Post-Miscarriage Abdominal Pain and Recovery

Intermittent dull pain in the lower abdomen after miscarriage?

Hello Doctor: My last menstrual period was on September 18.
I took a home pregnancy test on October 22, which showed a faint pink line.
On October 28, I experienced light pink spotting in the afternoon, and around 3:30 AM on October 29, I woke up to find deep red bleeding.
By around 5 AM, I began to experience severe lower abdominal pain accompanied by deep red bleeding.
At the emergency room, the doctor performed an abdominal ultrasound and said nothing was visible, suggesting a pelvic exam but did not use a transvaginal ultrasound; instead, a digital examination was performed (my husband later mentioned that the doctor just went in and out).
During this time, no medication was administered, and I was admitted for further evaluation by an obstetrician...
(Currently, I am in Thailand, so I did not go to the hospital for further checks during the period until October 28).
I saw a gynecologist around 10 AM on October 29, who performed another abdominal and transvaginal ultrasound and still reported nothing visible.
My blood test showed a level of 7, and it was determined that I had miscarried with retained tissue in the uterus.
The doctor recommended immediate hospitalization and a dilation and curettage (D&C) procedure, but I refused the surgery and went home to rest...
That night, I passed some blood clots that felt like membranes, and the blood was accompanied by clear fluid.
After October 29, I experienced intermittent dull pain in the lower abdomen, dizziness, headaches, and postprandial stomach pain.
The bleeding has decreased, but since October 31, I have started to experience lower back pain.
I plan to return to Taiwan on November 4 to confirm the condition of my uterus.
I would like to ask: 1) During the pregnancy, the discomfort was primarily in the lower left abdomen (above the pubic bone); is this position too low? 2) I had a medical abortion ten years ago, and my menstrual cycle has averaged 32 days (from one period to the next), lasting five days, but with heavier flow only on the second day.
Could this be due to issues with endometrial thickness leading to a lighter flow? 3) If I plan to conceive again, how long should I wait?

Tsai, 30~39 year old female. Ask Date: 2017/11/03

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The last menstrual period was on September 18.
On October 22, a home pregnancy test showed a faint pink line.
On October 28, there was a small amount of pink spotting in the afternoon, and around 3:30 AM on October 29, I woke up to find deep red bleeding.
By around 5 AM, I began experiencing severe lower abdominal pain accompanied by deep red bleeding.
At the emergency room, an abdominal ultrasound was performed, and the doctor stated that nothing was visible.
A pelvic exam was conducted, but a transvaginal ultrasound was not used; instead, a digital examination was performed (my husband later mentioned that the doctor just went in and out).
During this time, no medication was administered, and I was admitted to wait for an obstetrician's evaluation.
(Currently, I am in Thailand, so I did not go to the hospital for further examination during the period until October 28.) It was not until around 10 AM on October 29 that I saw a gynecologist, who performed another abdominal and transvaginal ultrasound and again stated that nothing was visible.
A blood test showed a level of 7, leading to the conclusion that a miscarriage had occurred with retained tissue in the uterus.
The doctor recommended immediate hospitalization and a dilation and curettage (D&C) procedure, but I refused the surgery and went home to rest.
That night, I passed blood clots that felt like membranes, and the expelled blood was accompanied by clear fluid.
After October 29, I experienced intermittent dull pain in the lower abdomen, along with dizziness, headaches, and postprandial stomach pain.
The bleeding volume decreased, but on October 31, I began to experience lower back pain.
I plan to return to Taiwan on November 4 to reassess the condition of my uterus.
I would like to ask: 1) During pregnancy, the discomfort was primarily in the lower left abdomen (above the pubic bone).
Is this position too low? Answer: The position is acceptable.
2) I had a medical abortion ten years ago, and my average menstrual cycle since then has been 32 days (from the start of one period to the next), lasting five days, but only the second day has heavy flow.
Could this be due to endometrial thickness causing a light flow? Answer: No.
3) If I plan to conceive again, how long should I wait? Answer: After two menstrual cycles.

Reply Date: 2017/11/03

More Info

After experiencing a miscarriage, it is common to have concerns regarding abdominal pain and recovery. Your situation, as described, involves a series of events that can lead to various physical symptoms and emotional distress. Let’s address your questions one by one, while also providing some additional context regarding post-miscarriage recovery.

1. Location of Discomfort: You mentioned experiencing discomfort in the left lower abdomen, which is a typical area for pain during early pregnancy and miscarriage. The pain can be attributed to several factors, including the natural process of the body expelling pregnancy tissue, uterine contractions, and even the surrounding ligaments and muscles reacting to the changes. The location of discomfort can vary from person to person, and while it may feel low, it is not uncommon for pain to radiate or be felt in different areas of the abdomen.

2. Menstrual Cycle and Flow: Your history of a medication-induced abortion and the subsequent menstrual cycles can influence your current situation. A menstrual cycle averaging 32 days with a five-day duration, where the second day is the heaviest, is within the normal range. However, if you are experiencing lighter flows, it could be due to several factors, including the thickness of the endometrial lining, hormonal fluctuations, or residual effects from the miscarriage. After a miscarriage, it may take some time for your body to return to its pre-pregnancy state, including the normalization of menstrual flow.

3. Timing for Subsequent Pregnancy: The recommendation for waiting before trying to conceive again after a miscarriage varies. Many healthcare providers suggest waiting for at least one menstrual cycle to allow the body to heal physically and emotionally. This waiting period can help ensure that the uterine lining is adequately prepared for a new pregnancy. However, some studies indicate that conceiving soon after a miscarriage may not pose significant risks and could even be beneficial for some women. It is essential to consult with your healthcare provider to discuss your specific situation and any underlying health considerations.

Additional Considerations:
- Post-Miscarriage Symptoms: It is not uncommon to experience intermittent abdominal pain, dizziness, and headaches after a miscarriage. These symptoms can be related to hormonal changes, the physical process of the body returning to its non-pregnant state, or even emotional stress. If the pain persists or worsens, or if you experience heavy bleeding, fever, or severe discomfort, it is crucial to seek medical attention.

- Follow-Up Care: Since you plan to return to Taiwan for further evaluation, it is advisable to have a thorough check-up, including an ultrasound to assess the uterus and ensure that there are no retained products of conception. This follow-up is vital to prevent complications such as infection or prolonged bleeding.

- Emotional Well-being: Miscarriage can be a deeply emotional experience. It is essential to take care of your mental health during this time. Consider reaching out to support groups or mental health professionals if you find yourself struggling with the emotional aftermath of your loss.

In conclusion, while your symptoms may be concerning, they can be part of the normal recovery process following a miscarriage. However, always prioritize your health and well-being by consulting with healthcare professionals who can provide personalized advice and care based on your medical history and current condition.

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