Spotting in early pregnancy: what causes it and what to do

Seeing blood when you’re pregnant, or think you might be, is frightening. It isn’t always a sign that something is wrong, but it should always be checked, so here’s what can cause it and what to do.

Is spotting normal in early pregnancy?

The NHS says vaginal bleeding in pregnancy is not always serious, but it can sometimes need urgent treatment. It also says that sometimes it isn’t possible to find the cause. So the safest approach is to treat any bleeding as something to get checked, rather than something to wait out or look up.

What can cause it

The NHS lists causes that include:

Implantation bleeding, when the fertilised egg attaches to the lining of the womb. Some people put early spotting down to implantation, but the evidence for this is weak, so don’t assume that’s the cause. Any bleeding is worth getting checked. See implantation bleeding.
Changes to the blood vessels in your cervix, which can cause light bleeding after sex.
An infection, such as a urine infection or a sexually transmitted infection.
Miscarriage.
Ectopic pregnancy, where the pregnancy grows outside the womb.
Molar pregnancy, a rare problem with the way the pregnancy has formed.
A leak of blood from inside the womb.
Complications with the placenta, such as placenta praevia.
A ‘show’ (the mucus plug, sometimes with a little blood), which can be a sign that labour is starting. This applies later in pregnancy.

The colour or amount of blood can’t reliably tell you the cause, so please don’t try to work it out yourself.

When to get help

If you’re pregnant and you have any bleeding or spotting, even if it’s light, get urgent advice. Call your maternity unit if you have the number. If you’re under 20 weeks you can also contact an early pregnancy unit, or call NHS 111 if you can’t reach either.

Call 999 if you have bleeding along with severe tummy pain, pain in your shoulder, or feeling sick, faint or dizzy, or if the bleeding is heavy (soaking a pad soon after putting it on). Also call 999 if you have sudden, sharp and intense tummy pain and you feel very dizzy or faint, feel sick or look very pale. These can be signs of an ectopic pregnancy or a miscarriage that need treating straight away.

The NHS describes severe pain as pain that means you cannot focus on TV, read a book or do daily tasks.

What to expect when you call

The NHS says if you have light bleeding or spotting with no pain, or only mild tummy pain that doesn’t stop you doing daily tasks, you should get urgent help from your maternity unit, an early pregnancy unit or NHS 111. The same applies if you also have diarrhoea, or pain or pressure when you pee or poo. They may ask you to come in for an examination or a scan. Contact details for your local early pregnancy unit are on your NHS trust’s website or in your maternity notes.

If you haven’t yet seen a midwife, ring NHS 111 or your GP surgery. You don’t need to wait for a booking appointment to ask for help.

While you wait

Note the time it started, how heavy it is and any pain. This helps when you speak to someone.
Try to have someone with you if you can.

If it turns out to be a miscarriage

Bleeding in early pregnancy does sometimes mean a miscarriage. If that happens, it is not your fault, and there is support. Miscarriage UK is on 0303 003 6464, and Tommy’s has a midwife line on 0800 0147 800. See also trying again after a miscarriage when you feel ready.

Questions people ask

Is spotting a sign I’m pregnant?

It can be, because implantation bleeding happens in the days around when your period would be due. But spotting can also be an early period or something else, so a pregnancy test is a better guide. See pregnancy or period. If the test is positive and you’re bleeding, get urgent advice.

Is brown blood less worrying than red?

Not necessarily. Brown blood is older blood and can still need checking. Treat any colour of bleeding in pregnancy the same way and get it checked.

I’ve had light spotting after sex. Does that matter?

The NHS says changes to the blood vessels in the cervix can cause bleeding after sex. It’s still bleeding in pregnancy, so tell your midwife, maternity unit or NHS 111 rather than waiting to see if it settles.

Can I just wait until my booking appointment?

No. Don’t wait for a routine appointment if you’re bleeding. Contact your maternity unit, early pregnancy unit or NHS 111 the same day.