Pregnancy can be exciting. But it can also be nerve-wracking, especially when symptoms such as bleeding and cramping crop up.

Most of the time, these issues aren’t anything to worry about, but sometimes they signal a serious complication. Dr. Elaine Stickrath, an obstetrician-gynecologist at UCHealth Women’s Care Clinics in Craig and Steamboat Springs, outlines how to distinguish between normal and worrisome symptoms below.

Common symptoms in early pregnancy

Cramping is a very common symptom during early pregnancy: up to 90% of women experience this issue. Most of the time, cramping is a normal result of the uterus responding to a growing baby.

However, women who experience more intense pain or have cramping that is associated with bleeding should see their health care provider.

“If you’re having mild cramping, that’s completely normal,” Stickrath said. “But if you’re having sharp pain, particularly if it’s on one side, or if you’re also having bleeding, you should be seen for that.”

Similarly, light bleeding is fairly common in pregnancy, while heavier bleeding can signal a problem.

“Spotting is very common and is not associated with miscarriage, but heavier bleeding is not normal,” Stickrath said. “The combination of cramping and bleeding is most associated with miscarriage.”

Possible issues

Intense cramps, heavy bleeding or cramping with bleeding may signal a miscarriage or an ectopic pregnancy, in which the fetus implants and starts growing outside of the uterus. An ectopic pregnancy can become life-threatening for the mother if the fetus is growing in the fallopian tube, as the tube can eventually burst.

Miscarriages and ectopic pregnancies are both diagnosed through ultrasound. Most of the time, further investigation shows there isn’t an issue.

“The vast majority of people who are worried because they’re having bleeding or having other issues do have a normal pregnancy,” Stickrath said.

When the worst happens

Still, Stickrath stresses that miscarriages are more common than many people may realize.

While ectopic pregnancies are rare, impacting only about 2% of pregnancies, about 20% of all pregnancies end in miscarriage.

Stickrath always reassures women who have experienced a miscarriage that they didn’t do anything to bring on the miscarriage, but that instead, it was most likely the result of the genetics of the developing fetus.

“It’s nothing that anyone did wrong or could have done differently or should have done,” Stickrath said. “It’s just how the pregnancy was developing, and it’s not the woman’s fault.”

While some women experience cramping and bleeding accompanying a miscarriage, others may stop feeling symptoms of pregnancy, such as fatigue and nausea. In those cases, ultrasound may reveal the baby isn’t growing.

Having one miscarriage doesn’t mean a woman has an increased risk of having another miscarriage, and she can begin trying to get pregnant again as soon as she feels emotionally and physically ready. If a woman experiences two or more miscarriages, there are interventions and tests that can be done in the future to help support pregnancy.

Stickrath encourages women who have experienced a miscarriage to seek support and help through the loss.

“A miscarriage can be more isolating than some of the other losses we experience because people don’t want to talk about it, but it is a loss,” Stickrath said. “People should reach out to their support systems. I think when they do, they’ll realize it’s much more common than they may have thought, and that other people they know have experienced the same thing.

“Just know that if the pregnancy is not normal, you’re not alone, and it doesn’t mean you can’t have a family.”