Spotting During Pregnancy: Should You Be Worried?

One of the scariest things you can experience when you’re pregnant is finding blood in your underwear.

We’ve been there and know how alarming it can be. But bleeding does not automatically mean you are having a miscarriage. There are several other explanations for spotting during pregnancy.

So, how do you know when bleeding or spotting is just a normal part of pregnancy and when it’s a sign of a more serious problem?

In this article, our medical team will discuss whether you can still have a light period while pregnant, what causes bleeding during pregnancy, and when you should seek help.

Can I Be Pregnant and Still Have a Period?

If you’ve been trying to conceive and noticed your period is much lighter this month, you may be wondering if you could be pregnant. Up to 25% of pregnant women still experience vaginal bleeding.

Although many women experience light, irregular bleeding or spotting during early pregnancy, there are several other reasons you could be experiencing a light period, including the following:

• stress
• hormone imbalance
• birth control pills
• menopause
• poor nutrition
• low body weight
• excessive physical exertion

Bleeding during pregnancy is typically dark brown to light pink. It should never be bright red.

There should also not be enough blood to fill pads and tampons over a few days. If you’re bleeding enough to fill pads or tampons, then it’s unlikely you’re expecting.

Although some women claim they were still having their period during pregnancy, according to the medical community, this is not possible and is most likely due to other reasons that require consultation by a health care professional. Spotting is normal, especially in the first trimester. However, heavy or consistent bleeding should not occur during pregnancy.

Editor's Note:

Dr. Njoud Jweihan, MD

If you are expecting, you might also be experiencing:

• Breast changes such as swelling, tenderness, or darkening of the areolas.
• Nausea and vomiting, otherwise known as morning sickness.
• Fatigue.
• Lightheadedness.
• Constipation.
• Loose stools or diarrhea.
• Food aversions or cravings.
• Mood swings.
• Frequent urination.
• Headaches.

If you’re experiencing spotting and light bleeding when you think you might be pregnant, you may want to take a home pregnancy test. For best results, take the test one week after your “missed” period and use your first-morning urine.

Causes Of Light Period During Pregnancy

Light bleeding or spotting is quite common, especially in the first trimester. But that doesn’t make it any less scary when it happens.

There are several reasons you might be bleeding during pregnancy:

1. Implantation bleeding

Implantation bleeding is one of the first signs of pregnancy for many women. Implantation bleeding can be confused with your regular period, as it tends to happen around the same time as your period would and is often accompanied by implantation cramps, which can be mistaken for PMS cramping.

However, with implantation bleeding, your period should be much lighter in color, flow, and length. Treatment is not usually necessary, and the symptoms will resolve on their own.

2. Sex

During the second and third trimesters, your cervix starts to swell because of increased blood flow, and the blood vessels in the area are easier to break during intercourse. Therefore, it’s not unusual to have some spotting after sex ⁽¹⁾. You can try other positions during intercourse that decrease the chance of spotting, such as the rear-entry position and side-lying.

3. Vaginal exams

Vaginal exams, such as a pap smear or cervical check, can irritate the cervix and cause spotting due to your increased blood volume. Bleeding can occur within 24 hours of your exam but should not last for more than a day. Your provider will most likely give you a light pad to wear following these exams.

4. Nearing Labor

Light bleeding toward the end of your pregnancy is often an indication your birthing day is almost here. As your body prepares for labor, your cervix begins to soften and dilate, and you may lose your mucus plug. Your mucus plug will most likely be a stringy and thick discharge that is brown with a tinge of pink or red.

Losing your mucous plug does not always mean you are in labor. Labor may not start until hours or even days after. Even though it might not mean you are about to be in labor, let your doctor or midwife know if you lose your mucus plug before reaching 37 weeks of pregnancy.

Editor's Note:

Dr. Njoud Jweihan, MD

When Do I Need to Worry?

Many expecting moms who experience light bleeding have normal and healthy pregnancies. However, there are times when bleeding can indicate a more serious problem with the pregnancy.

Bleeding during pregnancy is always worrisome if it’s heavy, bright red, lasts more than a few days, or presents with a fever, fainting, or cramps.

If you’re having any of these symptoms, you could be dealing with any of the following:

1. Miscarriage

Miscarriages are more common than you would think. Nearly half of all women who experience light bleeding early in their pregnancy go on to have a miscarriage, usually in the first 12 weeks of pregnancy. Contact your doctor if you have light bleeding that continues to get heavier or is accompanied by painful cramping or back pain or if you pass any tissue along with the blood.

2. Chemical pregnancy

A chemical pregnancy is a very early miscarriage that occurs when an egg gets fertilized but never fully implants in the uterus. This happens even before the fetus can be seen on ultrasound. There’s no specific treatment for these miscarriages. However, your doctor can run some tests to help diagnose possible underlying causes, such as checking the levels of the hormone human chorionic gonadotropin (HCG,) the hormone that forms after implantation. Many women who experience a chemical pregnancy don’t even realize they were ever pregnant ⁽²⁾.

3. Ectopic pregnancy

An ectopic pregnancy is where the embryo implants somewhere other than your uterus, most often the fallopian tubes. If left untreated, you could be dealing with a rupture that could lead to internal bleeding, fainting, shock, and even death. Be sure to head to the emergency room if your light bleeding is coupled with severe pelvic or abdominal pain, shoulder pain, or extreme lightheadedness.

Ectopic pregnancies can occur if you have scarring in the fallopian tubes due to prior infection, previous surgery in the area, or abnormal growths and congenital disabilities. Smoking and older age are examples of risk factors that can lead to an ectopic pregnancy.

If you’re diagnosed with an ectopic pregnancy, you will likely be treated with medication or surgery.

4. Placenta problems

After about 20 weeks, bleeding could be a sign of a problem with the placenta, such as placenta previa or placental abruption. Placenta previa is a rare condition that usually occurs in the third trimester. It is where the placenta is near or covers the cervical opening, leading to hemorrhage, birth defects, slow fetal growth, and preterm birth. Placental abruption is where the placenta separates from the uterus wall before birth and can cut off nutrients and oxygen to your baby. This is a dangerous condition that requires a prompt diagnosis ⁽³⁾.

The important difference between the two is that with placenta previa, the bleeding is usually painless, while placental abruption can be associated with abdominal pain, clotting, and back pain.

5. Uterine Rupture

This occurs when the scar from a prior cesarean section tears open during pregnancy. It is a rare but dangerous condition and usually requires an emergency C-section.

6. Premature labor

Vaginal bleeding in the second or third trimester could be a sign of premature labor, so it’s never a bad idea to get your health care provider to check it out. There are things your doctor can do to help delay an early delivery, and they may prescribe bed rest or medication that attempts to stop labor, mature the baby’s lungs, and prevent infections. If you are in preterm labor, you might also be experiencing backaches, cramping, contractions, pelvic pressure, vomiting, diarrhea, or fluid leakage along with your light bleeding.

7. Infection

A vaginal or sexually transmitted infection (STI) may or may not be related to your pregnancy, but they are known to cause cervical inflammation and irritation, making you more prone to bleeding. If this is the cause, your underlying condition will need to be treated since STIs can harm your baby. Symptoms associated with STIs can include bumps or sores near the mouth or genital area, skin rash, burning or pain upon urination, severe genital itching, and discharge.

What Should I Do if I’m Bleeding?

If you’re having an irregular period and haven’t confirmed your pregnancy yet, the first place to start is to take a home pregnancy test. If you get a positive result, call and schedule an appointment with your health care provider, and be sure to let them know about the bleeding.

If you know you’re pregnant and are having some spotting, call your provider and see if they need you to come in for testing or monitoring. Spotting usually isn’t concerning, but it’s best to have a proper diagnosis.

FAQs

Does a Light Period Mean Low Fertility?

Not necessarily. A light period isn’t usually a sign of infertility. But if your periods are consistently very light or irregular, it could indicate a hormonal imbalance or other medical conditions, so it’s worth discussing with your doctor.

How Long Does a Light Period Last During Pregnancy?

If you’re pregnant, what you’re experiencing may not be a period but implantation bleeding, which can be lighter and much shorter than a regular period. This usually happens around the time your period is due, so it’s easy to get confused.

Can You Get a Negative Pregnancy Test With a Very Light Period?

Yes, you can. If it’s early in the pregnancy, there might not be enough hCG (the pregnancy hormone) to be detected yet. If you still suspect you’re pregnant, try testing again in a few days.

To Sum it Up

While light bleeding or spotting is common during pregnancy, it’s always best to call your doctor if it happens to you.

Bleeding could be an early sign of pregnancy, but it could also indicate a serious complication with the pregnancy, such as a miscarriage or ectopic pregnancy. Sex and vaginal exams can also cause bleeding later in pregnancy, but late-term bleeding could also signify a placental problem or preterm labor.

If you’re in pain or your blood is heavy or bright red and you can’t get ahold of your doctor, head to the nearest ER. It might be nothing, but it’s better to be safe than sorry.