There are many signs and symptoms of pregnancy—some welcome (thicker, shinier hair), others not so much (hemorrhoids, for one). A few, like bleeding and pain, can be downright unsettling, because it's hard to know if what you're experiencing is normal or not. You might be worried, but do you need to be?

Real talk: This article can’t fully answer that question for you, and we’re not here to give you personal medical advice. Only your clinician can do that. "Without a discussion with your doctor and probably an evaluation, there's no way to know what’s causing your bleeding or pain," says Annelise Swigert, M.D., an obstetrics and gynecology physician at Southdale Ob/Gyn in Minnesota and a regional medical director at Unified Women's Healthcare.

What we can do, however, is give you more details about bleeding and pain during pregnancy, including some of the possible causes. Being informed can help you better understand what might be going on—and calm some of your fears. 

So keep reading to learn more about these perplexing symptoms. Just promise us you'll close your browser and call your doctor if you have them. 

Bleeding During Pregnancy

First, some reassuring news: 25% of all normal pregnancies will have some spotting in the first trimester, Dr. Swigert says. But there’s no way for you to determine on your own if it’s harmless spotting or something more serious. 

“If you have bleeding at any time in pregnancy, you need to reach out to your doctor,” Dr. Swigert emphasizes. If it turns out to be nothing, it’s no problem that you called—it’s what your clinician is there for. Always better to be safe.

These are 10 of the potential reasons you could bleed when pregnant.

Implantation Bleeding

This spotting or light bleeding happens about 10-14 days after conception. It’s triggered when the fertilized egg becomes a blastocyst (a ball of dividing cells) and implants in the uterine wall. 

Ectopic Pregnancy

When a fertilized egg implants somewhere other than your uterus (often in a fallopian tube), it’s considered an ectopic pregnancy, this is a type of miscarriage. If you are experiencing irregular bleeding, dizziness, or pain in the pelvis or lower back early in the first trimester, prior to 8 weeks, you could have an ectopic pregnancy.

If left untreated an ectopic pregnancy is a medical emergency, that will cause internal bleeding. It is imperative to see a provider for an ultrasound and blood tests to diagnose or rule out an ectopic pregnancy.

Subchorionic Hematoma

This is when blood pools between the amniotic sac and the wall of your uterus. It’s most common in the first trimester, and would be diagnosed with an ultrasound. It can trigger light vaginal bleeding, but usually heals on its own without causing any pregnancy complications.

Cervical Polyps

These are small, non-cancerous growths on your cervix. The hormonal changes that happen during pregnancy can make them more likely to bleed. 

Polyps are almost always benign, but historically have been removed when pregnant. New research, however, suggests a potential link between polyp removal during pregnancy and preterm birth. Your doctor may still recommend removal during pregnancy, so be sure to discuss the benefits, risks, and potential alternatives.

Intercourse

Sex when pregnant? Totally acceptable (so long as you don’t have pregnancy complications). Some bleeding afterward? A minor annoyance. The typical cause is increased blood flow to the cervix. 

Miscarriage

Pregnancy loss is most likely to happen in the first trimester; spontaneous chromosomal abnormalities are a leading cause. "Bleeding in the first trimester does not always mean you’re having a miscarriage," Dr. Swigert says. “But you need to reach out to your provider for further evaluation.”

Placental Conditions

Problems with the placenta can trigger bleeding. One potential issue is placenta previa, when the placenta has implanted over the cervix. This can occur in all trimesters, however it is most often diagnosed in the second trimester.      

Another concern is placental abruption, which is when the placenta separates from the uterus. This can happen at any time after week 20 but is most common in the third trimester. If you experience sudden and severe abdominal and back pain, with or without bleeding, you need to contact your doctor immediately; this could be a medical emergency.

Infections

Whether pregnant or not, urinary tract infections (UTIs) and sexually transmitted infections like chlamydia can cause bleeding. UTIs, also known as bladder infections, are a common complaint during pregnancy and can also cause pain in the back, sides, and pelvic area.

Bloody Show

It’s quite the name, we know—but the event itself is normal. A combination of mucus and a little bit of blood, this vaginal discharge can be a sign that you’re about to go into labor.

Pain During Pregnancy

“Mild cramping can be normal in pregnancy,” Dr. Swigert says. It’s often the result of constipation or your ligaments stretching (more on that, below). But—and we don’t mind sounding like a broken record—you should check with your doctor whenever you have pain. This is especially true if it’s acute or accompanied by other symptoms like nausea. 

Don’t wait to see if the pain goes away on its own, and don't go down a Google rabbit hole trying to diagnose yourself. "Pain doesn't always mean there’s something wrong with the baby, but you need to have a discussion with your provider," Dr. Swigert says. Here are five possible causes of pain during pregnancy.

Ligaments Stretching

Ligaments, if you need a refresher, are bands of connective tissue that support your bones, joints, and organs. The hormonal rollercoaster of pregnancy helps loosen your ligaments, especially the ones in your pelvic area, to make room for a growing fetus and prepare your body for childbirth. When the ligaments stretch, you might feel temporary sharp or shooting pain.

Constipation

Constipation is a usual suspect in pregnancy, especially in the third trimester. (Pregnancy hormones—surprise, surprise—are often the culprit.) Constipation can cause abdominal pain and cramping.

Stomach Flu

This is different from the flu-shot flu, and is also known as gastroenteritis. It’s caused by a number of different viruses, including norovirus (which has cursed many a cruise ship).

When you’re expecting, changes in your immune system occur to help your body support a pregnancy. There’s some evidence that these changes might also leave you more susceptible to viruses and other infections. 

Regardless, stomach bugs like norovirus are incredibly contagious. And they’re no fun—think vomiting plus diarrhea. Beyond the tummy upset, stomach flu also can cause muscle aches and abdominal cramping.

Kidney Stone

A 2021 study found that pregnancy increases the risk of a first-time kidney stone, particularly in the third trimester. A kidney stone can cause vague abdominal pain and more severe pain in your lower back.

Preterm Labor

This is defined as labor that happens between weeks 20 and 36. Symptoms include frequent contractions, a dull backache, and abdominal cramping that feels like strong menstrual cramps. Long story short, if you have more than mild menstrual cramping, reach out to your doctor immediately to determine if you might be in preterm labor.

Got a question about bleeding or pain during pregnancy? Or experiencing it now? It could be no big deal, but we always recommend—say it with us!—calling your clinician to make sure everything’s ok. 

A Pain in the…

Not neck, but many other body parts can hurt during pregnancy. What pain might mean in three of them.

Abdomen: Haven’t pooped in a while? Could be constipation. Stomach bugs like norovirus also can cause abdominal cramping (along with their signature vomiting and diarrhea).

Back: Lower-back aches are often a no-problem pregnancy thing. But if accompanied by irregular bleeding early on, it could be a sign of an ectopic pregnancy. A kidney stone can also trigger serious lower back pain.

Pelvis: Ectopic pregnancies can include pelvic as well as back pain. A hurting pelvic region could also signal a UTI, or it might be your ligaments stretching to make room for the fetus.