Several weeks after a miscarriage my serum beta‑human chorionic gonadotropin is about 5 mIU/mL, I have light spotting and an endometrial thickness of 8 mm—what is the appropriate next step?

Post-Miscarriage Management with Low hCG and Persistent Spotting

Your spotting with an hCG of 5 mIU/mL and 8 mm endometrial lining represents normal post-miscarriage healing and requires only expectant management with serial hCG monitoring until undetectable—no intervention is needed.

Understanding Your Current Situation

Your clinical picture is entirely consistent with a resolving spontaneous miscarriage:

• An hCG level of 5 mIU/mL is nearly undetectable and indicates that trophoblastic tissue has been almost completely cleared from your system 1
• An 8 mm endometrial thickness is well within the normal range for post-miscarriage healing and does not suggest retained products of conception, which would require endometrial thickness >20-25 mm with vascular flow on Doppler ultrasound 2
• Light spotting for several weeks after miscarriage is expected as the endometrium sheds and the placental implantation site remodels 2

Expected hCG Decline Pattern

Your hCG trajectory should follow a predictable decline:

• In spontaneous miscarriage, hCG declines 21-35% every 2 days and 60-84% every 7 days, with faster decline rates when starting from higher initial values 3
• Complete clearance to <5 mIU/mL typically occurs within 1-2 weeks after the miscarriage process begins, though this varies based on the initial hCG level 4
• Your current level of 5 mIU/mL suggests you are at the tail end of this decline and should reach undetectable levels (<2 mIU/mL) within days 1, 3

Recommended Management Algorithm

Follow this specific protocol:

1. Obtain a repeat quantitative serum hCG in 48-72 hours to confirm continued decline toward zero 1, 2
2. Continue serial hCG measurements weekly until the level is undetectable (<2 mIU/mL), which confirms complete resolution of trophoblastic tissue 2
3. No additional ultrasound is needed unless you develop warning signs (see below), as your 8 mm endometrial stripe is normal and does not warrant intervention 2
4. Expect spotting to continue for up to 2-4 weeks total as the endometrium completes its healing process 2

Warning Signs Requiring Immediate Evaluation

Return for urgent assessment if you develop:

• Heavy bleeding soaking more than one pad per hour for 2 consecutive hours 2
• Fever ≥38°C (100.4°F) or foul-smelling vaginal discharge suggesting endometritis 2
• Severe abdominal pain or hemodynamic symptoms (dizziness, syncope, orthostatic lightheadedness) 2
• hCG that plateaus or rises over 3-4 consecutive weekly measurements, which would raise concern for gestational trophoblastic disease 1, 2

Critical Pitfalls to Avoid

• Do not undergo dilation and curettage based solely on your 8 mm endometrial thickness—this measurement is normal after miscarriage and does not indicate retained products 2
• Do not diagnose retained products of conception without ultrasound evidence of a vascular endometrial mass with Doppler flow, which you do not have 2
• Do not stop hCG monitoring prematurely—continue until the level is truly undetectable to ensure complete resolution and exclude the rare possibility of gestational trophoblastic disease 1, 2

When You Can Resume Normal Activities

• Once your hCG reaches undetectable levels (<2 mIU/mL), you have completed the miscarriage process and can resume all normal activities 1, 2
• You can attempt conception again after one normal menstrual period, though this timing is based on dating convenience rather than medical necessity 1
• If your hCG remains detectable beyond 6 weeks or shows any plateau/rise pattern, you will need evaluation for gestational trophoblastic disease 1, 2