Chemical miscarriage: what it is and what comes next

A chemical miscarriage, also called a chemical pregnancy, is a very early pregnancy loss. The Cleveland Clinic describes it as a miscarriage that happens within the first five weeks, before the pregnancy can be seen on an ultrasound. You get a positive test, and then a period arrives or a later test turns negative. It is a real loss, it is common, and it is very rarely anything you caused.

How do you know if you have a chemical miscarriage?

Most women find out in one of two ways. The first is a positive pregnancy test followed by bleeding that arrives on or close to the day the period was due. The second is a faint positive test followed, days or a couple of weeks later, by a negative one. The Cleveland Clinic lists both patterns, and adds that the period may be heavier than usual, with stronger cramps.

Many women never know. A chemical pregnancy is only noticed if you test early, and before home tests the same loss would have looked like a late, heavy period.

A test cannot tell you where a pregnancy is growing, and bleeding on its own cannot tell you which kind of loss it is. The only way to confirm a loss is a blood test for human chorionic gonadotropin (hCG), the hormone that pregnancy tests detect, and sometimes a scan. The American College of Obstetricians and Gynecologists (ACOG) says several hCG tests and scans may be needed before a loss is confirmed, because a falling level is the signal and one number is not.

How long does a chemical miscarriage last?

For most women the bleeding looks like a period and passes in the same way. After any miscarriage, the National Health Service (NHS) says tummy pain may last a few days and bleeding or spotting up to two weeks. Your next period can take up to eight weeks to come back, and it may take a few months to settle into your usual pattern.

What causes a chemical pregnancy to happen?

The cause is usually chance. ACOG says that about half of early miscarriages happen because the embryo does not develop properly, often because of an abnormal number of chromosomes. Chromosomes carry the instructions for how a baby develops, and if the egg or sperm brings too many or too few, the embryo cannot continue. Nothing you did would have changed that.

ACOG puts early pregnancy loss at about 10 in every 100 known pregnancies. Risk rises with age, and the NHS lists other things that raise the chance, including thyroid conditions, diabetes, smoking and problems with the womb.

Is it your fault?

It is a question many Nigerian women ask in silence, often before anyone else has asked it for them. The people around you may offer a reason: stress, a quarrel, something you ate.

ACOG goes on to say that working, exercising, stress, arguments and having sex do not cause miscarriage. If you took a herbal mixture or a drug from a chemist during that time, tell the doctor, because a clinician can judge that and this guide cannot.

The NHS lists being of Black African or Black Caribbean background among the things associated with a higher chance of miscarriage. That is a pattern across large groups of women. It says nothing about what you did, and it is a reason to expect good care, including tests when losses repeat.

Can you recover from a chemical pregnancy, and does it need treatment?

Yes, and most women recover fully. The Cleveland Clinic says there is no treatment for a chemical pregnancy itself, and that many women go on to healthy pregnancies. If bleeding is heavy, goes on for a long time or comes with fever, a clinician decides what, if anything, is needed.

Recovery has an emotional part. ACOG says that for many women emotional healing takes longer than physical healing, and that your partner may feel it differently from you. If the sadness is not easing, or you are struggling to sleep or eat, speak to a doctor or a counsellor. The Gentle Mind Check-in is a private place to notice how you are doing, and it points you to real help.

When can you try again?

Physically, soon. The Cleveland Clinic says you can ovulate about two weeks after a chemical pregnancy, and ACOG says you can get pregnant again as soon as two weeks after an early miscarriage. ACOG also suggests waiting for one period if you can, because it makes the due date of the next pregnancy easier to calculate. The NHS says you can try again when you feel ready, after your symptoms have gone.

Ready is your decision, and it can be later than the calendar allows. When you do try again, the fertile window guide shows how to find your own days, and The Wait Check-in is a quiet place to track how the waiting feels.

When does it count as recurrent miscarriage?

One chemical pregnancy is almost always a one-off. Guidelines differ on when repeated losses need investigation. The Royal College of Obstetricians and Gynaecologists says three or more early miscarriages is called recurrent miscarriage, with tests offered from the third loss. ACOG recommends a thorough examination and testing after two.

Doctors also differ on whether a chemical pregnancy is added to the count. Because of that, keep a note of every positive test with its date, and tell the doctor about all of them. If you have had two losses of any kind, ask for a review without waiting for a third. Testing looks for treatable causes such as thyroid problems, diabetes, clotting conditions or the shape of the womb, and even when no cause is found, ACOG says most women go on to have successful pregnancies.

When to see a doctor, and what to ask at a clinic

Beyond emergencies, see a doctor if the bleeding does not settle, if a line stays positive for weeks, if you want to understand why it happened, or if this is not your first loss. In Nigeria, what is on offer depends heavily on where you go. A private clinic, a state hospital and a teaching hospital can differ in how quickly you are seen, which tests are available and who answers at night.

• Can I have a blood hCG test and a scan to confirm what has happened, and has an ectopic pregnancy been ruled out?
• What is my blood group, and do I need any follow-up because of it? ACOG says an anti-D injection may matter for Rh negative women.
• What should I do if the bleeding gets heavy at night, and where do I go?
• Should I come back for a check, and when? ACOG advises a follow-up visit a few weeks after a loss.
• How much will each test or visit cost, and can I have my results in writing?
• If this has happened before, which tests should I have to look for a cause?

Common questions

Sources

• Chemical Pregnancy: Causes, Symptoms and Treatment — Cleveland Clinic
• Early Pregnancy Loss: Frequently Asked Questions — American College of Obstetricians and Gynecologists
• Repeated Miscarriages: Frequently Asked Questions — American College of Obstetricians and Gynecologists
• Miscarriage: symptoms, treatment, trying again and causes — National Health Service
• Ectopic pregnancy: symptoms and when to get emergency help — National Health Service
• Recurrent miscarriage: patient information — Royal College of Obstetricians and Gynaecologists