It is not always easy to tell the difference between a period and an early pregnancy loss. Sometimes, the loss occurs before the person realizes that they are pregnant.
Pregnancy loss, what was once called a miscarriage, occurs in around 10% of pregnancies that have been confirmed by a test.
Around 80% of pregnancy losses occur in the first trimester, the first 12 weeks of pregnancy.
When the loss occurs very early, within the first 5 weeks, a person might say that they had a “chemical pregnancy.” This is not a medical term, and it usually refers to a pregnancy that a blood test or home test can detect but that an ultrasound scan cannot.
In this article, we describe ways to distinguish between a period and pregnancy loss and when to seek medical care.
When a person has an early pregnancy loss, they may have experiences similar to those of a period, including:
- vaginal bleeding
- abdominal pain
- passing blood clots or tissue
Menstruation patterns vary from person to person and they change over time.
Bleeding may become heavier or occur later, and this might be a natural shift or it might indicate that the person had been pregnant. It is not always possible to tell the difference.
Signs that a person may be experiencing pregnancy loss, as opposed to menstruation, include:
- Lower abdominal cramping: Cramps are also common with periods, but during pregnancy loss, there may be strong muscle contractions and pain in the lower back and pelvis.
- Passing fluid: This does not typically occur during a period.
- Passing pregnancy tissue or blood clots: There may also be clots that are gray or white.
- Bleeding: During pregnancy loss, the bleeding can begin quite suddenly, and it may be heavier than that of a period. The bleeding should ease off within a few days, but this can take up to 2 weeks.
- Easing of nausea and breast tenderness: If these pregnancy symptoms had occurred, they may fade away. However, they can also signal menstruation.
Pregnancy hormone levels are low in early pregnancy, and they may drop right before a pregnancy loss. By the time the bleeding begins, the levels may be too low to indicate that pregnancy had occurred.
It is worth noting that pregnancy tests can give false-negative readings if levels of pregnancy hormones are very low or the test is not sensitive enough.
Is it endometriosis?
If a person is not pregnant but their periods change in unexpected ways, they might be experiencing another health condition, such as endometriosis. This occurs when tissue similar to the lining of the uterus grows elsewhere in the body.
Symptoms of endometriosis include:
- menstrual cramps that worsen over time
- pain in the lower back and pelvis
- spotting and bleeding between periods
People sometimes use the term chemical pregnancy to refer to pregnancy loss at around 5 weeks or earlier.
A person might realize that they have experienced a very early pregnancy loss if they miss a period, receive a positive pregnancy test result, then soon begin bleeding and receive a negative result.
Around half of all early losses result from a chromosomal irregularity in the fetus that keeps it from developing any further.
The bleeding may resemble menstruation, or it may be lighter than usual, and it can occur with cramps.
Some ways to help identify very early pregnancy loss include:
- Taking a pregnancy test: Bleeding in early pregnancy is not uncommon, but bleeding after a positive test result may indicate an early pregnancy loss, especially if a follow-up test is negative.
- Measuring cycle length: If a period is late and a pregnancy test is positive, bleeding could mean that the pregnancy is ending.
- Having a blood test: If an initial blood test confirms a pregnancy, but another shows decreasing levels of telltale hormones, it can indicate pregnancy loss.
Most people recover from very early pregnancy loss without care from a doctor. A person can usually try to conceive again soon after, although a doctor may recommend waiting until after the next period.
The indications of pregnancy loss can differ, depending on when it occurs.
Up to week 6
Before week 6, pregnancy loss may involve bleeding that is lighter or heavier than a period. It may include clots and occur with abdominal cramping.
During this time, the bleeding of pregnancy loss may include clots and a small, fluid-filled sac that had provided nutrients for the developing fetus.
At around 8 weeks, a person may also pass tissue that may be dark red and shiny. In addition, they may be able to identify the gestational sac containing the embryo.
By week 10, the blood clots that pass may be dark red and jelly-like, and fluid may also pass from the vagina.
Bleeding or spotting is common in early pregnancy, but not after week 12. If it occurs after this time, seek urgent medical advice.
Pregnancy loss in the second trimester
After about week 12, pregnancy loss is no longer considered early. Only 1–2% of losses happen at this stage, before week 24.
In the second trimester, a person may not have any indication of pregnancy loss until they go for a routine scan.
See a doctor at once if blood or fluid passes from the vagina or if the baby has stopped moving.
By this stage, most people realize that they are pregnant and are unlikely to mistake pregnancy loss for a period. However, this may not be true for people who typically have irregular periods.
The type of bleeding that occurs with a pregnancy loss can be subtly different from a period, and other symptoms can distinguish these events. If in doubt, seek medical care or advice.
A change in the menstrual cycle may indicate a very early pregnancy loss, but a wide range of factors can affect menstruation patterns, which naturally shift over time, so changes in a period are not definitive proof of pregnancy loss.
Still, anyone who notices changes in the pattern of menstruation should seek medical advice, as delaying treatment can lead to complications, in some cases.
An early pregnancy loss usually has no physical complications.
If a person’s blood is negative for the Rhesus factor (Rh) and their fetus has Rh-positive blood, this can complicate future pregnancies. In the early stages, the fetal blood type can be difficult to determine, so doctors sometimes give an Rh immunoglobulin shot to prevent possible complications.
Any pregnancy loss can affect a person’s emotional and mental well-being. Anyone who experiences depression or anxiety or who has any concerns about pregnancy loss should speak with a healthcare provider or counselor or contact a support group.
Even for doctors, it can be challenging to identify very early pregnancy loss. Blood tests, methods of visualization, such as scans, and a close assessment of signs and symptoms can help.
Most people who have experienced early pregnancy loss do not require medical care. However, see a doctor if:
- Bleeding follows a positive pregnancy test.
- Heavy or painful bleeding seems as if it will not stop.
- There is a fever, which could indicate an infection.
It is also a good idea to see a doctor, and particularly a fertility specialist, if a person wishes to become pregnant and has:
- had multiple pregnancy losses
- has not continued a pregnancy after trying for 12 months
Anyone experiencing ongoing or unusual pain or bleeding should receive medical attention, as these issues can indicate endometriosis or another condition that needs professional care.
Once bleeding begins, it is usually not possible to stop a pregnancy loss. Sometimes, the bleeding begins days or weeks after the loss has occurred.
While early pregnancy loss does not usually require professional care, it can be important to rest. Over-the-counter pain relief can help manage cramps.
If there is bleeding, use pads rather than tampons.
Pregnancy tissue may remain in the uterus, but it typically passes out of the body after 2 weeks. If this does not occur, a doctor may recommend one of the following options, depending on the duration of the pregnancy:
- taking a pill at home or in the clinic that causes the remaining tissue to pass to pass
- having a procedure called dilation and curettage, or D and C, to remove the tissue
Also, anyone who experiences pregnancy loss may need emotional support. Speaking with loved ones can help, and support groups and specialist counselors are also available.
Most people recover physically from early pregnancy loss without complications, though it is best to avoid sexual activity for 1–2 weeks.
Depending on a person’s goals and other factors, the emotional toll of pregnancy loss can be high. There may be feelings of sadness, anger, guilt, and frustration, and time to grieve may be necessary.
The following strategies can help:
- talking with loved ones or members of a support group about the experience — in person or online
- seeing a grief counselor or a specialist in pregnancy loss
- receiving medical care if a low mood or any other depression symptoms last longer than 2 weeks
- doing something special to commemorate the baby
A healthcare provider can help a person connect with support groups and counselors, as can many online resources.
The Office on Women’s Health, for example, provide a helpline to support anyone who has experienced pregnancy loss. The number to call is 1-800-994-9662,and help is available from 9 a.m. to 6 p.m Eastern Standard Time.
Losing a baby can lead to depression. Anyone who is thinking about suicide should receive immediate help.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
It can be hard to distinguish between early pregnancy loss and a period.
If bleeding is heavier than is usual, appears suddenly, or occurs with unusual abdominal cramping, this can indicate pregnancy loss. In the early stages, a person may not have known that they were pregnant.
If bleeding occurs after a positive pregnancy test, take another test. It is worth noting that some bleeding can be common in the early stages of pregnancy.
An early pregnancy loss does not typically cause complications, but a healthcare provider can give confirmation and offer resources that help with the emotional impact of the loss.