What Should I Do If I Have No Period After Miscarriage?

It Can Take Up to 3 Months for Your Period to Return

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It can take some time for your body to get back to normal after a miscarriage, especially if you were further along in the pregnancy at the time the loss occurred. Most women will have a menstrual period within four to six weeks after a miscarriage, but it may take as long as two to three months before menstruation returns to normal. If it's been less than that time span, try to have patience -- your body may simply need a little time to recover.

What Should I Do If I Have No Period After Miscarriage?

If it's been longer than a couple of months since your miscarriage and you have not yet had a period, call your physician. Most likely, there's no serious problem, but a small number of women may develop adhesions or Asherman's syndrome following a miscarriage. Signs of Asherman's syndrome include having no menstrual periods, having cramping but little or no bleeding at the time of an expected menstrual period, or trouble getting pregnant or recurrent miscarriages.

Finally, if you have been having unprotected sex since the miscarriage, consider taking a pregnancy test--it is possible to become pregnant immediately after a miscarriage even if you haven't yet had a period. Some women do not experience any delay in the return of normal menstrual cycles, and thus, ovulation may occur as early as two weeks after a miscarriage.

Asherman's Syndrome Explained

Adhesions happen when the membranes in your body stick together.

When membranes stick together in the uterus, ovulation can get messed up. This condition is referred to Asherman's syndrome. 

Typically, the adhesions in Asherman's syndrome result from procedures and surgeries, which makes sense because membranes are cut during procedures. Once membranes are cut, they can grow back abnormally resulting in adhesions.

Adhesions are essentially scar tissue. With Asherman's syndrome this scar tissue can span the width of the uterus or lie against a wall of the uterus. When adhesions span the width of the uterus, they can obstruct or block the uterus.

Here are some procedures that can result in the formation of adhesions:

  • D&C (dilation and curettage).
  • myomectomy
  • C-section

D&C is performed to clear the uterus of any products of conception after either miscarriage or abortion. D&C is also performed to diagnose and treat causes of heavy bleeding. Asherman's syndrome is most commonly a complication of D&C--especially when the retained products of conception are infected.

Myomectomy is a surgery performed to clear the uterus of fibroids. In women who want to get pregnant, myomectomy can help. However, myomectomy can result in adhesions, which lead to Asherman's syndrome.

How Is Asherman's Syndrome Diagnosed?

The gold standard, or best way to diagnose, Asherman's syndrome is by means of direct visualization or hysteroscopy.

A hysteroscopy is performed by an OB-GYN. Specialized ultrasound and x-ray using dye can also be used to visualize scar tissue in the uterus and thus diagnose Asherman's syndrome.

Treatment for Asherman's Syndrome

The scar tissue or adhesions that characterize Asherman's syndrome can be removed surgically (lysis). Sometimes, these adhesions return; this return of adhesions can possibly be prevented with the administration of hormones (estrogen). Many women who have adhesions removed for the treatment of Asherman's syndrome regain fertility.

Sources:

After a Miscarriage: Physical Recovery. American Pregnancy Association. Accessed: 30 Jun 2010.

Miscarriage. March of Dimes. Accessed: 30 Jun 2010.

Simon A, Chang WY, DeCherney AH. Chapter 54. Amenorrhea. In: DeCherney AH, Nathan L, Laufer N, Roman AS. eds. CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e. New York, NY: McGraw-Hill; 2013. Accessed March 04, 2016.

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