Spotting during pregnancy 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 this is a thing. According to the American College of Obstetricians and Gynecologists (ACOG), spotting during pregnancy happens in 15 to 25 percent of pregnant people. 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 experience of growing a tiny human.
But when is spotting during pregnancy a sign of a possible problem and when is it normal? Here's what experts want you to understand about this.
What Is It
Spotting is another word for light bleeding, according to ACOG. Maybe you see a little bit of blood in your underwear or on the toilet paper after you wipe. Spotting during pregnancy essentially means any light bleeding from your vagina when you're most definitely not on your period—because, hello, you're pregnant.
What Causes It
There is not just one definitive cause for spotting during pregnancy. In some cases, 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, 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. It can also sometimes signal preterm labor or infection, he explains.
But there are also plenty of other less serious reasons for spotting during pregnancy.
Difference Between Spotting and Bleeding
Spotting is another word for light bleeding, ACOG says, and that’s definitely different from having a heavy flow. But spotting is technically still bleeding. Your cervix may bleed more easily during pregnancy because more blood vessels are developing in this area. ACOG specifically says that it’s “not uncommon” to have spotting or light bleeding after sex, a Pap test, or pelvic exam when you’re pregnant. If you’re soaking through less than one pad or tampon in three hours, that’s generally considered mild bleeding or spotting and is likely no big deal, 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. Still, if you’re concerned or it continues, that’s certainly worth bringing up with your doctor, midwife, or care provider.
When It’s Normal
In general, there are several circumstances that are thought of as typical, common reasons for spotting 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, according to ACOG.
Pregnancy also creates more blood flow than usual to the uterus, vagina, and cervix, says Dr. Abdur-Rahman. That blood can seep out after sex or any other physical activity, or even for seemingly no reason, he explains.
How to Tell If It’s a Problem
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 care provider.
1. The bleeding is pretty heavy.
If you’re going through more than one pad or tampon in three hours, that's considered moderate bleeding, Dr. Ross says. Anything more than that is heavy bleeding. During pregnancy, 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 or midwife 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.
Spotting Throughout the Trimesters
In general, doctors don’t tend to panic about light bleeding in the first trimester, when spotting is the most common. “If spotting happens early in pregnancy, we don’t get too hot and bothered about it,” Alyssa Dweck, M.D., a gynecologist in Westchester County, 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.
But if you’re bleeding during the second half of your pregnancy, that could indicate a placental issue like placenta previa, says Dr. Dweck. Placenta previa is a condition where the placenta, the structure that provides oxygen and nutrition to the baby during pregnancy, implants over the cervix, the outlet for the uterus, the Mayo Clinic says. Placenta previa can be full or partial.
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 midwife or doctor and describing the discharge so you'll know if it's time to get your baby-having show on the road.
When to See a Doctor
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."
Originally Appeared on SELF