Post-Miscarriage Spotting: What to Expect & When to Worry

Question
Dear Dr. Kandeel,

I just recently experienced a miscarriage on 1/25/10 at 8 weeks.  This was my first pregnancy.  I experienced heavy bleeding and cramping for a week.  I followed up with my OB and she said that my HCG lvl was almost neg and that my US showed no signs of left over tissue.  She also told me that bleeding/spotting was normal for two weeks, but that everyone is different.  Its almost been three weeks and I am still spotting.  I did stop for half a day, but my husband and I had sex and there were clots found afterwards.  Then the spotting started up again.  Is this normal?

I also wondered about trying to conceive again and how soon is too soon?  My doctor said to wait 6 months, but everything I have seen on the internet says it is safe as long as there is one normal cycle.  I had to be put on progesterone to regulate my period before the pregnancy and I figure I will need it after the miscarriage also.  I asked my doctor about this and she said she would put me on progesterone at my 6 month follow up, if it is needed.  I want to ask my PCP for it before then, but wanted to know what you think about that.  

Sorry for being long winded.  I appreciate your thoughts and patience.  I am just concerned and frustrated being reminded of this awful experience every time I go to the bathroom!

Thanks again....

Answer
Dear Vanessa

I advise the following:
1-A transvaginal ultrasound by an experienced sonographer to confirm that your uterus is empty and does not contain any remnants of conception as this is the most common cause for post miscarriage bleeding.

2- There is no need to wait for 6 months to get pregnant. Usually ovulations returns back 2-4 weeks after miscarriage and this means you can get pregnant in your first cycle after miscarriage.

3- I do not know why you have to take progesterone in order to get pregnant. Have you been diagnosed with luteal phase defect??. This would be the only reason to prescribe progesterone. I am not aware of any other indication for prescribing progesterone in order to get pregnant?

I hope this info answers your questions.

Best luck