Dr. Siobhan Dolan explains how to handle irregular periods and spotting after a miscarriage.

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An irregular period is no woman's idea of a good time, but when your cycle is unpredictable after a miscarriage it can be especially difficult. Not only are those irregular periods a reminder that you're no longer pregnant, they may also be different than before -- a heavier flow, some spotting, or nothing at all.

Though most women do start ovulating again within one to two months after miscarrying, don't freak out if your periods are still less than predictable. It doesn't mean you won't be able to get pregnant again. In fact, there are several common reasons for irregular periods after miscarriage, explains Siobhan Dolan, M.D., a medical advisor to the March of Dimes and an attending physician in the Division of Reproductive Genetics at Montefiore Medical Center, the University Hospital for Einstein, in New York City.

There's a clot or residual tissue in the uterus. If you have a miscarriage within the first few weeks of pregnancy, it will look and feel a lot like a regular period. Around 6 to 7 weeks, it's more akin to a heavy period. But if you're farther along -- say, 10 to 11 weeks or more -- your uterus has to flush out more tissue and possibly some placenta, which could take a while.

Persistent spotting could last for weeks and should lighten up over time, but if it doesn't, call your ob-gyn. "If you have a couple of days of no bleeding, then heavy bleeding, then no bleeding, then heavy, there's likely something in the uterus," Dr. Dolan says. "See your doctor -- she'll likely do an ultrasound to get a picture of what's going on and see if there's a clot or tissue." Most doctors prefer to let the body see the miscarriage through naturally, but your ob-gyn may need to perform a procedure called a D&C to remove any remnants.

You had irregular periods before you got pregnant. If your cycle was all over the place before, you can count on an unpredictable cycle after a miscarriage, too, as your body returns to normal. If your periods came like clockwork before the pregnancy but are unpredictable a few months after a miscarriage, contact your ob-gyn. She may give you progesterone (a hormone) to clean out your uterine lining, or put you on birth-control pills to regulate your cycle.

You're not ovulating. In a normal period, when you produce an egg, the lining of the uterus, also called the endometrium, is shed. But if no egg is produced, the endometrium will just continue to grow and thicken. Eventually, the overgrowth causes bleeding, which can range from spotting to heavy bleeding. Also, "if you have a period, then don't for a few months, then have another period, you're probably not ovulating regularly," Dr. Dolan says.

You're obese or very underweight. "I don't think that women are at fault at all when it comes to miscarriage, but extremes in weight do play a role and can be associated with irregular periods," Dr. Dolan says. "The factors affecting cycles prior to getting pregnant come back into play after a miscarriage. Now you're going back to how you were before."

You could be pregnant. If possible, wait a few months before you try to get pregnant again. The time off can help you figure out exactly when you're ovulating (which makes the whole conception process much easier!) and give you an opportunity to mourn and heal from the loss you just experienced. But if your period is behind schedule, Dr. Dolan recommends taking a test to be sure you're not pregnant.

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