Why am I still having light vaginal bleeding three weeks after a miscarriage despite a beta-human chorionic gonadotropin (β‑hCG) level of 6 mIU/mL, a negative home pregnancy test, and an endometrial thickness of 8 mm?

Light Vaginal Bleeding Three Weeks Post-Miscarriage with Low hCG and 8mm Endometrial Lining

Your light bleeding at three weeks post-miscarriage with an hCG of 6 mIU/mL, negative pregnancy test, and 8mm endometrial lining is most likely normal uterine healing and does not indicate retained products of conception.

Why This Bleeding Is Expected

Normal endometrial shedding after miscarriage:

• An endometrial thickness of 8mm is well within the normal range for post-miscarriage healing and does not suggest retained products of conception (RPOC), as ultrasound findings become suspicious only when endometrial thickness exceeds 20–25mm 1
• The shedding of residual endometrial tissue measuring approximately 8mm is a normal component of uterine healing after miscarriage 1
• Ongoing uterine involution involves gradual breakdown and expulsion of the endometrial lining, which can produce spotting for several weeks 1

Your hCG confirms resolution:

• An hCG level of 6 mIU/mL with a negative home pregnancy test indicates near-complete resolution of trophoblastic tissue 1
• Serial quantitative β-hCG measurements should demonstrate a progressive decline to undetectable levels following a complete miscarriage, which your level of 6 confirms is occurring 1
• After first-trimester pregnancy loss, hCG typically becomes undetectable within 2–4 weeks, and your timeline is consistent with normal clearance 2

Placental site remodeling:

• Intermittent bleeding may arise from the placental implantation site as it remodels and heals after tissue expulsion 1

What Would Indicate a Problem (You Don't Have These)

Ultrasound findings that would suggest RPOC include:

• An echogenic endometrial mass with Doppler-detected vascularity 1
• Focal endometrial thickening accompanied by blood flow on Doppler imaging 1
• A discrete, identifiable mass rather than diffuse, uniform thickening like your 8mm lining 1

hCG patterns that would raise concern:

• Persistent or plateauing β-hCG levels over 3–4 consecutive weekly measurements 1
• Rising hCG >10% across three values within 2 weeks 1
• Persistence of detectable hCG for ≥6 months after pregnancy loss 1

When to Seek Immediate Care

Return immediately if you develop:

• Heavy vaginal bleeding (soaking more than one pad per hour for ≥2 consecutive hours) 1
• Fever ≥38°C (100.4°F) or foul-smelling vaginal discharge suggesting endometritis 1
• Hemodynamic instability such as dizziness, syncope, or orthostatic symptoms 1

What You Should NOT Do

• Do not undergo dilation and curettage based solely on your 8mm endometrial thickness, as this measurement is normal after miscarriage 1
• Dilation and curettage should be reserved only for cases with heavy bleeding requiring transfusion, confirmed vascular RPOC on Doppler, or persistent/rising hCG 1

Recommended Follow-Up

Monitor your hCG to zero:

• Continue monitoring until your hCG reaches undetectable levels (<5 mIU/mL) to confirm complete resolution 1
• If your hCG plateaus or rises instead of continuing to decline, contact your provider immediately 1

Expect gradual resolution:

• Light spotting or pink discharge can persist for several more weeks as your endometrial lining continues to shed 1
• This is part of normal healing and does not require intervention unless warning signs develop 1