints via email, so people can write their thoughts and feelings down,” Johnston says.
Each person’s recovery from a pregnancy loss is unique. Similar to when we experience other biological shifts, the body requires time to recalibrate and return to homeostasis. “The best thing you can do to get back to normal is take it slow and take care of yourself.” Dr. Tolentino explains. Don’t be afraid to ask for support. Whether it’s in a health coach, loved one, or friend, more people than you know have gone through something similar or know someone who has and can provide you with the sounding board you need.