This information is about pain and bleeding in early pregnancy clinics. Not all of the problems discussed will apply to you as causes of bleeding and pain are varied.
Our aim is continuity of care, however this is not always possible, and when you are in hospital you will be looked after by a team of doctors and nurses.
Is it normal to have bleeding/spotting in pregnancy before 18 weeks?
Spotting or bleeding in early pregnancy can be common. It can occur in about 20 in 100 people, and may also come with lower abdominal (tummy) pain and back pain. These symptoms do not mean there is a problem with the pregnancy.
Why am I bleeding?
There are many causes of bleeding in early pregnancy. If you have been scanned, this may help us understand why.
If the scan is normal we will discuss with you possible causes of bleeding but may never be sure of the exact reason. The main aim of scanning is to assess whether the pregnancy is normal.
The bleeding may be coming from the neck of the womb. Some changes on the cervix related to hormones (ectropian) are common in pregnancy, which can cause bleeding.
In an ectropian, cells that line the inside of the canal (behind the cervix) change position. These cells are more fragile and are prone to bleeding. This is not a sinister or worrying problem, and it is commonly seen. However, in pregnancy, it can make you anxious. Bleeding can be light, pink, dark, or red, and can sometimes be a heavy ‘gush’. The pregnancy is rarely affected by this.
In other cases, an area of bleeding outside of the pregnancy sac (commonly related to the placenta) has occurred. This usually resolves without any prolems. This is called a subchorionic bleed and occurs in about 1% of pregnancies.
Sometimes on a scan, we can measure this and look at the size of the sac/pregnancy in comparison to the size of the area of bleeding. We may scan again if the bleed is the same size or larger than the the sac.
In cases where the subchorionic bleed continues to be present on future scans and remains equal to or larger than the size of the sac, further scans may be needed including a dating scan.
If large subchorionic bleeds do not resolve the placenta can struggle to function as well as it should. This is not common.
Although bleeding in pregnancy is not uncommon, we appreciate having bleeding in pregnancy remains an anxious time for many women.
What if the bleeding continues?
It is normal following a bleed in pregnancy to have some brown pink or vaginal bleeding/discharge for a week or so. If the bleeding becomes heavy, or you pass any blood clots, along with pain, you should contact the clinic via a self-referral form. If you are very concerned you can contact 111. You maybe advised to return to EPC for review.
Our usual advice is to allow the bleeding to settle over about 10 to 14 days. If you are having persistent slight bleeding past this time, we may consider a re-referral for advice .
Many women experience bleeding and/or pain in pregnancy and carry on to have a normal pregnancy. Some of these women have more than one bleeding episodes in the pregnancy.
This does not mean a miscarriage will happen, but if the bleeding does not settle over a number of weeks, or heavy bleeding starts, a further scan will be needed.
Sometimes bleeding is a sign of a problem with the pregnancy. If your scan is normal then this is reassuring.
Can I still have intercourse?
Sexual intercourse is perfectly safe in pregnancy. However if you have had bleeding or spotting, wait until this completely settles or any discharge stops before resuming sex.
Should I rest in bed?
There is no reason to rest in bed – you may carry on normal activities, just be sensible and rest when you are tired.
Should I go to work?
There is no reason to stay at home, however if you have a strenuous job you may wish to remain off work until the bleeding settles off. See the GP if you need to be signed off.
Can I use tampons?
Sanitary pads are safer, and better. Make sure you change pads or liners regularly.
Can I have a bath?
Personal hygiene is important. Showers are more hygienic if you are bleeding, but it is ok to have a bath.
Pain in pregnancy
Why do I have pain?
If you have unexpected abdominal or back pain during pregnancy it is easy to worry. Some pain may need medical attention, but often pain is relatively harmless.
We do not always find a cause for pain but we know that episodes of discomfort are common during early pregnancy.
Will the pain affect the pregnancy?
In most cases the baby will be absolutely fine, and the pain will not harm the pregnancy in the future.
Most common reasons for pain in pregnancy
- One of the first times when you may experience pain is around the time of your first missed period. For a day or two, some women have a pain that is low down in the abdomen (tummy) and feels a bit like a dull period pain. It is thought that the embryo is beginning to implant itself in the lining of your womb at this time.
- At any time during pregnancy, constipation, bloating and wind can cause aches, pains and abdominal discomfort. Constipation is common, and pregnancy hormones slow down the way the gut works.
- As the pregnancy progresses, women often have discomfort or pain on and off as the womb begins to change more. The ligaments or muscles around your uterus stretch and thicken as they support a growing baby, and can cause of discomfort.
- In later pregnancy, Braxton-Hicks contractions may cause some pain. These contractions, (which are irregular tightenings of the uterus), can occur from early pregnancy, but most women don’t notice them until the second half of a pregnancy. This is a normal but can feel uncomfortable.
If you are concerned, or the contractions become more frequent, do talk to your doctor or midwife, or send a new referral in to the early pregnancy clinic and we will triage you by phone.
Causes of pain
Common gynaecological causes of pain include:
- Pelvic infection. Thrush occurs in about 25 in 100 pregnant women. Chlamydia/pelvic infection in up to 5 in 100 women.
- Ovarian cysts occur in 1 to 2 in 100 women (many cysts resolve without any treatment, and are usually nothing to worry about).
- Fibroids (can occur in 1 in 1000 to 1 in 1500 women.
- Irritable bowel syndrome – can get worse in pregnancy if you already have this.
- Musculoskeletal pain for example low back pain is common in pregnancy.
Renal causes
- Urinary tract infection (water/kidney infection) are common in pregnancy and can affect 1 in 25 women.
- Renal stones (kidney stones). (Rare in pregnancy)
Other causes include:
- Appendicitis - this is rare in pregnancy.
- Gallstones (which can enlarge during pregnancy and may present for the first time) - also rare in pregnancy.
What will happen to work out why I have pain?
If you have mild pain and are well, with a normal scan, you will be discharged back to their GP.
If you fell less well or have a lot of pain you may need to be seen by a nurse or doctor.
What does this include?
- Asking you about your symptoms: pain history, vaginal bleeding, urinary symptoms.
- Last period date, and what your periods are usually like.
- Previous operations or medical problems.
- Examination.
- General examination - to see how you are feeling and look for signs of infection. This may include blood pressure, pulse, temperature, breathing rate, and a urine dipstick.
- Abdominal examination - to see where you are tender, and also to assess the pregnancy and uterus.
- Possibly, vaginal examination.
- The neck of the womb can be examined and bleeding assessed.
Other possible investigations
- MSU (urine testing) to look for a water infection.
- Vaginal swabs - to look for infection.
- Full blood count to look for infection and to make sure your iron count is normal.
How we look after you
We look after you by trying to find the cause of the pain and treating you once we are sure we know what the problem is.
If we have taken any blood tests or swabs or water samples, we will let you know if there are any problems.
We will not contact you if everything is normal.
Please note that swabs and urine samples take 1 to 2 days to come back. Some specialist swabs can take longer.
If needed we may refer you to a different specialist.
Basic painkillers (paracetamol) are used to control pain.
Summary
There are many reasons for pain in pregnancy, but the majority of women we see have nothing seriously wrong.
The main aim of assessing you is to exclude any worrying cause for pain, and to ensure the pregnancy itself is doing well.
If in the next week the pain gets worse, or does not go away, speak your GP.
References and sources of further information
- Antenatal care NG201. 19 August 2021.
- Bleeding and pain in pregnancy RCOG (2016)
- Ectopic pregnancy and miscarriage NICE guidance NG126 2019 (Reviewed August 2023).
- Tommys: www.tommys.org
Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002073