Miscarriage treatment: waiting, tablets or surgery

If you’ve been told you’re having a miscarriage, you’ll usually be offered a choice of how to manage it. There’s no right or wrong option, only what feels right for you.

Your options

If the miscarriage hasn’t fully passed, there are 3 options before 14 weeks: waiting, tablets or a procedure. What’s suitable depends on your symptoms, how many weeks pregnant you are and your health.

Where it’s safe, you should be able to choose, and to take time to decide unless you need urgent treatment. From 14 weeks, your team will talk you through your care.

Waiting (expectant management)

This means letting the miscarriage happen on its own, at home. NICE guidance suggests it as the first option, for 7 to 14 days. You can’t know exactly when it will start.

Cramps are usually stronger than period pain, and bleeding can be heavy, with clots and tissue. The first few days are usually the heaviest. After that it tails off, and usually stops within 2 to 3 weeks. Have thick pads, old towels and painkillers ready, and someone with you if you can. A hot bath can make you feel faint while the bleeding is heavy, so it’s best to wait until it eases.

If nothing has happened after 7 to 14 days, or bleeding isn’t settling, you’ll be offered another scan.

Another option may suit you better if you’re more likely to bleed heavily (for example, later in the first trimester), have a condition that makes heavy bleeding riskier, have signs of infection, or had a traumatic experience in a past pregnancy.

Tablets (medical management)

For a missed miscarriage, you’ll usually take a tablet called mifepristone first. About 48 hours later, you take misoprostol, by mouth, under your tongue or in your vagina. If some of the pregnancy has already passed, you’ll usually have misoprostol on its own.

You might go home after the tablets or stay in hospital. Bleeding usually starts within a few hours. It’s heavier than a period, and many people find it more painful than waiting. You might be sick or have diarrhoea, so ask for anti-sickness medicine if it isn’t offered.

If bleeding hasn’t started within 48 hours of the misoprostol, contact your team. Sometimes the tablets don’t complete the miscarriage, and you may then be offered surgery. Tablets aren’t suitable with some health conditions.

If you see the pregnancy

With waiting or tablets, what you pass might look like a blood clot, especially early on. You might also see the pregnancy sac, or from around 10 weeks, your baby. It can help to know this might happen, though it can still be very upsetting.

There’s no right or wrong thing to do. Many people flush without thinking, and that’s natural too. Others keep the remains to bury at home (on your own land, or with the landowner’s permission) or ask the hospital about burial or cremation. If you might want the hospital to look at the remains or arrange this, keep them somewhere cool and call your early pregnancy unit to ask what they offer. If you’re having surgery, ask the team early on what happens and tell them your wishes.

Surgery (surgical management)

A thin tube is passed through your vagina and cervix into your womb, and gentle suction removes the pregnancy. There are no cuts or stitches. Your team might recommend it if heavy bleeding won’t settle, if you have signs of infection, or if tablets haven’t worked.

Where it’s suitable, you should be offered a choice of:

Manual vacuum aspiration (MVA) under local anaesthetic. You’re awake, in a clinic, with the area numbed. It takes about 10 to 15 minutes. Some cramping pain is usual, and you can ask about gas and air. Someone can usually stay with you.
Surgery under general anaesthetic. You’re asleep in an operating theatre. You can usually go home the same day, but shouldn’t drive for 24 hours.

Afterwards, you might have cramps for a few days and bleeding for up to 3 weeks. The risk of complications, such as heavy bleeding, infection or damage to the womb, is small.

Pain relief

You should be offered pain relief. Have paracetamol to hand, and ibuprofen if you can take it, and ask about stronger painkillers if needed.

Anti-D

If your blood group is RhD negative (sometimes written as D negative) and you were 12 weeks pregnant or more, you’ll usually be offered an anti-D injection to help protect a future pregnancy. Before 12 weeks, it isn’t usually needed. See rhesus negative and anti-D.

Follow-up

After waiting or tablets, you’ll usually be asked to do a home pregnancy test 3 weeks later. If it’s still positive, contact your early pregnancy unit.

The NHS advises waiting to have sex until the bleeding and pain have stopped, because of the risk of infection.

Changing your mind

If you’re waiting, you can change your mind at any time and ask for tablets or surgery. During MVA, you can ask to stop and have a general anaesthetic instead, though you may need to wait for it.

When to get urgent help

Call 999 if the bleeding is heavy (soaking a pad soon after putting it on), or comes with severe tummy or shoulder pain, or with feeling sick, faint or dizzy. Also call 999 if you have sudden, severe tummy pain and feel faint or dizzy, even without bleeding.

Contact your early pregnancy unit or hospital straight away, or NHS 111 if you can’t reach them, if you notice any of these:

a high temperature or flu-like symptoms
discharge that smells unpleasant or looks unusual
pain that’s getting worse, or isn’t eased by painkillers
bleeding that’s getting heavier instead of lighter
feeling very unwell, frightened or unable to cope
a painful, red, swollen or hot leg after surgery (call 999 if you’re also short of breath or have chest pain)

Go to A&E if you’re soaking through 2 thick pads an hour for 2 hours or more, or passing clots bigger than the palm of your hand.

Miscarriage UK (0303 003 6464) and Tommy’s midwives (0800 0147 800) are there to talk, too.

Questions people ask

Which miscarriage treatment is best?

There’s no single best option. Waiting avoids medicine and surgery but can take longer. Tablets can be more painful. Surgery is the most likely to complete it, but means a procedure.

Does a miscarriage hurt?

Often, yes. Cramps can be stronger than period pain, so ask for pain relief.

How long will I bleed after a miscarriage?

Usually 2 to 3 weeks, getting lighter over time. If it gets heavier instead, contact your early pregnancy unit.