Finding blood in your underwear when you are pregnant is terrifying. Your heart drops, your palms sweat, and your mind immediately races to the worst-case scenario.
We understand the fear. However, while bleeding is startling, there are often rational explanations for it. Not every instance of spotting signals a catastrophe. In fact, many women experience some form of discharge or light bleeding and go on to have perfectly healthy babies.
Read on to learn exactly what bleeding or spotting during pregnancy means, the specific symptoms to watch for, and when you need to call your doctor.
Key Takeaways
- It is relatively common: Bleeding impacts up to 30 percent of pregnancies, especially in the first trimester.
- Know the difference: Spotting is usually light and pink or brown, while bleeding is heavier and bright red.
- Identify the cause: Common triggers include implantation, hormonal shifts, infections, or placental issues.
- When to act: Always inform your doctor about bleeding, but seek immediate help for heavy flow, clots, or severe pain.
Spotting vs. Bleeding: What Is the Difference?
Doctors often refer to any blood outside your period as “breakthrough bleeding” (1). However, there is a distinct difference between “spotting” and actual “bleeding.” Knowing which one you are experiencing helps your doctor determine the urgency of the situation.
Here is how to tell the difference:
Spotting
- Volume: It is very light. You typically only see it on the toilet paper when you wipe or notice a small stain on your underwear.
- Color: It usually appears light pink or brown, similar to the very beginning or end of a period.
- Management: It does not require a pad or panty liner to control.
Bleeding
- Volume: The flow is heavy enough to require a sanitary pad.
- Color: It is usually bright or dark red.
- Consistency: It is similar to a menstrual period and may contain clots.
Is Bleeding During Pregnancy Normal?
When you see blood, it is hard not to panic. However, your body is undergoing massive changes right now. Hormones are shifting, tissues are stretching, and blood volume is increasing rapidly. Because of this, some bleeding can be a physiological side effect of pregnancy rather than a sign of loss.
Try To Relax
How Common Is It?
Bleeding is surprisingly common. Statistics show that up to 30% of women experience some bleeding during their first trimester (2). Overall, roughly one in five women will have bleeding at some point during their pregnancy journey (3).
You are most likely to see this in the early first trimester or late third trimester. Regardless of the timing, you should always report it to your healthcare provider just to be safe.
11 Common Causes of Bleeding or Spotting
There are many reasons you might see blood. Here are the most common causes, ranging from harmless to those requiring medical attention.
1. Implantation Bleeding
Fertilization happens in the fallopian tubes before the egg travels down to the uterus. Once it arrives, the fertilized egg must burrow into the blood-rich uterine lining.
This process can cause light bleeding known as implantation bleeding. It affects about one-third of pregnant women. Since it typically happens 3 to 7 days before your expected period, many women mistake it for a light menstrual cycle.
Duration
2. Miscarriage
Miscarriage is the loss of a pregnancy before 20 weeks. It is the most common fear when mothers see blood. Sadly, about 10 to 20 percent of known pregnancies end in miscarriage, with most occurring in the first 13 weeks (4).
Symptoms usually include brown or bright red bleeding, clots, tissue passing, or a gush of clear/pink fluid (5). If you suspect a miscarriage, your doctor will perform an ultrasound to check for a heartbeat and may use blood tests to track your hCG levels.
If hCG levels drop rather than double every 48 to 72 hours, it may indicate a loss. However, doctors always rely on ultrasounds for a confirmed diagnosis.
Sometimes, women experience a miscarriage, and after the initial symptoms of pain and bleeding, and after they notice tissue passing, they can start feeling their symptoms disappear and might not want to see their doctor. This can potentially be very dangerous for the woman since there are different types of miscarriages, and they can happen due to an ectopic pregnancy. So if you feel you are having a miscarriage, you should always see your doctor.
Editor's Note:
Dr. Irena Ilic, MD3. Ectopic Pregnancy
An ectopic pregnancy occurs when the fertilized egg implants somewhere outside the uterus, usually in a fallopian tube. This is a medical emergency because the egg cannot survive there, and it poses a severe risk to the mother if the tube ruptures.
Symptoms often include sharp abdominal pain, shoulder pain, lightheadedness, and vaginal bleeding. If you feel severe pain on one side of your abdomen accompanied by spotting, head to the emergency room immediately.
4. Molar Pregnancy
This is a rare complication where abnormal tissue grows inside the uterus instead of a baby. It is caused by a genetic error during fertilization. A molar pregnancy often causes bright red or dark brown bleeding, severe nausea, and a uterus that measures larger than expected for the date. Immediate medical treatment is required.
5. Placenta Previa
The placenta is the organ that nourishes your baby. Usually, it attaches high on the uterine wall. However, in cases of placenta previa, the placenta attaches low in the uterus and covers part or all of the cervix (6).
This is typically spotted during the mid-pregnancy anatomy scan. It can cause painless, bright red bleeding in the second or third trimester.
What It Means For You
6. Placental Abruption
Placental abruption is a serious condition where the placenta detaches from the uterine wall before delivery (7). This deprives the baby of oxygen and nutrients.
Unlike previa, abruption is often painful. You may feel sudden back or abdominal pain, a rigid uterus, and see heavy bleeding. If you experience these symptoms, call 911 or go to the hospital immediately.
7. Subchorionic Hematoma
A subchorionic hematoma is a pool of blood that collects between the uterine wall and the chorionic membrane (part of the placenta). It occurs in roughly 11% of pregnancies, particularly those conceived via IVF (8).
While it sounds scary, many small hematomas resolve on their own without harming the baby. Your doctor will monitor the size of the clot via ultrasound. You may be advised to rest and avoid lifting heavy objects until the bleeding stops.
8. Cervical Changes and Polyps
Your cervix is incredibly sensitive right now. High estrogen levels can cause cervical polyps (harmless growths) to develop. These polyps are prone to bleeding.
Additionally, the cervix has an increased blood supply. A cervical exam by your doctor or a transvaginal ultrasound wand bumping the cervix can cause light spotting for 24 hours afterward.
9. Vaginal Infection
Infections like yeast or bacterial vaginosis cause inflammation. Because your tissues are already engorged with blood, this inflammation can lead to light spotting.
Watch for other symptoms like itching, burning during urination, or foul-smelling discharge (9). Your doctor can prescribe pregnancy-safe antibiotics to clear this up quickly.
10. Sex
Yes, you can still be intimate. Sex is generally safe during pregnancy unless your doctor tells you otherwise. However, because the cervix is “friable” (easily irritated) due to increased blood flow, penile contact can cause light spotting.
Don't Panic
Don’t be shy about discussing sex during pregnancy with your partner and with your health care provider. There are some cases when your doctor might suggest you avoid sex, such as having an incompetent cervix, placenta previa, or unexplained bleeding. Even then, nine months will pass soon, and in the meantime, there are other ways to maintain intimacy with your partner, so don’t feel discouraged.
Editor's Note:
Dr. Irena Ilic, MD11. Mucus Plug and “Bloody Show”
Your mucus plug seals the cervix to protect the uterus from bacteria (10). As your body preps for labor, the cervix softens and dilates, causing the plug to release.
This discharge is often stringy, thick, and tinged with pink or brown blood. This is called the “bloody show.” It is a normal sign that labor is approaching, though it could still be days or weeks away. If you see bright red blood or a large amount of fluid before 37 weeks, contact your provider immediately.
Unknown Causes
Sometimes, women experience intermittent bleeding throughout pregnancy with no identifiable medical cause. It is frustrating, but if your ultrasounds show a healthy, growing baby, your doctor will simply monitor you closely.
Check Your Iron
When Should I Seek Medical Help?
Always mention any bleeding to your provider. It is better to be safe than sorry.
Call your doctor or go to the ER immediately if you experience:
- Severe, sharp abdominal cramping or pain.
- Bleeding heavy enough to soak through a pad in an hour.
- Passing large clots (bigger than a quarter) or grey tissue.
- Fainting, dizziness, or severe nausea.
- Fever of 100.4°F or higher.
- Shoulder pain (a sign of ectopic pregnancy).
Note: Never use a tampon while pregnant. Use a pad so you can monitor the amount and color of the blood (11).
FAQs
Why Am I Bleeding After a Positive Pregnancy Test?
You are likely experiencing implantation bleeding. This happens when the fertilized egg burrows into the uterine lining, causing light pink or brown spotting. It is a natural process and usually resolves within two days.
Can Dehydration Cause Spotting in Pregnancy?
Yes, severe dehydration can cause spotting. Dehydration decreases blood volume and can trigger uterine contractions. Always drink plenty of water throughout the day. Avoid sugary sodas and stick to water or electrolyte drinks.
Can Stress Cause Bleeding During Pregnancy?
Yes, extreme physical or emotional stress can affect your pregnancy and potentially cause spotting. High cortisol levels may impact hormone balance. If you feel overwhelmed, speak to a counselor or your doctor about stress management techniques.
What Kind of Bleeding Is OK In Early Pregnancy?
Light spotting that is brown or pink and not accompanied by pain is often normal. It can be due to implantation, sex, or cervical changes. However, bright red blood, clots, or bleeding with cramps requires immediate medical evaluation.
Can Heavy Lifting Cause Bleeding During Pregnancy?
Yes, lifting heavy objects can increase intra-abdominal pressure and cause strain, leading to spotting or bleeding. It is best to ask for help with heavy items, especially if you have a history of miscarriage or placenta previa.
The Bottom Line
Seeing blood during pregnancy is stressful, but it does not always mean the worst. From implantation to simple cervical irritation, there are many manageable causes for spotting.
However, you should never diagnose yourself. Always inform your doctor about any vaginal bleeding so they can rule out complications and help you have a safe, healthy pregnancy.
