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Approximately one-fifth of pregnancies end in miscarriage annually in the United States. But while pregnancy loss is a common occurrence, it is no less devastating for expectant parents.
Now imagine experiencing not only pregnancy loss, but a serious medical complication from your miscarriage treatment.
This is exactly what happened to Rescripted co-founder and Chief Creative Officer Kristyn Hodgdon:
“When I was offered misoprostol after my miscarriage at 6.5 weeks, it was brushed off like it was no big deal,” Hodgdon tells Rescripted. “But what actually happened was the complete opposite — I ended up bleeding so much I had to go to the ER, where I needed a blood transfusion and an emergency D&C.”
Dilation and curettage, or D&C, is a procedure where pregnancy tissue is removed from inside your uterus, usually following a miscarriage.
Although misoprostol is considered a safe and effective medication for miscarriage management, Hodgdon feels she didn’t receive enough information at the outset: “I wish someone had given me more of a real choice and prepared me for what that would actually feel like, both physically and emotionally,” she says.
For patients to make informed choices about their miscarriage management, they need to know their options before they even get pregnant. To understand the differences in miscarriage medication treatments, Rescripted spoke with Jessica Ryniec, M.D., a double-board-certified reproductive endocrinologist and infertility specialist at CCRM Fertility in Boston.
Breaking down your miscarriage treatment choices
Once a miscarriage is diagnosed, Dr. Ryniec says there are a few different options for treatment:
- Expectant management: You would wait for the pregnancy tissue to pass on its own
- Surgical management: This is typically done via a uterine aspiration or a dilation & curettage (D&C) procedure
- Medication
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Dr. Ryniec says there are several medication options for miscarriage management. They are “typically either a combination of mifepristone (an anti-progesterone) and misoprostol (a prostaglandin that causes cervical softening and uterine contractions).” However, she says that if mifepristone is unavailable, miscarriage management can be conducted with misoprostol alone. (Despite being safe, effective, and FDA-approved for miscarriage management, mifepristone is increasingly difficult to obtain in states with abortion bans.)
The way the mifepristone and misoprostol combination works is as follows: “Mifepristone first blocks progesterone (which is a hormone necessary for a pregnancy to continue),” explains Dr. Ryniec. This is then “followed by misoprostol, which will help expel the pregnancy tissue through contracting the uterus.”
Given Hodgdon’s experience with misoprostol as the sole medication prescribed for her miscarriage treatment — where she ended up needing a D&C anyway — it’s worth noting that the combination of mifepristone and misoprostol is the “preferred regimen if mifepristone is available,” according to Dr. Ryniec. This is “because there are higher efficacy rates and a lower chance of needing a procedure afterwards compared with misoprostol alone.”
Miscarriage medication risks and potential complications
There are always risks with any treatment plan, which is why it’s so important to have as much information about your miscarriage management options from the start. “Risks of medication management include retained products of conception, which occur 5-20% of the time,” says Dr. Ryniec. Additional medication management risks include “infection, which occurs 1-2% of the time, and complications such as a hemorrhage requiring transfusion and further intervention occur only 0.7-2% of the time." (The latter is what happened to Hodgdon.)
Miscarriage management complications commonly occur “when the pregnancy tissue is incompletely expelled, if the uterus is not contracting properly after the loss is completed, or if someone has a preexisting clotting disorder or is on anticoagulation medications,” explains Dr. Ryniec.
While there’s a possibility that Hodgdon’s complication could’ve been prevented if Hodgdon had received additional information, Dr. Ryniec also acknowledges that all treatment options still carry risks: “It is also possible that this could have occurred also with expectant management or with the combination regimen of mifepristone and misoprostol, or even if [Hodgdon] went with surgical management to begin with.”
At the same time, Dr. Ryniec reiterates the importance of informed consent when presenting medical treatment options to patients: “[This] involves discussing the risks, benefits, and alternative options. If [Hodgdon] had been more prepared, maybe she would have chosen a different route.”
Taking control of your treatment plan
No one should feel helpless, clueless, or rushed when they are presented with a miscarriage treatment option. This should be an equal discussion between you and your healthcare provider, where you have as much agency in the conversation as your doctor.
So if you are experiencing a miscarriage, and your healthcare provider is recommending medication treatment, here are some questions you can ask, courtesy of Dr. Ryniec:
- Knowing my specific history, current findings, and future fertility goals, what is the most effective option you would recommend for me?
- Ask the following questions for each option:
What are the expected side effects and symptoms, and how can we manage them (for example, nausea meds, pain meds)?
What are the possible complications? How will I know I am having a complication? What should I do if I suspect I am having a complication? - How much time do I have to make a decision?
- Are there support resources available for people experiencing miscarriage?
“No one should have to go through this alone or feel like they have to suffer in silence,” says Hodgdon.
We can stop our collective suffering in silence with knowledge — and by knowing the right questions to ask.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Subscribe to her Substack, the Critical Communicator, and follow her on Instagram, BlueSky, or Threads.