Up to one in four pregnancies end in miscarriage, which means more than 150,000 Australian families go through early pregnancy loss every year.

Many of these patients come to their GP at the first sign that something might not be quite right. And what they remember, often years later, isn’t the ultrasound report or the management plan. It’s how they were spoken to. At Pink Elephants we hear those stories every week, the good and the painful. Here’s what I’d love every GP to know.

Treat it as a bereavement, not just a procedure

Clinically, an early loss might be routine. Emotionally, it rarely is. For many people the pregnancy already had a due date, a nickname, a place in the family’s future. When care focuses only on bleeding, hCG levels and retained tissue, patients can leave feeling their grief doesn’t count.

The evidence shows how significant this is. A large prospective cohort study found that one month after early pregnancy loss, 29% of women met criteria for post-traumatic stress, 24% for moderate-to-severe anxiety and 11% for moderate-to-severe depression. Nine months later, 18% still had post-traumatic stress symptoms. The Lancet’s Miscarriage Matters series called for miscarriage care to be reformed worldwide, with psychological support built in.

A simple “I’m so sorry about your baby” (or “your pregnancy”, if that’s their word) validates the loss and opens the door.

Words matter more than you’d think

Australia’s first national miscarriage and ectopic pregnancy guideline, released by RANZCOG in 2025, stresses clear, empathetic and respectful communication, including following the patient’s lead on language. A few easy swaps:

• Say “miscarriage” or “pregnancy loss” rather than “spontaneous abortion” or “failed pregnancy”. Technically accurate words can land like blame.
• Use “pregnancy tissue” rather than “products of conception” when talking with patients.
• Skip the silver linings: “at least it was early”, “at least you know you can get pregnant”, “you can always try again”. They’re well meant, but they minimise.
• Tell them it wasn’t their fault. Many people quietly blame the gym session, the stress or the glass of wine before they knew. Say it out loud, even if they don’t ask.

Threatened miscarriage: who should get progesterone?

Bleeding in early pregnancy is frightening, and many patients arrive having already read about progesterone online.

The RANZCOG guideline gives clear, evidence-based answers:

​​​No more than one previous miscarriage: progesterone is not recommended for threatened miscarriage. It makes little to no difference to rates of live birth, stillbirth or preterm birth.

Two or more previous miscarriages but no bleeding: first-trimester progestogens are not recommended, as there’s no evidence they improve live birth rates.

Two or more previous miscarriages and bleeding now: progesterone is recommended. The regimen is 400 mg micronised progesterone vaginally, twice daily, continued to 16 weeks’ gestation. RANZCOG says it “probably increases the live birth rate​​ and has no association with congenital abnormalities or serious adverse events.” Much of this evidence comes from the PRISM trial.

The guideline has also changed the definition of recurrent miscarriage. It’s now two or more losses, which need not be consecutive, rather than three in a row. That means more of your patients will qualify for progesterone, and for earlier investigation and referral.

The Australian Government is ​​​​currently reviewing the PBAC recommendation to add progesterone to the PBS for this use. If successful, this would make treatment significantly more accessible for Australian women.

For patients who don’t meet the criteria, explaining why matters. “The evidence shows it wouldn’t change the outcome for you” lands very differently from “there’s nothing we can do.”

Practical pearls for the consult

• Flag the file. Update the record and cancel antenatal recalls so NIPT or 12-week scan reminders don’t arrive after a loss. It’s a common and completely avoidable hurt.
• Explain what to expect. Whether management is ​​​​expectant, medical or surgical, talk through how much bleeding and pain is normal, what they might see, and when to seek urgent care. Fear of the unknown adds to the trauma.
• Offer a certificate for work. Many people don’t know that compassionate leave under the Fair Work Act covers miscarriage, for the person who was pregnant and for their partner. Offering a certificate for compassionate or bereavement leave, rather than a generic “unfit for work” note, recognises the loss for what it is and gives them time to grieve.
• Book the follow-up before they leave. A check-in at two to four weeks, in person or by telehealth, is your chance to ask “How are you going, really?” Screen for mood, anxiety and trauma symptoms, and consider a Mental Health Treatment Plan where appropriate.

Don’t forget the partner

Partners, including dads and non-birthing mothers, are often cast as the “support person” and only asked how she’s going. But research shows partners experience post-traumatic stress, anxiety and depression after early loss too, and they’re far less likely to seek help. If a partner is in the room, ask them directly how they’re coping. If they’re your patient as well, it’s worth a follow-up with them too.

To help close this gap, Pink Elephants has just launched dedicated support for dads, so you now have somewhere specific to refer them.

You don’t have to do it all yourself

The RANZCOG guideline encourages clinicians to know their local grief and mental health supports. Having a couple of referrals ready takes pressure off you and gives patients somewhere to land once they leave your room.

Pink Elephants offers free peer support, including LiveChat with trained Peer Support Companions, The Circle email support program, online communities and group programs, plus a pregnancy loss helpline on 1300 726 306, delivered with PANDA.

Where care is heading

Early pregnancy loss is still largely invisible in national data, and care is patchy across the country. It’s especially hard in rural and regional areas, where some women travel up to 500 km for surgical care.

We are calling for national care standards, continuity of care, trauma-informed communication, culturally safe support and digital-first peer services. The Pink Elephants Care Standards set out what good care looks like at every point in the journey, and GPs are central to all of it.

You won’t be able to take away the loss, but you can help make sure the care around it is something your patient remembers for the right reasons.

Key takeaways

• Early pregnancy loss is a bereavement, so acknowledge it, follow your patient’s language and avoid reassurances that minimise it.
• RANZCOG recommends progesterone for women with two or more miscarriages and current bleeding.
• ​​​​​Document the miscarriage in the patient’s record, cancel antenatal recalls and book a follow-up to screen for anxiety, depression and trauma symptoms.
• Ask partners directly how they’re coping, because their grief is often overlooked.
• Keep a few referral options handy, including free peer support through Pink Elephants.

Further reading and resources

RANZCOG Miscarriage, Recurrent Miscarriage and Ectopic Pregnancy Clinical Guideline (2025)

The Lancet: Miscarriage matters — the epidemiological, physical, psychological and economic costs of early pregnancy loss (2021)

Coomarasamy et al. A randomized trial of progesterone in women with bleeding in early pregnancy (PRISM, NEJM 2019)

Farren et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy (AJOG, 2020)

Pink Elephants: Not Just A Loss report Not just a loss | Pink Elephants Support Network – The Pink Elephants Support Network

Pink Elephants Care Standards Care standards | Pink Elephants Support Network – The Pink Elephants Support Network

Pink Elephants: find support and support for dads and partners Dads – The Pink Elephants Support Network

Pregnancy loss helpline, delivered by PANDA: 1300 726 306