You’re pregnant or hoping to become pregnant and have experienced some bleeding and/or cramping. You may be feeling nervous and wondering what this means for your pregnancy. Let’s take a look at symptoms and causes of bleeding and cramping during early pregnancy, and when to call your healthcare provider.
How Common Is Bleeding and Cramping During Early Pregnancy?
Around 20% of women report spotting or light vaginal bleeding in the first trimester (1). Likewise, cramping is also not at all uncommon in early pregnancy. It’s usually mild and described as being similar to period cramps. While these symptoms can at times signal a problem, many women who experience bleeding, cramping, or both go on to have healthy babies.
Heavy Bleeding vs Spotting
All blood that comes from the vagina is technically vaginal bleeding. However, in order to most accurately describe symptoms, caregivers make distinctions between bleeding and spotting.
Bleeding is vaginal bleeding that is usually as heavy as, or heavier than, a menstrual period (2). It’s the amount of blood that would saturate a pad in a few hours. Spotting is vaginal bleeding that is lighter than a regular menstrual period. It’s the amount of blood that would require a thin pantyliner to control the flow. Your doctor or midwife will use these terms to best assess the situation and move forward with care, if necessary.
Causes of Bleeding and Cramping During Early Pregnancy
Sometimes, when the fertilized egg attaches to the uterine wall, it causes some slight spotting (1). This usually occurs shortly before the expected start of the menstrual period.
Growth and Attachment
In early pregnancy, your uterus is growing, the placenta is forming, and vascular (vein) connections are made (1). This may cause some light bleeding.
When you’re pregnant, your cervix is tender and there is an increase in blood supply to the pelvis (1). For these reasons, you may experience some spotting after sexual intercourse.
Miscarriage or Molar Pregnancy
Sadly, sometimes bleeding does mean that a miscarriage has occurred. At least 10 to 15 percent of known pregnancies end in miscarriage (1).
My Experience with Miscarriage Bleeding
I’ve personally experienced two miscarriages. One was an ectopic pregnancy, described below. The other was a more typical miscarriage that occurred at around 9 weeks pregnant. I remember that my bleeding started out light, and I initially hoped it was just spotting. But over the course of the day, the bleeding became heavy – much heavier than my normal period – and had clots. Overall, the experience was physically similar to a heavy menstrual period, but of course much more emotional.
Rarely (1:1500 pregnancies), a molar pregnancy can occur. This is a condition in which abnormal placental tissue grows into a cluster. A pregnancy test will show as positive, but there is no baby. I mention it, despite it’s rarity, because a symptom of a molar pregnancy is brownish to bright red vaginal bleeding in the first trimester (4).
Cramping on One Side
If you experience painful, persistent cramping on one side, it’s a good idea to call your healthcare provider. It may be a result of the normal early pregnancy processes. However, the one-sided nature of it could suggest the possibility of an ectopic pregnancy. This is especially true if the pain is severe or comes along with nausea, dizziness, vomiting, or a sharp pain in the shoulder (1). In an ectopic pregnancy, a fertilized egg implants somewhere other than inside the uterus, typically in the fallopian tube (3). It can become more serious with time, so it’s best to consult your doctor or midwife, just in case.
Implantation Bleeding or Period
If you haven’t yet gotten a positive pregnancy test and are trying to conceive, you may be watching like a hawk for any sign of your period starting. Implantation bleeding, when present, usually happens shortly before a woman’s menstrual period is expected. This can make it difficult to determine whether bleeding is a sign that you’re pregnant or confirmation that you’re not.
Implantation bleeding is usually very light, lasting no more than 48 hours. In fact, it’s often just a few hours, or even a single spot or streak of discharge. Unless you have very light or atypical periods, implantation bleeding should be significantly lighter than a menstrual period. There may be no way to know for sure in the first day or so, if your period usually starts off light. But within a day or two, you should have a pretty clear answer.
What Should I Do if I Experience Bleeding and Cramping During Early Pregnancy?
If you experience any bleeding after a positive pregnancy test, call your doctor or midwife. He or she will assess your specific symptoms and let you know how to proceed. They may suggest some extra rest, ask you to wait a little longer to see what happens, or encourage you to come in for a blood test or ultrasound to assess your pregnancy.
Bleeding and Cramping During Early Pregnancy: What to Track
If you need to call your provider about bleeding, cramping, or spotting, write down as much information as possible about your symptoms.
- Bleeding or spotting – As we discussed above, there’s a difference between the two. Is your bleeding heavier or lighter than a period?
- Color – Is the discharge you’re seeing bright red, brown, pink, clear or white with a tinge of color? Brown discharge is old blood, not fresh. And pink means there’s very little blood.
- Texture – Are you passing blood with clots?
- Duration – How long have you been experiencing the symptoms? Hours? Days? Has it been a solid flow or intermittent spotting?
- Intensity – Are your cramps mild or severe? Do they feel like menstrual cramps or is it a different type of discomfort?
Remember, bleeding and cramping is common in early pregnancy. Most often, the symptoms are temporary and you’ll go on to have a healthy pregnancy and baby. When you’re concerned, reach out to your doctor or midwife. The more information you can give your provider, the better able he or she will be to decide the appropriate next steps.
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1. Simkin, P. (2010). Pregnancy, Childbirth and the Newborn, 4th edition. Meadowbrook Press
2. Glade, B.C., Schuler, J. (2011). Your Pregnancy Week by Week, 7th edition. First Da Capo Press
3. The American College of Obstetricians and Gynecologists. (2010). Your Pregnancy and Childbirth Month to Month, 5th edition
4. Olds Maternal-Newborn Nursing & Women’s Health. (2012). Pregnancy at Risk: Gestational Onset. p 456-457.