Twenty‑five days after passing a gestational sac, with intermittent bleeding, red tissue on voiding, serum β‑hCG 6 IU/L, endometrial thickness 8 mm, and a negative urine pregnancy test, is this a normal menstrual period (uterine shedding)?

Post-Miscarriage Bleeding: Normal Uterine Shedding vs. Retained Products

This is most likely normal post-miscarriage uterine shedding (essentially your first period), not retained products of conception. Your β-hCG of 6 IU/L and 8 mm endometrial lining 5 days ago are both reassuring findings that make retained tissue extremely unlikely.

Why This Represents Normal Healing

Your clinical picture fits the expected pattern of post-miscarriage endometrial shedding:

• An endometrial thickness of 8 mm is well within the normal range for post-miscarriage healing and does not suggest retained products of conception, which typically require thickness >20-25 mm to raise suspicion 1
• The β-hCG of 6 IU/L indicates near-complete resolution of trophoblastic tissue, as levels should progressively decline to undetectable after miscarriage 1
• A negative urine pregnancy test confirms that β-hCG has fallen below the detection threshold of 20-25 mIU/mL, consistent with pregnancy resolution 2
• The intermittent bleeding pattern you describe—slowing then picking back up with small red tissue—is characteristic of normal endometrial breakdown and expulsion during uterine involution 1

Ultrasound Criteria That Rule Out Retained Products

Retained products of conception require specific ultrasound findings that you do not have:

• An echogenic endometrial mass with Doppler-detected vascularity 1
• Focal endometrial thickening (not diffuse) accompanied by blood flow on color Doppler 1
• A discrete, identifiable mass rather than uniform thickening 1

Your 8 mm endometrial stripe represents diffuse, uniform tissue—the residual decidua that normally sheds after miscarriage 1.

Timeline and Expected Course

Twenty-five days post-sac passage is within the typical window for first menses:

• The shedding of residual endometrial tissue is a normal component of uterine healing and does not indicate retained products 1
• Intermittent bleeding may arise from the placental implantation site as it remodels and heals 1
• Ongoing uterine involution involves gradual breakdown and expulsion of the endometrial lining, producing spotting for several weeks 1
• The small red tissue you see when urinating represents normal menstrual-type shedding, similar to the start of a period 1

When to Seek Immediate Evaluation

Return for urgent assessment if you develop any of these warning signs:

• Heavy vaginal bleeding (soaking >1 pad per hour for ≥2 consecutive hours) 1
• Fever ≥38°C (100.4°F) or foul-smelling discharge suggesting endometritis 1
• Hemodynamic instability (dizziness, syncope, orthostatic symptoms) 1
• Severe or worsening abdominal pain 1

Rare Scenarios Requiring Further Workup

Although your β-hCG of 6 IU/L makes this extremely unlikely, gestational trophoblastic disease should be considered if:

• β-hCG plateaus over 3-4 consecutive weekly measurements 1
• β-hCG rises >10% across three values within 2 weeks 1
• Detectable β-hCG persists for ≥6 months after pregnancy loss 1

What NOT to Do

Avoid unnecessary intervention based on your current findings:

• Do not diagnose retained products solely on an 8 mm endometrial thickness; this is normal after miscarriage 1
• Dilation and curettage should be reserved for heavy bleeding requiring transfusion, confirmed vascular retained products on Doppler, or persistent/rising β-hCG 1

Bottom Line

Your β-hCG of 6 IU/L, negative urine pregnancy test, and 8 mm endometrial lining all indicate that the pregnancy has resolved and you are experiencing normal post-miscarriage endometrial shedding—essentially your first period 1. The small red tissue and intermittent bleeding are expected findings during uterine involution 1. No intervention is needed unless you develop the warning signs listed above.