After a miscarriage and D&C, how long does it take before your menstrual cycle begins again? Can you get pregnant before you start your cycle again? Is it unsafe to get pregnant before you have that first cycle after the D&C?

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It is hard to predict when the next menstrual period will return after a D&C, a gynecological procedure often used to remove tissue from the uterus after a miscarriage. During pregnancy, your body produces a hormone called hCG, which suppress the pituitary gland's production of other hormones that normally stimulate ovulation (release of an egg). The hCG level drops after the pregnancy tissue is removed during the D&C. It must drop to zero before your cycles resume. Although the length of time it takes for this to occur depends predominantly on the value of hCG present before the miscarriage, hCG suppression of the pituitary gland usually subsides within two weeks. Rarely, a small amount of placental tissue is left behind at the time of the D&C. In this case, a woman may experience persistent bleeding along with a delay in the fall of hCG levels and the return to normal cycles.

Once the hCG levels fall, your pituitary gland begins secreting the stimulatory hormones LH and FSH, and ovulation resumes. If the hCG levels were low at the time of the D&C, normal ovulation can return about two to three weeks after the D&C. Alternatively, if the fall in hCG is delayed, the first ovulation may occur three to six weeks later. As ovulation occurs two weeks before the menstrual period, you can, in fact, get pregnant before your first post-D&C menstrual period. If you do not ovulate, and your menses were irregular before the pregnancy, all bets are off.

Is it safe to get pregnant immediately? That depends. Pregnancy without an intervening menstrual period can make managing the pregnancy more difficult, as your obstetrician will need to follow you more closely to accurately determine your due date. Additionally, after a D&C, there can be a low-grade inflammatory response in the uterus that may interfere with pregnancy, making the risk of repeat miscarriage a bit higher in the first post-D&C cycle.

If you have had miscarriages before, it is important that you and your physician try to determine the cause before you attempt to get pregnant again. Many women are discouraged after a miscarriage and rush to try again, without taking the necessary steps to avoid a subsequent miscarriage. In their haste to conceive again, these women condemn themselves to more suffering and potentially another pregnancy loss. The most difficult part of managing recurrent pregnancy loss is to address the emotional aspects that often interfere with completion of a comprehensive evaluation and treatment plan.