Post-Miscarriage Bleeding: When It Will Stop
You should undergo an immediate transvaginal ultrasound with Doppler imaging now, as bleeding that stops and starts at 3.5 weeks post-miscarriage is abnormal and most commonly indicates retained products of conception (RPOC), which affects approximately 1.5% of first-trimester miscarriages and requires evaluation to prevent complications. 1, 2
Understanding Your Bleeding Pattern
The bleeding you experienced at 3.5 weeks may have represented:
- Retained products of conception (RPOC) — the most common cause of late post-miscarriage hemorrhage occurring between 24 hours and 6 weeks, which can cause intermittent bleeding that stops and starts 3, 1
- Enhanced myometrial vascularity (EMV) — abnormal vascular changes that occur in 1.52% of miscarriages and are always associated with retained tissue 2
- Normal menstrual return — though this typically occurs at 6-8 weeks post-miscarriage in non-breastfeeding women, not at 3.5 weeks 4
Immediate Diagnostic Steps Required
Get a transvaginal ultrasound with color Doppler immediately — this is the first-line imaging modality with 90-95% sensitivity for detecting RPOC and can identify vascular complications 1, 4
The ultrasound will assess for:
- RPOC appearance — an echogenic endometrial mass with internal vascular flow on Doppler (though lack of vascularity does NOT rule out RPOC, as some retained tissue is avascular) 1
- Endometrial thickness — up to 2.0-2.5 cm may be normal early post-miscarriage, but thickened endometrium with fluid, gas, or debris suggests infection 1
- Vascular abnormalities — pseudoaneurysms or arteriovenous malformations that can cause intermittent bleeding 4
Timeline for Bleeding Resolution
The timeline depends entirely on what is causing your bleeding:
If RPOC is present and managed expectantly:
- Mean time to resolution: 48 days (range 21-84 days) from detection of enhanced myometrial vascularity 2
- This prolonged timeline explains why your bleeding may have stopped temporarily but the underlying issue persists
If RPOC is surgically removed:
- Mean time to resolution: 10.6 days (range 3-29 days) after surgical evacuation 2
- Surgical evacuation (suction curettage) is definitive treatment when medical therapy fails or bleeding is heavy 1
If findings are normal:
- Bleeding should resolve within days to 1-2 weeks as the uterus completes involution 4
Warning Signs Requiring Immediate Emergency Care
Seek emergency evaluation immediately if you experience:
- Heavy bleeding — soaking through a pad within one hour 1
- Severe abdominal pain 1
- Fever or foul-smelling discharge — suggests endometritis requiring antibiotics 1, 4
- Dizziness, lightheadedness, or rapid heartbeat — signs of significant blood loss 5
Additional Testing You Need
Beyond ultrasound, your provider should order:
- Serial quantitative β-hCG measurements — failure of β-hCG to decline appropriately indicates persistent trophoblastic tissue and warrants further evaluation 1
- Complete blood count — to evaluate for anemia from ongoing blood loss; significant hemoglobin reduction may require iron supplementation or transfusion 1
Common Pitfall to Avoid
Do not assume the bleeding that stopped was your period returning — true menstrual return typically occurs at 6-8 weeks post-miscarriage, and intermittent bleeding at 3.5 weeks is more consistent with RPOC or vascular complications that require imaging evaluation 4, 2
Bottom Line
You will not know definitively when bleeding will stop until you have diagnostic imaging to identify the cause. The American College of Radiology considers persistent or recurrent vaginal bleeding three weeks after miscarriage to be abnormal and requiring immediate transvaginal ultrasound evaluation. 1 If RPOC is found and managed expectantly, resolution typically takes 48 days on average, but surgical management resolves the issue in approximately 11 days. 2