Normális-e a menstruáció terhesség alatt?

Menstruation cannot occur during pregnancy. If an expectant mum notices any kind of bleeding, she can be sure the issue has another cause.

This question usually comes up in two situations. One is when a woman is hoping to conceive and, despite bleeding on or around the usual date, still hopes she might be pregnant. This belief can be strengthened if the bleeding is a little late or lighter than usual. The other is when bleeding or brown spotting appears during an already confirmed pregnancy.

It is important to know that any bleeding during pregnancy, whether bright red, darker red, brown or pale pink, should be assessed by a doctor. The symptom may be harmless, and most often it is, but it can be due to a sensitive cervix or a hormonal issue, or another change that a specialist can address straightaway.

Why might bleeding occur during pregnancy 

Bleeding can happen in any trimester, which often causes great worry, although some mums-to-be take the opposite view and do not pay much attention to the symptoms. In most cases, with these small bleeds the pregnancy progresses healthily, but finding the cause is important.

Bleeding in the first trimester 

In the first third of pregnancy, even a little blood loss can be very stressful. It is a common symptom and rarely signals a problem. If clotted blood comes away, which can be very frightening, it may be due to slow, minor bleeding that collects and then passes at once. Only a medical examination can determine the exact cause. If needed, the doctor can prescribe the appropriate preparation or medicine.

• Bleeding related to implantation is completely harmless and can occur 10 to 14 days after fertilisation. This is when the egg embeds in the uterine lining. As pregnancy is usually not yet known at this point, this light bleeding does not tend to cause concern, and it often coincides with the time of the next period. This is why a woman may think she is menstruating while missing early pregnancy checks.
• Changes or infections of the cervix can be detected by a specialist, and treating them is important so that pathogens do not travel towards the baby and potentially harm them. Bleeding noticed after sex can also indicate cell changes around the cervix.
• In an ectopic pregnancy, the fertilised egg develops in the fallopian tube instead of the womb. This can be life-threatening.
• Bleeding with lower abdominal cramping can be a sign of threatened miscarriage.

Bleeding in the second and third trimesters 

• In this period it is even more important to pay attention to any bleeding, as it can signal several risks.
• Cervical changes and infections, as in the first trimester, can cause bleeding now as well.
• Strain or physical impact on the cervix, for example during sex or after a vaginal examination, can also lead to some bleeding. Doctors usually point this out during checks.
• Sadly, a miscarriage beginning spontaneously can be accompanied by bleeding if it occurs before 24 weeks.
• If the cervix starts to open too early, this can lead to premature birth.
• With threatened preterm labour, slight bleeding is usually accompanied by contractions that can feel like back pain.
• If the placenta starts to separate from the wall of the uterus, this is not always accompanied by bleeding. Sometimes there are only brown spots and pain. It is a serious and dangerous condition.
• The placenta can lie low, next to or covering the cervix. This is generally a barrier to vaginal birth and can cause sudden, heavy, fresh bleeding.
• Separation of a previous caesarean scar comes with intense pain and bleeding, causing a life-threatening situation.
• Other causes are also possible. Even the smallest amount of bleeding or brown spotting in pregnancy should be taken seriously. Do not delay, contact a doctor immediately, because even without other symptoms these signs can indicate the start of a problem that a specialist can help with. It is important to observe the symptoms carefully and report exactly when they first appeared and in what form.
• If an expectant mum feels the situation is serious, feels unwell, has cramps, has heavy bleeding, or her pregnancy is high risk, she should call 999 and ask for an ambulance.

Investigating the cause of bleeding

A specialist will examine the expectant mum manually, with a speculum, and with a transvaginal or abdominal ultrasound, while assessing how much bleeding there is and where it is coming from. Blood tests may be requested, and other imaging methods may be used as additional investigations.

Why can there be no real menstruation during pregnancy 

Menstrual blood is essentially the shedding uterine lining, which does not occur during pregnancy, or only in very small amounts as light spotting. This is why, if pregnancy is present, we cannot speak of true menstruation, only of bleeding from other causes.

Brown spotting is also a sign of bleeding 

The brown colour forms when red blood cells come into contact with air, which suggests more time has passed since the blood left the vessel and became visible on underwear. So brown discharge is also bleeding, in a small amount, but it needs attention.

Haemorrhoids can be misleading 

Although bleeding from haemorrhoids does not come from the womb, it can cause sudden alarm, especially during or after using the loo. Many women have never had this issue before, yet during pregnancy they may experience inflamed piles and even bleeding. These unpleasant symptoms usually settle well after birth. If they persist, it is worth seeing a colorectal specialist.

Can the expectant mum do anything to prevent bleeding 

A gynaecological check before a planned pregnancy can reveal issues that might cause bleeding later, such as cell changes around the cervix.

During pregnancy it is best to avoid overexertion. Most sports can be suitable during this time, but an expectant mum should consider how used her body is to the particular activity and intensity. She should not start a brand new sport now that would place extreme strain on her body. It can be worth asking the advice of the doctor in charge, especially when there might be some risk. People often say that pregnancy is not an illness. That is true, yet for the sake of health it calls for increased attention and, in some cases, taking it easier.

Light spotting can occasionally occur during sex, and there are situations where a doctor advises avoiding intercourse, for example when the placenta lies close to the cervix. This may resolve as pregnancy progresses. In the third trimester, using condoms may be advised to reduce the risk of infection.

Preventing bleeding itself is often not possible, since changes can occur during pregnancy that bring this symptom with them.

Sources:

NHS — Vaginal bleeding in pregnancy

Tommy’s — Bleeding and Spotting During Pregnancy