Meredith McKenzie* was on a plane, travelling in Pakistan on business, when she came down with a fever. Since she was only eight weeks pregnant she started to worry. “I knew a fever for any reason wasn’t good in the first trimester,” says McKenzie. In the airplane washroom, she saw that was spotting, and she just broke down and cried. That night at her hotel, the bleeding worsened and she experienced painful cramps. McKenzie went to a local hospital only to have her worst fears confirmed—she had experienced a miscarriage.

For most women, spotting is the first sign of a miscarriage, but symptoms are unique to each individual. Some women have no signs of a miscarriage at all. “I see so many miscarriages that happen at an early stage,” says Jan Silverman, founder of the Infertility Support and Education Program at Women’s College Hospital in Toronto. “Many of these women don’t find out that they’ve had a miscarriage until they have an ultrasound and there’s no heartbeat.”

In terms of actual symptoms of a miscarriage, there’s a huge continuum. “In the same way that morning sickness is unique to each pregnancy, all miscarriages are unique to the individual, both emotionally and physically,” says Dr. Doug Wilson, department head of obstetrics and gynecology at the University of Calgary. Signs of a miscarriage can be anything from minor bleeding and/or cramping to extreme pain and the expulsion of actual tissue. Or, it can be as simple as just not feeling like you’re pregnant anymore. “You don’t have to have any physical symptoms to know you’re having a miscarriage,” says Dr. Wilson. “There are usually subtle symptoms that are recognized in retrospect, such as pregnancy-related breast tenderness or nausea that change with the loss of the placental hormones.” That said, it should be noted that “not feeling pregnant” is a very commonly reported symptom among pregnant women in their first trimester, and is not always connected to miscarriage.

Beverly Hanck, executive director of the Infertility Awareness Association of Canada (IAAC), experienced two miscarriages before she had a viable pregnancy. Each was unique and ranged in symptom severity from minor spotting to a 16-week miscarriage that required multiple dilation and curettage (D&C) surgeries to remove the tissue. The one mainstay with each miscarriage was that horrible feeling that she just wasn’t pregnant anymore. “Your heart just aches,” says McKenzie. “You know in your gut what’s happened before anyone tells you—your baby, your hopes and dreams, are gone.”

Bleeding during pregnancy doesn’t always mean you’re having a miscarriage, however. Read more about bleeding during pregnancy.

*Name has been changed