I am 2.5 weeks post‑miscarriage with quantitative β‑hCG 6 IU/L, endometrial thickness 8 mm, negative urine pregnancy test, and have had continuous spotting for 3.5 weeks—what should I do?

Your Bleeding Pattern is Consistent with a Completed Miscarriage—No Further Intervention is Needed

With an hCG of 6 mIU/mL at 2.5 weeks post-miscarriage, an 8 mm endometrial lining, and a negative urine pregnancy test, you have experienced a completed miscarriage that has resolved spontaneously. 1 The continuous spotting you've had for 3.5 weeks represents the normal physiologic process of your uterus returning to its pre-pregnancy state, and no surgical or medical treatment is required. 2

Why This Represents a Completed Miscarriage

Diagnostic confirmation: Your clinical picture—an hCG near the detection limit (~6 mIU/mL), endometrial thickness of 8 mm, and negative urine pregnancy test—definitively rules out retained products of conception and confirms complete expulsion of all pregnancy tissue. 1, 2

• An endometrial thickness of 8 mm after miscarriage falls within the normal post-miscarriage range and does not suggest retained tissue; the threshold for concern is ≥14 mm with increased vascularity on ultrasound. 2
• The combination of near-zero hCG and lack of significant endometrial thickening effectively excludes retained products of conception. 2
• Your negative urine pregnancy test at 2.5 weeks post-miscarriage, combined with the very low serum hCG, confirms that pregnancy hormone levels have appropriately declined. 1

Understanding Your Bleeding Pattern

The spotting/light bleeding you've experienced for 3.5 weeks is a normal physiologic response as your endometrium sheds and your hormones (estrogen and progesterone) normalize after pregnancy loss. 2

• An 8 mm endometrium corresponds to a proliferative or early secretory pattern, and transient shedding causes bleeding as hormone levels stabilize. 2
• What you describe as "getting your period" at 3.5 weeks is actually the final phase of this hormonal readjustment, not a true menstrual period. 2
• Continuous spotting for several weeks after miscarriage is common and does not indicate complications when hCG has appropriately declined. 1

What You Should Monitor

Return precautions—seek immediate care if you develop:

• Heavy vaginal bleeding (soaking more than one pad per hour for 2+ consecutive hours) 1
• Fever >38°C (100.4°F), chills, or foul-smelling vaginal discharge (signs of infection) 2
• Severe abdominal pain or cramping that worsens or doesn't respond to over-the-counter pain medication 1
• Dizziness, lightheadedness, or syncope (signs of significant blood loss) 1

Next Steps for Your Care

Contraceptive counseling should begin immediately because ovulation can resume within 2-4 weeks after a completed miscarriage, and you could become pregnant again before your first true menstrual period. 2

• Combined hormonal contraceptives or implants can be initiated immediately without waiting for your next menses. 2
• If you start contraception within 7 days of the completed miscarriage, no backup contraception is needed. 2

If you are Rh-negative: Verify that you received anti-D immunoglobulin (RhoGAM) after your miscarriage, as 32% of spontaneous abortions involve fetomaternal hemorrhage. 2 The recommended dose is 50 mcg for first-trimester losses. 2

Your first true menstrual period should occur approximately 4-6 weeks after the miscarriage (counting from when bleeding started), though this timing varies. 1

Common Pitfalls to Avoid

Do not undergo unnecessary surgical evacuation (D&C) based solely on persistent spotting when your hCG is near zero and endometrial thickness is normal, as this exposes you to procedural risks (hemorrhage 9.1%, infection 1.3%, uterine perforation) without benefit. 2

Do not assume you need treatment for "retained products" based on the 8 mm endometrial measurement alone—this thickness is normal after miscarriage and only becomes concerning at ≥14 mm with vascularity. 2

Do not delay contraception if you wish to avoid immediate pregnancy, as ovulation can occur before your first period returns. 2