Why Am I Still Bleeding 23 Days After Miscarriage?
Your ongoing light bleeding at 23 days post-miscarriage with an hCG of 6 mIU/mL, negative pregnancy test, 8 mm endometrial lining, and clean ultrasound represents normal uterine healing—not retained products of conception. 1
Normal Post-Miscarriage Healing Process
Your clinical picture is entirely consistent with expected recovery:
Endometrial shedding of residual tissue at 8 mm thickness is a normal component of uterine healing and does not indicate retained products of conception. 1
Intermittent bleeding arises from the placental implantation site as it remodels and heals after tissue expulsion, which can continue for several weeks. 1
Ongoing uterine involution involves gradual breakdown and expulsion of the endometrial lining, producing spotting that may persist for several weeks after passage of the gestational sac. 1
Your hCG has appropriately declined to near-zero (6 mIU/mL), confirming resolution of trophoblastic tissue and ruling out retained products or gestational trophoblastic disease. 1, 2
Why Your Ultrasound Findings Are Reassuring
The 8 mm endometrial stripe is well within normal limits:
Endometrial thickness up to 20–25 mm in the early post-miscarriage period is considered nonspecific; your measurement of 8 mm is far below any threshold that would suggest retained products. 1
Ultrasound findings that would raise concern for retained products include an echogenic endometrial mass with Doppler-detected vascularity, focal thickening with blood flow, or a discrete identifiable mass—none of which you have. 1
Your "clean uterus" on abdominal scan combined with appropriately declining hCG confirms complete passage of pregnancy tissue. 1
Expected Timeline for Complete Resolution
Based on your current hCG level:
After spontaneous abortion, hCG can remain detectable for 9 to 35 days (median 19 days) following tissue passage. 3
Your hCG of 6 mIU/mL at day 23 is consistent with the tail end of normal clearance, and bleeding typically resolves as hCG reaches undetectable levels (<5 mIU/mL). 1, 3
Qualitative urine pregnancy tests can remain positive for several weeks after pregnancy termination even when serum hCG is very low, so your negative urine test at hCG 6 is expected. 2
Warning Signs That Would Require Immediate Evaluation
You should seek urgent care only 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
When to Worry About Gestational Trophoblastic Disease
Your declining hCG rules this out, but for completeness:
Plateau of hCG over 3–4 consecutive weekly measurements would indicate gestational trophoblastic disease. 1
Rising hCG >10% across three values within 2 weeks would raise suspicion. 1
Persistence of detectable hCG for ≥6 months after pregnancy loss would require evaluation. 1
Your hCG is declining appropriately, so none of these apply. 1
What NOT to Do
Do not diagnose retained products of conception solely on an endometrial thickness <20 mm; your 8 mm stripe is normal. 1
Dilation and curettage should be reserved for heavy bleeding requiring transfusion, confirmed vascular retained products on Doppler, or persistent/rising hCG—none of which you have. 1
Recommended Management
Continue expectant management with light activity and pad monitoring. 1
Repeat hCG in one week to confirm it reaches <5 mIU/mL, which will correlate with cessation of bleeding. 1, 2
No further ultrasound is needed unless bleeding becomes heavy or you develop fever/pain. 1
Bleeding should resolve within 1–2 weeks as your hCG reaches zero. 1, 3
Your body is completing a normal healing process after miscarriage—the light bleeding you're experiencing is the final phase of endometrial shedding and implantation-site remodeling, not a complication requiring intervention. 1