hCG Levels and Miscarriage: What Low Levels Can Mean
Human chorionic gonadotropin (abbreviated as hCG) is a key pregnancy hormone. In early pregnancy, its primary function is to help ramp up the body’s production of estrogen and progesterone. This helps to support the growth of the uterus and uterine lining.
Up until weeks 6-10 of pregnancy, hCG rapidly increases and can double nearly every 2 days. If hCG does not continuously double during this phase of pregnancy, this may be a sign that the pregnancy is at risk.
To help, this article will address some concerns you may have about hCG, miscarriage, and the hormonal fluctuations involved. We’ll follow up by offering guidance on the best methods for tracking and monitoring your hCG levels throughout your pregnancy.
Do low hCG levels mean a miscarriage?
Not necessarily. The primary symptoms that doctors use to diagnose a potential miscarriage include:
- Abdominal and back pain
- Spotting and bleeding
- Fluid or tissue passing from the vagina
- Loss of pregnancy symptoms
However, research does show that if your hCG levels are low during the first trimester, you are at an increased risk of miscarriage. If this is the case, your doctor will likely want to run further tests to assess the health of your pregnancy.
hCG levels and miscarriages
HCG is only produced after implantation and throughout pregnancy. So what happens when a miscarriage occurs?
Here are all of your questions answered regarding how hCG levels change during pregnancy and miscarriage, how long it can take them to return to normal, and how long you should wait to get pregnant again after experiencing a miscarriage.
What are normal hCG levels?
Pre-pregnancy, hCG levels are typically below 5 mIU/ml. However, among pregnant women, hCG levels can vary depending on the individual and the stage of pregnancy.
Here is a guideline provided by the American Pregnancy Association of hCG ranges that are considered “normal” as a pregnancy progresses.
- Week 3: 5-50 mIU/ml
- Week 4: 5-426 mIU/ml
- Week 5: 18-7,340 mIU/ml
- Week 6: 1,080-56,500 mIU/ml
- Weeks 7-8: 7,650-229,000 mIU/ml
- Weeks 9-12: 25,700-288,000 mIU/ml
- Weeks 13-16: 13,300-254,000 mIU/ml
- Weeks 17-24: 4,060-165,400 mIU/ml
- Weeks 25-40: 3,640-117,000 mIU/ml
Note that these levels may be up to 30-50% higher in women carrying multiples, such as twins or triplets. For more information on the role of hCG in multiple pregnancies, check out our recent article: hCG Levels & Twins: Understanding a Pregnancy with Multiples.
What are hCG levels during a miscarriage?
During a miscarriage, the body halts the production of hCG. This results in hCG levels falling continuously until they reach their pre-pregnancy baseline, which can take up to 6 weeks.
The exact hCG levels to expect during a miscarriage will depend on how high hCG levels were immediately prior to the loss. For example, if the loss occurred very early in the pregnancy, it may only take a few days for hCG levels to reset.
What are hCG levels after a miscarriage?
After a miscarriage, you can expect hCG levels to return back to their normal level of less than 5 mIU/ml.
If this isn’t the case and hCG remains elevated, this could be a sign that a molar pregnancy has occurred. Molar pregnancies are rare and should be treated by your doctor immediately. Alongside elevated hCG levels, other symptoms of a molar pregnancy include bright red or brown vaginal bleeding, pelvic pain, and severe nausea.
What if hCG levels are rising but not doubling?
In cases where hCG levels are slow rising and not doubling, this could potentially be a cause for concern. While it does not necessarily indicate that a miscarriage is happening or could happen, it does indicate to your doctor that further testing should be done.
How long does it take hCG levels to return to normal?
How long it takes your hCG levels to fall back to normal will depend on how far along you are in your pregnancy. For example, if you have only been pregnant for a few weeks before experiencing a miscarriage, it may take a few days for your hCG levels to return to normal. If you are further along in your pregnancy, this process can take up to 6 weeks.
When can you try to get pregnant again?
Once hCG is back to its pre-pregnancy level, ovulation and your period should resume within a few weeks or months. However, before trying to get pregnant again, it’s important to wait until you are ready.
It’s worth noting that miscarriage not only takes a physical toll on your body, but it can be emotionally traumatic as well. That’s why many doctors advise waiting 6-12 months before trying to conceive again. This gives couples the chance to grieve and emotionally recover in the aftermath of a miscarriage.
What hormones are affected by a miscarriage
Miscarriage affects several pregnancy-related hormones. Primarily, this includes hCG, estrogen, and progesterone.
During and after a miscarriage, hCG levels drop rapidly and return back to 0-5 mIU/ml within 6 weeks. Because hCG helps to stimulate the production of estrogen and progesterone, these hormones will also return to their pre-pregnancy levels.
This hormonal fluctuation can cause a number of physical and emotional side effects that may be difficult to manage. This includes:
- Increased feelings of fatigue, irritability, anxiety, and depression
- Difficulty with falling asleep or staying asleep
- Easing of early pregnancy symptoms such as nausea and breast tenderness
Managing mental health after miscarriage
In some cases, the psychological distress from a miscarriage can persist for a prolonged amount of time.
The American Journal of Obstetrics and Gynecology surveyed over 700 women with early pregnancy loss and found that 29% experienced symptoms of post-traumatic stress disorder (PTSD) one month after miscarriage. At nine months after miscarriage, 18% of participants reported continued symptoms.
Symptoms of PTSD include:
- Flashbacks to the experience
- Problems with sleeping
- Anger and irritability
- Depressive mood
If you are struggling to cope with your emotions following a miscarriage, try to bear the following tips in mind.
- Be kind to yourself. During this difficult period, it’s important to show yourself some compassion. A miscarriage is not your fault. You did not cause it, and you should not blame yourself.
- Allow yourself and your partner time to grieve. Grieving is a natural process that takes time. Healthy ways to grieve include commemorating your loss by lighting a candle or planting a tree, reflecting in a journal, and opening up to those you love.
- Take time off. Rest and relaxation are crucial to the recovery process. If possible, try to take some time off work so that you can focus on your health and wellbeing. If that’s not an option, try to eliminate as many stressors in your life as you can. This can help your grief feel more manageable.
- Reach out for further support. If you are still finding it difficult to manage your grief and mental health following a miscarriage, know that you are not alone. It’s okay to reach out to a therapist or counselor, support group, or close family member if you are struggling.
How to track and monitor hCG levels during a pregnancy
If you have recently become pregnant after a miscarriage, you may be anxious about your hCG levels and looking for ways to monitor them. It’s important to note though that while you can test for the presence of hCG at home, you can only track and monitor your hCG levels at your doctor’s office with a blood test. Here’s why.
The most basic type of hCG test is an at-home pregnancy test. This type of test involves testing a urine sample to see if your hCG levels are elevated enough to be pregnant. Testing thresholds can vary depending on which brand you use, however, they are usually greater than 5-25 MIU/ml.
While pregnancy tests are convenient for confirming whether or not you are pregnant, they cannot tell you what your exact hCG concentration level is. Instead, they will only give you a positive or negative result. This means that they cannot give any insight into whether or not your hCG levels are high enough for where you are in your pregnancy.
At the doctor
Alternatively, testing at the doctor’s office can provide you with more specific information about your hCG levels.
This type of test, often referred to as “beta hCG tests”, requires a blood sample to be taken. After the blood sample has been analyzed at a lab, you will then receive your result in the form of a specific measurement of hCG.
When measured regularly, your doctor will be able to see if your hCG levels are increasing and doubling as they should be. If not, they may want to check your progress with an ultrasound or run further testing to make sure that your pregnancy is healthy.
Unfortunately, going to the doctor’s office each week or every other week can be inconvenient, time-consuming, and expensive. To address this, Mira plans to release hCG wands in the future to make regular, at-home testing for hCG a possibility. Please check our shop regularly for further details and to stay in the loop.
✔️ Medically Reviewed by Katerina Shkodzik, M.D., OB-GYN
Dr. Katerina Shkodzik is a certified OB-GYN with a special focus on reproductive endocrinology and infertility issues. She has been practising since 2015.
Dr. Shkodzik completed her residency program in the Department of OB/GYN at the Belarusian State Medical University and fellowship program in the Department of Gynecological Surgery at the Medical University of Bialystok, Poland.
Dr. Shkodzik is extensively involved in digital health projects providing her medical expertise and integrating of cutting edge technologies in medical science and clinical practice since 2018.
Dr. Shkodzik has participated in several studies focused on PCOS, endometriosis, menstrual cycle characteristics and their abnormalities based on big data of digital health in collaboration with leading universities.
She believes that paying special attention to women's health is a crucial step to improving the world we live in.