Pregnant women do not menstruate! That’s right! And any type of bleeding during pregnancy can and should be investigated. There are several reasons that can cause bleeding during pregnancy1, so a good diagnosis is very important, and the sooner the cause is treated, the better for the health of both the mother and the baby.
Hormonal Deficiency
When the embryo implants, the human body starts producing a large amount of progesterone through the corpus luteum, a hormone responsible for maintaining a thick enough endometrium for the pregnancy to develop. However, sometimes the body cannot produce the ideal amount to maintain the endometrium during the initial period of pregnancy2. Thus, the endometrium can start to shed and the woman may have the beginning of a miscarriage due to this hormonal deficiency, causing bleeding.
This type of bleeding is the most common among pregnant women, but it can be fully managed in 80% of cases with appropriate medication such as progesterone supplementation and also with total rest for the woman.
Bleeding Color and Texture
Bleeding at the start of pregnancy can seem like a strange or different period and some aspects should be considered. The blood’s shade, for example, is important and should be carefully examined by the doctor.
Normally, a lack of progesterone causes a brown-colored shedding, which in some cases may appear as light red, but one should be alert when the blood is a bright red shade, really similar to menstrual bleeding. The presence of clots is also very concerning, as it means the endometrium is not being properly supported, which is dangerous during the first trimester of pregnancy.
But how many days does this bleeding at the start of pregnancy last? In reality, it shouldn’t happen; that’s why if you detect bleeding, your doctor should be informed to analyze what is happening and address the situation.
Gestational Sac Detachment
The detachment of the gestational sac is also a factor that can cause bleeding and may occur due to hormonal causes as mentioned above, a lack of maintenance hormones, or trauma or impact. It is quite common in soap operas and movies for a woman to experience strong pain and bleed after an accident or a big scare, as this can lead to sac detachment and cause a miscarriage due to trauma3. Detachment is always diagnosed via ultrasound.
Bleeding in the First Weeks
The most concerning pregnancy bleeding is the one at the beginning of pregnancy, that is, before the 12th week. That’s because the body may ‘reject’ the baby or fail to support it hormonally, which is why doctors advise caution during the first trimester. Both for sac detachment and for hormonal deficiency, the treatment is practically the same: medication and rest, and sometimes contractions inhibitors and anticholinergics for the uterus.
Bleeding Starting from the Second Trimester of Pregnancy
Bleeding during the second trimester of pregnancy is also concerning. That’s why it is essential to determine its cause. A doctor or the maternity ward should be sought at any sign of bleeding.
Placenta Previa
Usually, bleedings during the third trimester are caused by placenta previa. Placenta previa is simply a placenta that has implanted in the wrong place inside the uterus, closer to the exit or even on the cervix, causing bleeding because of its position.
This occurs either because of effort from the pregnant woman or simply the weight of the belly. Usually, bleeding during pregnancy caused by placenta previa should be seen by the doctor to avoid a bigger, significant problem. The explanation in the video below is very useful.
Premature Placental Abruption
Now, bleedings in the third trimester, between the 29th and 35th weeks, can be due to premature placental abruption and cannot be managed with medication. The doctor must pay full attention as there is a risk of premature birth. In these cases, corticosteroid-based medications are usually prescribed to help the baby’s lungs mature.
Bleeding During Sexual Intercourse
Bleeding during sexual intercourse can occur at any stage of pregnancy and, if it happens, it’s important to go to the emergency room or speak to your obstetrician to rule out major concerns. These bleeds may originate from the rupture of a small blood vessel in the vagina or from the penis touching the cervix.
Placenta previa is also one of the reasons for bleeding during intercourse. In fact, it is common for pregnant women to complain about bleeding during or after sex. Ideally, the couple should pay attention to warning signs or even abstain from intercourse until the doctor gives clearance for sexual activity.
Bleeding During Labor
Already at the end of pregnancy, between the 37th and 40th week, bleeding can be a sign of labor, and it is a strong indication that you should go to the hospital or doctor’s office for an assessment of a possible imminent delivery.
In any case, bleeding must be diagnosed and treated. In summary: if you are pregnant and notice any sign of bleeding, seek help. It is important to know that pregnant women do not menstruate and that any bleeding must be investigated.
Readers’ Questions:
How do you differentiate period bleeding from a miscarriage?
It is actually a bit complicated to differentiate, but when in doubt there is no better option than to see a doctor or take a pregnancy test. The best thing is to use a highly sensitive test to detect pregnancy early. If you go to the emergency room and pregnancy is confirmed, an ultrasound will be done to check the progress and see if there are any signs of miscarriage.
Is brown discharge during pregnancy dangerous?
It may or may not be! It is advisable to see your OB-GYN to check the causes. If the brown discharge happens in the first trimester, it may mean endometrial loss and put the pregnancy at risk of miscarriage, since that’s where the embryo implants. But it can also be a hormonal deficiency, requiring appropriate treatment.
How to stop bleeding during pregnancy?
If any bleeding appears during pregnancy, you should go to the emergency room or your obstetrician, especially if accompanied by other symptoms such as pain, cramps, and fever. Normally the bleeding stops on its own and is just observed. In isolated cases, the doctor may treat the “cause” of the bleeding. The best thing to do is always seek care as soon as possible.
