March 8, 2011— -- Singer Lily Allen, who has kept a low profile since her second miscarriage last year, is now speaking out about the subject on a British documentary that will air March 15.
The documentary, "Lily Allen: Rags to Riches," will be shown on Britain's Channel 4.
"It was a really long battle, and I think that kind of thing changes a person," Allen said of her second miscarriage, which happened in November.
Allen also revealed that she had suffered from bulimia, an eating disorder.
"I used to vomit after meals," she said in the documentary. "It's not something I'm proud of.
"But, I tell you what, a lot of people came up to me telling me how great I looked and I'd be on the cover of every magazine.
"I thought I looked good and it was great to be able to try on clothes and feel a million dollars," the British singer said. "But I wasn't happy, I really wasn't.
Allen was sighted recently in Paris at the Chanel show during Fashion Week, discussing her wedding dress at designer Karl Lagerfeld's studio.
Allen, 25, is engaged to her boyfriend Sam Cooper, a builder she met in 2009. They plan to marry later this year.
Their first baby died -- her second in three years -- after Allen contracted a viral infection six months into her pregnancy.
Technically, because it occurred after the 20th week, Allen's second loss was a pre-term delivery. Her first miscarriage was at four months in 2008.
The couple was expecting a boy. At the time, friends said the couple was grief-stricken by their loss.
"Lily and Sam are both devastated," a friend told Britain's Daily Mail newspaper. "She had kept quiet for three months until she had the scan and doctors told her everything was OK. She was, understandably, so nervous after having had a miscarriage before.
"This is a nightmare for her and Sam," the friend said. "It's too early to say how she will be able to cope with this. They are both heartbroken."
After Allen's miscarriage, British pop star Emma Bunton revealed her second pregnancy on Twitter, saying her thoughts were with Allen.
Former Spice Girl Bunton is now seven months pregnant.
Of the nearly 6 million pregnancies each year in the United States, about 15 percent end in miscarriage, according to the Centers for Disease Control and Prevention.
In about half the cases, a cause cannot be determined. Among the conditions usually linked to miscarriage are a woman's age, chromosomal abnormalities, structural problems, infections, autoimmune disorders or a condition that causes the blood to clot in the placenta, known as thrombophilia.
Only about 2 to 5 percent of all pregnant women will experience a second miscarriage, according to Dr. Wendy Chang, director of research and patient education at Southern California Reproductive Center and an assistant professor at UCLA Geffen School of Medicine.
"It's still very rare," said Chang, but that risk increases as the number of miscarriages increases.
"The odds are greater," she said. "After one miscarriage, the chances of a live birth are 90 percent. At two, the chances are still low -- a 35 percent chance of another miscarriage. But it does go up linearly."
And so does the stress.
Celebrities Who Had Repeat Miscarriages
"Many of them are doing their own tests at home and if they see a positive pregnancy, that begins a whole cycle of anxiety again; whether the test will go away and not be positive anymore or how long they will be able to hold on to the pregnancy," she said.
Once they are pregnant again, these women, "literally are holding their breath trying to make sure with sonograms that this baby is going to make it further than the next," Chang said.
Celebrities, from Marilyn Monroe to modern actresses Courtney Cox Arquette and Christy Brinkley, have had repeat miscarriages.
Brinkley was 31 when she had daughter Alexa Ray with Billy Joel, and 41 at the birth of son Jack with real estate developer Rick Taubman. But in her fourth marriage to Peter Cook, she had three miscarriages, before giving birth to daughter Sailor Lee in 1998.
Olympic skater Nancy Kerrigan had six miscarriages in the eight years between her first and second child.
New research published recently in the British Medical Journal reveals that women who try to get pregnant again soon after a miscarriage may be more successful than those who delay conception, but fertility doctors say that doesn't eliminate the anxiety and trepidation.
"We don't tell people to stop trying just based on the numbers of miscarriages they've had," Chang said. "We give advice on the results of their testing. If they have chromosomal abnormalities, we have them consider going to an egg donor. If this is something autoimmune or clot-related or a septum, pregnancy rates can be improved, sometimes surgically. It depends on many factors."
Doctors also recommend counseling, because facing another pregnancy can take a "huge toll" on patients' emotions and even their marriages, she said.
As for Allen, "I hope she knows to see a reproductive endocrinologist to get an evaluation," Chang said.
But the psychological impact of repeat miscarriages is incalculable, many experts said.
Television actress Kirstie Alley confessed in 2005 that her big weight gain began after she miscarried her only pregnancy a decade earlier.
"When the baby was gone, I just didn't really get over it," she told People magazine. "Neither did my body. I so thoroughly convinced my body that it was still pregnant after nine months that I had milk coming from my breasts.
"I was still fat, I was still grieving, and I had just been told it was very possible I would never be able to have children."
Tracy Gaudet, an obstetrician and gynecologist who is executive director of the Duke Integrative Medicine facility in Durham, N.C., said women need support for their grief after miscarriage.
"For years, I have seen women come into the emergency room late at night having a miscarriage," she said. "My heart goes out to them. This is not something medicine does well, meaning we have a good way to assess and evaluate and work up patients, but what we don't care for the whole person.
"There is a norm in the culture to dismiss the loss very quickly," she said. "The most common response from family and friends is, 'Oh, well, it's probably a blessing. There was probably something wrong with the pregnancy.' That might be true but it's not an acknowledgement of the loss."
Grief can be as great with the loss of an early pregnancy as with the loss of a child, according to Gaudet.
"It's compounded exponentially if it's a second or more loss," she said. "It hooks into the fear, 'Is there something wrong with me? Will I be able to have a baby?' We don't support women in processing that."
Even women who didn't intend to become pregnant are "confused and distressed" by miscarriage.
"It's ... very primal and deep-seated," she said. "We are genetically programmed to procreate, and even if we choose not to, it's life-affirming for a woman to know she has the capacity to create life and give birth. When that is threatened, that's a loss, compounded by fear."
Despite research that suggests women should try to get pregnant quickly after a miscarriage, Gaudet advises waiting until the grief -- "whatever it looks like" -- has been resolved.
"When they are feeling horrible and depressed and crying, it's not best to get pregnant," she said. "They need to honor and walk through the mourning process and they well know, internally, when they are ready to step into this again."