Adjusting Hormone Levels After Miscarriage

Too many women still go through the harrowing experience that is miscarriage during their reproductive years, and unfortunately, modern medicine doesn’t always have the answers to why it happens.

Following a miscarriage, several things need to be in place before your doctor can recommend that you get pregnant again, not the least of which is a stable emotional state of being and peace of mind. It’s important to confirm that you can take your time, cope with the loss, and deal with what has happened. The other thing your physician will look for is your hCG levels, which need to be back to zero before a new pregnancy should take place.

Why is this necessary and what is hCG?

According to Medical News Today, hCG stands for Human Chorionic Gonadotropin, and it is a hormone produced by the cells in the body that become the placenta.

Many women experience nausea and fatigue during the early weeks of their pregnancy. These symptoms are considered to be due to the rising levels of hCG in your body, and a woman who is pregnant with twins or multiples is likely to have higher levels of hCG than a woman having only one baby. By measuring hCG levels in the body, physicians can detect pregnancy and determine whether it is progressing as it should.

For the first eight weeks following conception, hCG levels in the body will rise dramatically to double every 24 - 48 hours and peak during weeks eight to eleven. After the 16-week mark, hCG levels will start tapering off again and then remain relatively stable until the pregnancy ends. In the case of a miscarriage, the hCG levels will gradually drop until returning to zero, as it was before you became pregnant.

Did you know?

The placenta is an incredible, highly specialized organ that scientists still consider the least understood out of all human organs. It’s the only organ that the body grows long after all the other organs have been formed, and usually only functions for nine months. It also develops from the fertilized egg - meaning it is genetically composed half from mom and a half from dad - and has multiple functions to ensure the baby’s health. The placenta operates as the baby’s lungs and kidneys before they’re born.

How long does it take for hCG levels to drop to pre-pregnancy numbers?

The time it takes for hCG to leave a woman’s system after a miscarriage varies enormously. It can range from a few days to several months and is dependent on the levels of hCG in the body before the miscarriage happened. When it does reach zero, this is a sign from the body that the lining of the uterus has thickened again and is ready to host a fertilized egg, meaning that a new pregnancy is possible.

Your physician will make their recommendation for the timing of a new pregnancy based on several factors, like your medical history and the details of the miscarriage, along with your hCG levels.

When should a couple try again after a miscarriage?

This decision is up to the couple, under the guidance of your physician, and should take into account all the factors relating to the physical and mental health of the woman after the miscarriage.

Notably, new research published in the Journal of Obstetrics and Gynaecology does show that, rather than waiting for three to six months as was the practice in the past, it might be better to try again earlier than that. The study found that couples who began trying within 3 months following an early loss of pregnancy were more likely to achieve live birth than those who waited longer than three months before trying again.  

However, most physicians agree that it’s important to check a woman’s hCG levels so that she may be ready to conceive again once they’ve normalized. This is because it’s possible to get a false-positive test reading from a pregnancy test if your hormone levels are still high from the previously failed pregnancy. Also, if you are actively trying to conceive again and your hCG hormone levels are still dropping, it may appear like another miscarriage when testing, while the numbers are still referring to the first pregnancy.

In another study published in Laboratory Medicine, following an emergency surgical procedure to manage an ectopic pregnancy, the patient’s hCG levels remained high for a long period. This was a sign there was still some tissue from the previous pregnancy that stayed behind in the uterus. Under these conditions, the physician has to remove the tissue with further treatment, and medication becomes necessary before conditions are deemed suitable for another pregnancy. The study found that close collaboration between the laboratory and clinical service is essential in the interest of optimal patient care.

Bottom line

While it’s estimated that between 10-20% of pregnancies end in miscarriage, they can still be devastating to expectant parents. It can be particularly hard on the mother because she still has to deal with the rollercoaster of hormones flooding her body, even though the baby the hormones are there for no longer lives. She might also have to deal with feelings of loss and the fear of it happening again. Some women also experience emotions like guilt over the loss and anxiety about not being able to conceive again.

At the same time, a miscarriage is often not discussed - or if it is, it is not always treated with the same sympathy the parents would have received, had they lost a baby born at full term. Recovering from a miscarriage is not a one-size-fits-all, but the emotional component needs to be prioritized as much as the physical. It can help to speak to other women who have suffered similar losses - take comfort in friends, family, and support groups, if necessary. Nobody needs to feel like they’re going through it alone, and this can take time. The partner should also receive support since they also suffered a loss, even though they weren’t physically carrying the baby.

To promote recovery and support future efforts to conceive, the following steps are advised:

1. Speak to your doctor about any underlying health issues that may get in the way of your recovery and future pregnancies
2. Carefully watch your stress levels. Try breathing exercises, mindfulness, and spending time in nature
3. Try to keep your weight at a healthy level
4. Limit caffeine and alcohol, and if you smoke, stop

References:
Schliep, Karen C. Ph.D.; Mitchell, Emily M. Ph.D.; Mumford, Sunni L. Ph.D.; Radin, Rose G. Ph.D.; Zarek, Shvetha M. MD; Sjaarda, Lindsey Ph.D. Schisterman, Enrique F. Ph.D. Trying to Conceive After an Early Pregnancy Loss, Obstetrics & Gynecology: February 2016 - Volume 127 - Issue 2 - p 204-212 doi: 10.1097/AOG.0000000000001159

Michelle Kurt-Mangold, MD, Bradley J. Van Voorhis, MD, Matthew D. Krasowski, MD, Ph.D., Persistent Human Chorionic Gonadotropin After Methotrexate Treatment and an Emergency Surgical Procedure for Ectopic Pregnancy, Laboratory Medicine, Volume 46, Issue 3, 1 August 2015, Pages 254–258, https://doi.org/10.1309/LMTDRFGJVJIM3VNM

Danielson, K. 2020. How long until HCG falls to zero after miscarriage? Verywell Family. https://www.verywellfamily.com/how-long-until-hcg-falls-to-zero-after-miscarriage-2371511