Charting Your Cycle After Miscarriage
Life changes after a miscarriage. I speak from experience: nearly seven years ago, I lost my second child to miscarriage, and every part of me changed. In the time since, with care for myself and love from my family and friends, I am in many ways stronger for having been so broken.
At the time I wasn’t charting my cycle. In retrospect, I wish I had had a better understanding of what was going on in my body, so that I could be more confident about making decisions regarding trying to conceive again.
Many women who suffer miscarriage wonder what their experience means for charting. Basic instruction in Fertility Awareness-Based Methods (FABMs) or Natural Family Planning (NFP) may not include a procedure for post-loss observations, as currently there isn’t research on their effectiveness. Still, FABMs offer a detailed understanding of the menstrual cycle, which can be applied to a post-miscarriage situation.
The best option is to speak with your FABM or NFP instructor, who can help you determine a route for you, based on your health history and whether you are ready to try to conceive again or not.
Starting to Chart Again
There isn’t a hard rule as to when you will ovulate after having a miscarriage. It could take up to six weeks, or you may not ovulate at all in your first post-miscarriage cycle. Your body is recalibrating, and good nutrition and rest (as much as is possible as you grieve) can only help. Often, the first cycle is longer than average—because it takes longer to ovulate—yet has a shorter luteal (post-ovulatory) phase, as your hormones return to their baseline.
Research shows that while “that there is a lot of variability in the return of fertility” post-miscarriage, “parameters of the menstrual cycle normalize quickly, i.e., by the second cycle.” In layman’s terms, that means it’s tough to say how soon you’ll be fertile again, but once you are, it’s likely that you’ll quickly return to your typical patterns.
In the meantime, understand that your hormones are undergoing a drastic shift, especially if the pregnancy was further along. Be gentle with yourself and try to be flexible with the transition you’re experiencing. When you do begin to ovulate again, you’ll likely soon see the same patterns of basal body temperature or cervical mucus that you did before. Your cervical position may be a bit more open from this point forward.
If you’re ready to chart, you can chart the first day of bleeding as Day 1 of your cycle. Bleeding can last up to two weeks, as can cramping. If you have bleeding or cramping beyond two weeks, check in with your healthcare provider about the possibility of infection.
To Try or Not to Try
There is some evidence that fertility will be temporarily improved in the weeks and first months following a miscarriage. One study showed that “the shorter the time following a miscarriage, the more likely the subsequent pregnancy is to result in a live birth.” However, some healthcare providers recommend waiting two to four cycles before attempting to conceive again. What to believe, and how to proceed?
Those who suggest waiting are likely looking to see that pregnancy hormone human chorionic gonadotrophin (hCG) has returned to its regular level before conception occurs. This hormone is produced by the embryo after fertilization, and it’s what’s measured in home pregnancy tests. In theory, waiting for hCG to return to baseline elevates the chances of bringing a subsequent pregnancy to term. However, in practice, research shows no increased risk of loss when a woman conceives shortly after miscarriage. If an otherwise healthy woman is ready to try again soon after an uncomplicated miscarriage, there is no medical evidence to deter her from that decision.
It’s Also Okay to Wait
Every woman experiences miscarriage differently, and no one way of handling the loss is superior to another. Some couples need more time to process their grief, while others find that trying again helps to mend their broken hearts. While one study found ovulation occurred, on average, 50 days post-miscarriage, some of these women recorded ovulation after just 10 days. Because of this, FABMs typically recommend abstaining from intercourse until after the first menses, if the goal is to avoid pregnancy.
In this time, a woman will be looking out for signs of ovulation, as she did before, such as an increase in fertile mucus or a rise in basal body temperature. This could mean a longer period of abstinence than a couple is used to, so having other means of connecting, especially as emotions can be more challenging, is key to maintaining a healthy relationship.
A healthcare provider can offer guidance about what to expect in terms of symptoms and recovery, depending on whether the miscarriage proceeded naturally or performed surgically with a dilation and curettage (D&C).
It’s possible that bleeding will occur for about two weeks and taper off before regular cycles resume. It’s also possible that bleeding will stop and then start again less than twenty days later, sometimes with accompanying cramping. In this situation, it’s likely due to a piece of the placenta that didn’t initially detach from the uterus. Your body may continue to produce pregnancy hormones to nourish this piece of the placenta, and will not be able to conceive. Now that the placenta has been fully separated, your body is flushing it out. (That less-than-twenty days is a sign that it’s not a period.)
If your hormone levels aren’t returning to normal, your provider may do an ultrasound to examine the interior of the uterus. It’s important that the uterus is clear to prevent infection and to prepare the body for a healthy conception later on.
Miscarriage is a challenging ordeal to experience physically, emotionally, and spiritually. With a trained instructor, Fertility Awareness-Based Methods and Natural Family Planning can help women to understand how their bodies are healing and may be able to identify solutions to prevent future miscarriage. If you’re charting your cycle, a NaProTECHNOLOGY trained doctor can help you analyze your charts and determine if a hormonal imbalance is a cause of miscarriage for you. A NaPro doctor can also assist you in ensuring your next pregnancy goes to term.
Life after a miscarriage will never be the same as it was before. What’s most important after miscarriage is that you have space and support to grieve in your own way, to find your path to healing.