From the Guidelines
A period can start as early as 2-3 weeks after a miscarriage, with ovulation potentially occurring within 2-3 weeks and as early as 8-13 days after the end of the pregnancy. The timing of the first period after a miscarriage can vary significantly among women, with factors such as the stage of pregnancy at the time of miscarriage influencing the return of menstruation 1. According to the U.S. selected practice recommendations for contraceptive use, 2013, ovulation can occur within 2-3 weeks after a spontaneous or induced abortion, and the likelihood of ovulation is low ≤7 days after an abortion 1.
Key Considerations
- The first period after miscarriage may be heavier or lighter than usual and might contain more clots as the uterine lining continues to shed.
- If a woman does not have a period within 8 weeks after a miscarriage, it is advisable to consult a healthcare provider to rule out a new pregnancy or evaluate for other causes of delayed menstruation.
- Ovulation typically returns before the first period, so it is possible to become pregnant before having that first post-miscarriage period if sexually active.
- The benefits of starting to use a contraceptive method likely exceed any risk, even in situations in which the healthcare provider is uncertain whether the woman is pregnant, except for IUDs 1.
Clinical Implications
- Healthcare providers should consider having patients start using contraceptive methods other than IUDs at any time, with a follow-up pregnancy test in 2-4 weeks 1.
- For women who want to begin using an IUD, the woman should be provided with another contraceptive method to use until the healthcare provider is reasonably certain that she is not pregnant and can insert the IUD 1.
From the Research
Resumption of Menstruation after Miscarriage
- There is limited research directly addressing how fast a period can start after a miscarriage.
- However, studies on hormonal contraception and uterine bleeding may provide some insight into the resumption of menstruation after a miscarriage 2, 3, 4.
- A study on medroxyprogesterone acetate (MPA) given orally during the first trimester for threatened miscarriage found that MPA carries no specific risk for fetal abnormalities, but the rate of abnormalities is higher than in non-threatened pregnancies 5.
- Another study compared the resumption of ovulation after cessation of oral contraceptives and MPA in women with polycystic ovary syndrome, finding that MPA users have a similar chance of ovulation resumption as oral contraceptive users after cessation of medication 6.
- While these studies do not directly answer the question of how fast a period can start after a miscarriage, they suggest that hormonal factors can influence menstrual bleeding and ovulation resumption.
Factors Influencing Menstrual Resumption
- Hormonal changes after a miscarriage can affect the resumption of menstruation.
- The use of hormonal contraceptives, such as MPA or oral contraceptives, can influence menstrual bleeding and ovulation resumption 2, 3, 4, 6.
- Individual factors, such as the presence of polycystic ovary syndrome, can also impact menstrual resumption 6.
- Further research is needed to fully understand the factors influencing menstrual resumption after a miscarriage.