Spotting during pregnancy—as in, bleeding from your vagina when you’re most definitely not on your period because, hello, you’re pregnant—can be a perplexing issue. Isn’t one of the boons of pregnancy not ruining more underwear with period blood? Sorry to break it to you, but spotting during pregnancy is a thing. Though it’s probably easier said than done, there’s no need to automatically panic because you have some pregnancy spotting—it can actually be a completely standard part of the pregnancy experience.
“You can have spotting throughout your whole pregnancy, and it can be considered normal,” Sherry Ross, M.D., an ob/gyn and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, tells SELF. It’s especially common to experience spotting during your first trimester, Alyssa Dweck, M.D., a gynecologist in Westchester, New York, assistant clinical professor of obstetrics and gynecology at Mount Sinai School of Medicine, and coauthor of The Complete A to Z For Your V, tells SELF. According to the American College of Obstetricians and Gynecologists (ACOG), this happens in 15 to 25 percent of pregnant people. “If spotting happens early in pregnancy, we don’t get too hot and bothered about it,” Dr. Dweck says.
But when is spotting during pregnancy a sign of a possible problem? Here’s what experts want you to understand about spotting during pregnancy.
What causes spotting during pregnancy?
There can be various reasons you might spot during pregnancy.
First and foremost, spotting can occur because of implantation bleeding, which happens when a fertilized egg implants into your uterine lining, the experts explain. This typically happens within one to two weeks after conception, ACOG says.
Also, pregnancy creates more blood flow than usual to the uterus, vagina, and cervix, Jamil Abdur-Rahman, M.D., board-certified ob/gyn and chairman of obstetrics and gynecology at Vista East Medical Center in Waukegan, Illinois, tells SELF. That blood can seep out after sex or any other physical activity, or even for seemingly no reason, he explains.
Another reason for pregnancy spotting is subchorionic hematoma or hemorrhage, which occurs when blood collects between the chorion, or outermost membrane around the embryo, and the uterine wall, Jacques Moritz, M.D., an ob/gyn at NewYork-Presbyterian and Weill Cornell Medicine, told SELF in a previous article. Those are all pretty normal reasons for spotting during pregnancy and aren’t really worrisome (although experts are investigating if there’s a relationship between subchorionic hematoma and increased risk of miscarriage).
On that note, yes, spotting can be a sign of miscarriage or ectopic pregnancy, which happens when a fertilized egg implants in a fallopian tube instead of the uterus, says Dr. Abdur-Rahman. It can also signal preterm labor or infection, he explains.
If you’re bleeding during the second half of your pregnancy, that could indicate a placental issue like placenta previa, says Dr. Dweck. “This happens when instead of the placenta implanting at the top of the uterus where it’s out of the way of everything, it implants covering your cervix, either fully or partially,” she explains.
That’s a problem since the cervix is the passageway for your baby during birth. “Any irritation to the cervix can lead to heavy bleeding and could be cause for emergency,” says Dr. Dweck. If you have placenta previa, your doctor may recommend avoiding certain activities including sex, using tampons, or doing anything that could increase your risk of bleeding such as jogging, doing squats, and jumping, according to the Mayo Clinic.
Finally, seeing some vaginal discharge that’s pink or contains blood at the end of your pregnancy could be a sign you’ll go into labor soon, the Mayo Clinic says. This is known as a “bloody show,” which is an apt term. The Mayo Clinic recommends calling your doctor and describing the discharge so you’ll know if it’s time to get your baby-having show on the road.
Here’s when you should worry about spotting during pregnancy.
To reiterate, pregnancy spotting is usually nothing to freak out about. But it’s good to know what’s normal and what’s not. Below are the signs that something might be up with your pregnancy and when you should call your doctor.
1. The bleeding is pretty heavy.
It’s hard to quantify exactly what to look for, but Dr. Ross says if you’re soaking through less than one pad or tampon in three hours, that’s generally considered mild bleeding and is likely NBD. If it’s more than one pad or tampon in three hours, that’s moderate. Anything more than that is heavy bleeding, and both moderate and heavy bleeding can be worrisome, she explains. If you think you’re experiencing either of those, get in touch with your doctor ASAP. This is especially important if you see a lot of tissue or clots in the blood, the Mayo Clinic notes.
2. It’s accompanied by intense pain, fever, or chills.
Cramps often accompany spotting, so you might feel some twinges of discomfort here or there. But anything that morphs into more significant pain is worth noting and potentially calling your doctor about. “Mild cramping can be considered normal, but if you have to sit down or put a hot water bottle on your lower back or it’s anything more than a little cramping, it’s more of a cause for concern,” says Dr. Ross. Dr. Abdur-Rahman agrees, saying a lot of pain with spotting is one key sign there may be a problem. Similarly, unusual accompanying symptoms like fever or chills along with your bleeding are a sign that you should talk to your doctor immediately, the Mayo Clinic says.
3. Along with the heavy bleeding and intense pain, you are spotting for several hours or days.
If you’re only noticing light bleeding every once in a while without much discomfort, you’re probably in the clear, says Dr. Abdur-Rahman. “As a general rule, if there’s no pain, it’s not persistent, and it’s not heavy, it’s probably nothing to be concerned about,” he explains. What counts as persistent enough to potentially be worrisome depends in part on how pregnant you are. The Mayo Clinic recommends calling your doctor if you’ve been spotting for longer than a day in your first trimester (and telling your doctor at your next appointment if you had spotting that abated within a day). As for your second trimester, get in touch with your health care provider the same day if you see some spotting that fades in a few hours, and immediately if it lasts longer than that. And in your third trimester, the Mayo Clinic recommends getting in touch with your doctor immediately if you see any amount of spotting.
With all of that said, the experts emphasize that you should feel free to call your health care provider or go in for an appointment even if your spotting doesn’t meet these criteria. “I tell people, just to be on the safe side, call or come in,” says Dr. Abdur-Rahman. Dr. Ross agrees. “The word ‘spotting’ is so different for everybody, so I think any kind of bleeding—even if it’s light—is worth a phone call to the doctor’s office,” she says. “Does it have to happen at 3:00 A.M.? No, not if there aren’t any other symptoms. But it never hurts to call just for reassurance. That’s what doctors are for.”