Keith Williams

During pregnancy, your body changes. A lot. And in early pregnancy, you may deal with some large hormonal shifts. Between mood swings, exhaustion and morning sickness, you might not feel your best. But there’s another symptom that can happen in early pregnancy that you might not be thinking about — bleeding or spotting.

Bleeding occurs in about a quarter of early pregnancies. Most of the time, it’s nothing to worry about.

Bleeding during the first 12 weeks of pregnancy, also called early pregnancy bleeding, can look different for everyone. The amount of blood can range from light to heavy. For some, it can be intermittent. Others may have more constant bleeding or spotting. And it may or may not be painful.

Here are a few things that might be behind it:

Implantation bleeding

Early in pregnancy (sometimes before you know you’re pregnant), you may have some spotting when your period is due. This common occurrence is called implantation bleeding. It happens between 6 and 12 days after conception as the fertilized egg implants into your uterus. This bleeding is typically light and may last for a few days.

Cervical changes

During pregnancy, there’s increased blood flow to your cervix. Having sex or getting a Pap smear, which cause contact with the cervix, can trigger light bleeding. Other cervical changes that can trigger bleeding include:

— Polyps

— Minor infections

— Cervical ectropion (when cells from the inside of the cervix move to the outside)

— Hormones

In the early weeks of pregnancy, your body starts making the hormones you need to sustain a pregnancy. This change can cause your progestin levels to drop. That drop may lead to spotting or light bleeding.

Miscarriage

Since miscarriages are most common during the first trimester, worrying about bleeding is normal. Light bleeding or spotting doesn’t automatically mean you’re miscarrying. But if your bleeding is heavy, bright red or you’re passing clots and in pain, contact your healthcare provider. They can explain next steps and recommend if treatment is needed to prevent infection or other complications.

Most early miscarriages can’t be prevented. They aren’t caused by normal physical activities like having sex, exercising or lifting heavy things.

Most people who miscarry go on to have healthy pregnancies. But having a miscarriage is a loss that families may need help handling. Don’t rush the grieving process, and find a support group or counselor if you feel you need it.

Ectopic pregnancy

An ectopic pregnancy happens when a fertilized egg implants outside the uterus, like in your fallopian tube. When that happens, it can lead to heavy bleeding, pain and other serious symptoms. An ectopic pregnancy is an emergency. If you have symptoms, contact your provider or seek emergency care immediately.

Call 911 or go to the nearest emergency room if you have any of these symptoms:

— Severe pain or cramps low in the abdomen

— Severe bleeding, soaking greater than one heavy pad per hour, with or without pain

— Passage of blood clots or tissue

— Dizziness or fainting

— Chills

— Fever higher than 100.4 F

If you’re pregnant and bleeding heavily, don’t use a tampon. Wear a pad instead.

Doctors need to know how much you’re bleeding to decide the best way to help you.

And if you’re passing tissue, consider bringing it in for testing.

When you visit your doctor

When you see a healthcare provider for bleeding in the first trimester, they may:

— Perform a pelvic exam

— Take an ultrasound

— Draw blood to check your hormone levels and blood type

These tests show whether the pregnancy growing as expected, and if it’s growing safely in your uterus. Once they find the cause, your provider will work with you on a treatment plan, if needed.

Building good habits now can help you have the healthiest pregnancy possible. Follow these suggestions to help you (and your baby) feel your best:

— Eat a nutritious, well-balanced diet

— Exercise regularly

— Avoid alcohol, recreational drugs and cigarettes

— Reduce caffeine intake to 1-2 cups a day

— Attend regular prenatal visits

— Take your prenatal vitamins

For more health and wellness tops, visit Geisinger.org/balance.

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Dr. Keith Patrick Williams, MD, is Geisinger division chief of OB-GYN.