Recurrent Miscarriage: Causes, Testing and Finding Support

Recurrent miscarriage, also called recurrent pregnancy loss, means having two or more consecutive losses before 20 weeks of pregnancy, counting from the first day of your last period. It affects around two to three in every hundred women trying to have a baby, so if this is your experience, please know you are not alone and you are not to blame. In my practice I meet women who are carrying not only grief but a heavy weight of self-questioning. This guide is here to give you clear answers about why it happens, what can be investigated, and where to find real support.

It is completely natural to ask yourself why this is happening, whether you did something wrong, and whether you will ever carry a baby to term. Understanding the causes, the risk factors and the options available will not undo the pain, but it can replace fear with information, and give you a plan to work from with your doctor.

What causes recurrent miscarriage?

There is often no single answer, and in many cases more than one factor is involved. These are the causes I look for most often.

Genetic and chromosomal factors

This is the most common cause of sporadic miscarriage. Genetic abnormalities account for a large proportion of recurrent losses, and the risk rises with age, climbing noticeably once a woman is in her late thirties and beyond. It happens when an embryo has the wrong number or structure of chromosomes, which are the packages of DNA that direct a baby’s development. Occasionally one or both partners repeatedly pass on an abnormal chromosome, which is why genetic testing can be worthwhile.

Hormonal imbalances

Having too much or too little of certain hormones can contribute to repeated losses. Thyroid problems are a good example. An underactive thyroid can cause tiredness, weight gain despite a poor appetite, constipation, dry skin, feeling the cold and low mood, while an overactive thyroid can cause weight loss, feeling too hot, a racing or shaky feeling and frequent bowel movements. Both are treatable, and getting your thyroid into a healthy range before conceiving genuinely matters. Polycystic ovary syndrome and poorly controlled diabetes can also increase miscarriage risk, and both can be managed with the right care.

Problems with the womb

• Structural issues such as fibroids or a septum inside the womb
• An unusually shaped womb, which can affect how a pregnancy implants and grows
• A weak cervix (cervical insufficiency), which can open too early and lead to loss in the second trimester
• Asherman’s syndrome, where scar tissue forms inside the womb, often after previous surgery

Autoimmune and clotting conditions

Conditions such as antiphospholipid syndrome and lupus can affect blood flow to the developing placenta, reducing the oxygen and nutrients reaching your baby. The important message here is that these conditions can be identified with blood tests and, once found, are often very treatable in pregnancy.

When no cause is found

For some women, every test comes back normal and no clear reason emerges. This is understandably frustrating when you are searching for answers. The genuinely reassuring news is that women with unexplained recurrent miscarriage still have a high chance of a successful pregnancy in future, often without any specific treatment.

What increases the risk?

• Age, as the chance of miscarriage rises as we get older
• A previous history of miscarriage
• Being of Black ethnicity, which research links to a higher risk of loss
• Underlying conditions such as lupus, antiphospholipid syndrome, PCOS, diabetes and thyroid disorders
• Lifestyle factors including smoking, heavy alcohol use, a high caffeine intake and a very high or very low body weight

I mention Black ethnicity specifically because it is too often left out of these conversations. Understanding your own risk is part of getting care that truly fits you, something I write about in Black women and the menopause journey.

Tests worth having

After recurrent loss, it is reasonable to be offered investigations rather than simply being told to try again. Depending on your history these may include blood tests for thyroid function and for antiphospholipid antibodies, a pelvic ultrasound to look at the shape and structure of your womb, and genetic testing for you and your partner. Not every woman needs every test, and part of my role is to tailor the right investigations to your situation.

Management and treatment options

• Lifestyle steps such as regular exercise, a balanced diet, stopping smoking, limiting alcohol and keeping caffeine below around 200mg a day
• Progesterone support in early pregnancy for some women, guided by your history
• Low-dose aspirin and heparin where antiphospholipid syndrome is diagnosed
• Metformin and PCOS management where relevant
• Surgery to remove a septum or fibroids in selected cases
• Preimplantation genetic testing of embryos where chromosomal problems are the cause

Looking after your heart, not just your health

Every new pregnancy after a loss carries hope and anxiety in equal measure, and each further loss can feel harder to bear. Please hear me clearly: a miscarriage does not define you, and it says nothing about your worth or your ability to become a parent. Lean on the people who love you, be patient and gentle with yourself, and give yourself full permission to grieve in whatever way you need to.

Professional counselling can offer you and your partner a safe space to process what has happened, and support groups connect you with others who truly understand. In the UK, Tommy’s offers excellent information and support around baby loss.

“A miscarriage is not a verdict on your body or your future. With the right investigations and support, most women who experience recurrent loss go on to have a healthy pregnancy.”

Dr Itunu Johnson

When should we try again?

There is no single right time. What matters is that you are physically well, that any necessary tests or treatments are in place, and that you feel emotionally ready. This is exactly the kind of decision I like to make with a woman rather than for her.

If you have experienced recurrent miscarriage and would like a thorough, compassionate review, you can book a consultation or read more about my women’s health care and private GP services.