Vaginal bleeding, cramping and a decrease in pregnancy symptoms can be signs — but can have other causes, too

The media often portrays miscarriages as obvious and dramatic moments. Movies and TV shows like Grey’s Anatomy, Reign and Antebellum show women experiencing painful cramps and heavy bleeding that indicate that they’ve miscarried.

In real life, though, a miscarriage isn’t always so apparent, says Ob/Gyn Erin Higgins, MD. She explains the signs that can raise a red flag — and what else they could mean.

Can you have a miscarriage without any symptoms?

The unfortunate reality is this: Often, a miscarriage has no symptoms at all. That means no bleeding, no pain and no obvious indication that anything has gone wrong. This is called a missed miscarriage.

“Many times, patients don’t know they're having a miscarriage until they get an ultrasound or testing shows a decrease in the pregnancy hormone hCG,” Dr. Higgins confirms.

The risk of a missed miscarriage is highest around six to eight weeks of pregnancy. But any pregnancy loss that occurs before the 20-week mark is considered a miscarriage.

Common early miscarriage signs

Sometimes, your body gives you clues that something is wrong. Signs of a possible miscarriage include:

  • Bleeding:The most common sign of a miscarriage is vaginal bleeding, which can range from light to heavy. It may include blood clots or grayish-white tissue.
  • Cramping:Some pelvic pain or cramping can be normal during pregnancy. But severe cramps can be a sign of miscarriage, especially paired with bleeding.
  • A decrease in pregnancy symptoms:After a miscarriage, early signs of pregnancy, like morning sickness and sore breasts, start to fade.
  • Changes in vaginal discharge:Discharge may be very watery and either clear or pink. Or it can be dark brown or blackish, resembling coffee grounds. “This is due to old blood making its way out of your uterus,” Dr. Higgins explains.
  • Lower back pain:Sometimes your uterus contracts to push out tissue, which can cause mild to severe pain in your back muscles.

Not all signs are a cause for concern

When you’re pregnant, it’s understandable to worry about any signs or symptoms that could indicate a problem. But cramping and even bleeding don’t always mean that something is wrong.

There are many reasons you might experience bleeding during pregnancy. And many of them are normal and not cause for concern, like implantation bleeding, when a fertilized egg implants into your uterine lining. You could also be dealing with a manageable condition, like a subchorionic hematoma or cervical ectropion.

“It’s not uncommon to have some spotting during pregnancy, or to notice a little blood when you wipe,” Dr. Higgins says. “Just be sure to let your doctor know about it so they can look into it and keep an eye on it.”

Bleeding isn’t the only sign of miscarriage that could mean something else. Others include:

  • Cramping:Mild, period-like cramps and abdominal pain are common in the early weeks of pregnancy.
  • Lower back pain:Hormonal shifts and softening ligaments lead to back pain in about 40% of pregnancies.
  • Vaginal discharge:An increase in the hormone progesterone can cause your body to make more cervical mucus than usual. Normal pregnancy discharge is thin, odorless and either clear, white or pale yellow in color.
  • Fading pregnancy symptoms: “Sometimes people are concerned if all of a sudden their fatigue or nausea improves. But those are things that typically get better as a pregnancy passes 10 to 12 weeks,” Dr. Higgins points out.

When to call a doctor

When you’re pregnant, heavy vaginal bleeding always warrants a call to your healthcare provider — and sometimes a trip to the ER.

“If you have so much bleeding that you're soaking through a pad an hour, that rises to the level of seeking emergency care,” Dr. Higgins says. “Bleeding with severe cramping can suggest a miscarriage, as well.”

If you’re in the early weeks of pregnancy, your healthcare provider will want to be sure you’re not experiencing an ectopic pregnancy (when a fertilized egg implants outside of your uterus). This is a life-threatening emergency that requires urgent treatment.

Other symptoms can indicate an infection, which also requires immediate attention. Seek emergency care if you have:

It’s OK to reach out to your healthcare provider for less urgent symptoms, too. If you have any worries or concerns about your pregnancy, Dr. Higgins says, it’s always best to err on the side of caution.

“If you're unsure or worried about something, call your provider,” she stresses. “I always tell people: You’re never wrong to call.”