Implantation bleeding vs miscarriage: How to tell the difference

Bleeding during pregnancy can be worrying, but it doesn’t necessarily mean anything bad is happening. In fact, quite the opposite can be true.

If implantation bleeding isn’t on your radar, it’s not because you weren’t paying attention in biology class. Lots of us don’t know much about the spotting or bleeding that can take place when a fertilized egg implants in the uterine lining. We’ll get you up to speed quickly below.

Though bleeding isn’t uncommon in early pregnancy – the American College of Obstetrics and Gynecology (ACOG) suggests it happens in 15% to 25% of pregnancies — it can be tricky to tell the difference between implantation bleeding vs miscarriage or even a period in some instances.

Understanding what implantation bleeding looks and feels like can not only help to clue you in about one of the earlier signs of pregnancy. Knowing how to recognize implantation bleeding vs miscarriage symptoms will also help ensure you access medical help when you need it.  

Here, Dr. Jennifer Boyle, OB-GYN (obstetrician and gynecologist) at Massachusetts General Hospital, talks us through what implantation bleeding is. She also shares some of the other causes of bleeding in early pregnancy, how to recognize implantation bleeding vs miscarriage, and what to do if you’re concerned.

What is implantation? What is implantation bleeding?

Implantation occurs when a fertilized egg travels down the uterine tubes and embeds itself into the uterine lining. By this stage, the fertilized egg will have become a ball of rapidly dividing cells known as a blastocyst. Implantation typically occurs 6 to 10 days after conception, and it’s not uncommon for some women and people who menstruate to experience implantation bleeding during this process.

“Implantation bleeding refers to bleeding that happens around the time that the fertilized egg burrows into the endometrium or uterine lining,” explains Dr. Boyle. “We do not know why some women experience implantation bleeding, and others don’t,” she adds. Implantation bleeding is thought to occur in around a quarter of pregnancies.

When implantation bleeding does happen, it tends to occur because the uterus and its lining become more sensitive during early pregnancy, explains Dr. Boyle. The process of implantation can cause some small blood vessels in the uterine wall to rupture, which is where the blood comes from.

Interestingly – and confusingly – implantation bleeding tends to occur around the time a person would expect to have their next period, according to Dr. Boyle. This can make it tricky to determine whether you’re pregnant or not, but bear in mind that implantation bleeding will be lighter and will stop much sooner than a typical menstrual cycle, which continues over several days. Implantation bleeding also doesn’t come with typical period-related symptoms such as acne and bloating (although breast tenderness is the one symptom that you might notice accompanying both).

Understanding the timing of your cycle can also be helpful in determining what your body is experiencing. A cycle tracking app like Flo can help you predict when you’ve ovulated and can therefore give you some idea about whether your bleeding is more likely to be implantation bleeding (if it’s around two weeks post-conception), a regular period, or something else entirely.

What does implantation bleeding look and feel like? Is it different from early miscarriage symptoms?

Noticing you’re bleeding during early pregnancy can be alarming, and it’s totally natural to feel anxious. But if you’re clear on the hallmarks of implantation bleeding, it might help you to keep calm in the moment. Bear in mind that everyone’s bodies work in different ways, so some people may stray from what’s expected, but generally, you’re looking out for the following if it’s implantation bleeding:

• The color of implantation bleeding tends to be more pinkish or brownish in color than it might be if you were experiencing a miscarriage. 
• The consistency is generally different too, with no clots.
• “Implantation bleeding should be light or spotting and should not be associated with pain,” says Dr. Boyle. 
• “It may be noticed only once or a few times in a single day and certainly shouldn’t last more than two or three days at the very most,” she adds.

When is bleeding in early pregnancy a sign of a miscarriage? What are the other symptoms of miscarriage?

Bleeding in early pregnancy can easily make you jump to worrying conclusions, especially if it’s accompanied by other symptoms that are linked to pregnancy loss (more on those below). If you’ve confirmed you’re pregnant and have ruled out implantation bleeding due to timing, it’s wise to reach out to a medical provider immediately. 

“If you know you are more than four weeks pregnant, meaning more than two weeks from when you ovulated, then any bleeding you have is not implantation bleeding,” advises Dr. Boyle.

Sometimes, a miscarriage won’t display any obvious symptoms. But common signs that you’re miscarrying can include heavy bleeding along with the following:

• Cramping
• Pain in the lower abdomen
• Discharge of fluid or tissue

Your health and safety are paramount, so if you’re experiencing any of these symptoms, a medical professional can confirm if you’re having a miscarriage, and if so, talk you through options (whether you opt for surgery or allow the miscarriage to continue naturally).

It can be devastating to learn that a pregnancy — whether it’s longed-for or not — has ended, especially if you’re also experiencing discomfort with some of the physical symptoms. While it may not come as much solace, miscarriages are very sadly quite common. It’s estimated that approximately one in every four pregnancies ends in miscarriage, so you’re not alone in any feelings of grief you might experience.

The most important thing to know is that you shouldn’t blame yourself. Dr. Boyle emphasizes to all her patients that if a miscarriage occurs, it wasn’t because of something they did. Miscarriages are not caused by sex, exercise, lifting, caffeine, stress, or having had an alcoholic drink prior to knowing you were pregnant. “Although it is normal to have these thoughts, you did not cause it and could not have prevented it,” Dr. Boyle assures. Remember that. 

“Miscarriages are outside the realm of what medicine and science can prevent. Having come to the doctor earlier wouldn’t have changed the outcome,” the doctor continues. “The overwhelming majority of miscarriages are caused by genetic or chromosomal errors that occur when the sperm fertilizes the egg,” she says. 

Does implantation bleeding increase chances of miscarriage?

In short: no. The only confirmed link between implantation and a miscarriage is that both can be characterized by some blood loss — and that’s not always the case, anyway.

“Implantation bleeding does not increase the risk of a miscarriage,” says Dr. Boyle. “Bleeding from a miscarriage will usually be heavier and will be associated with cramping. Implantation bleeding will only occur at about four weeks of pregnancy, so bleeding that occurs later is not implantation bleeding,” she reminds.

Rest assured that having one miscarriage doesn’t always increase your risk of having another, either. If you were to sadly experience more than one miscarriage, however, you may have an elevated risk of having pregnancy loss in the future, and it may be that there’s something else at play. In this case, your health care provider may offer some tests to find out what’s going on.

“Most of the time, we will not find any explanation for why someone has experienced this. However, testing can sometimes reveal risk factors for miscarriage, and then, in some cases, treatments can be offered that might help lower the risk of another miscarriage,” she notes.

Some of the most common risk factors for miscarriage include:

• Older maternal age
• Being overweight
• Thyroid abnormalities
• Diabetes
• Hormonal problems
• Uterine abnormalities such as a uterine septum (an abnormal tissue band in the center or cavity of the uterus)

How to cope after miscarriage

A miscarriage can feel like physical and emotional agony. And while you most certainly won’t be the only one to have experienced something like this, it can still feel like a very isolating time.

As Dr. Boyle explains: “Miscarriage is a loss. It is a loss of a pregnancy and future baby you thought you would have. It is important to get through the process physically, which can sometimes be hard too, but then to make sure that you take care of your emotional health as well.”

She recommends talking about the loss. You may discover others who have gone through similar situations and later delivered healthy babies, which may provide some comfort. Healing and recovering after miscarriage are important, but there’s no “one size fits all” approach to how to deal with the loss. Some people benefit from taking time off work, while others find it helps to get back to their normal routine. 

“I try to acknowledge the loss that patients are experiencing and validate their feelings. We want to let them know that we feel confident that they will have a good outcome in the future but do not want to dismiss the pain they are feeling now.” 

The loss of a pregnancy can be challenging for a relationship, too. Partners experience the loss as well, but they may react differently, partly because they don’t have the same hormonal changes going on. Encouraging patience and understanding with one another is key to working through this together.

When it comes to optimizing your physical health during and after a miscarriage, Dr. Boyle suggests continuing to take prenatal vitamins. This can help the body recover from extra bleeding thanks to iron, while folic acid will help lower the risk of neural tube (brain and spine) defects in a future pregnancy.

If you’re struggling after pregnancy loss and feel you could use some additional support, the following organizations in the US, UK, Australia, and Canada could help:

• National Share Pregnancy and Infant Loss Support
• Miscarriage Association UK 
• The Ectopic Pregnancy Trust
• PILSC Pregnancy and Infant Loss Support Center
• SANDS
• The Pink Elephants Support Network

Is early pregnancy bleeding common?

Bleeding in early pregnancy may feel distressing, but it’s actually relatively common. Figures vary, but one medical study in which women tracked their symptoms daily while trying to become pregnant showed that light bleeding or spotting occurred in about 9% of pregnancies. ACOG puts the number a lot higher, stating that “bleeding in the first trimester happens in 15 to 25 in 100 pregnancies.”

According to Dr. Boyle, there are various reasons someone might bleed in early pregnancy, aside from implantation bleeding or early miscarriage symptoms. Some bleeds result from changes to the cervix in early pregnancy, which “can often become much more sensitive.” Other possible causes of bleeding include: 

• Cervical or vaginal infections and sensitive blood vessels at the cervix
• Bleeding after a pap test or speculum exam (more common)
• Bleeding after sex that is light/spotting without any cramping (unlikely to be a sign of a miscarriage)

Generally, these causes are nothing to worry about. “However, if you haven’t had an exam to let you know your pregnancy is healthy yet, you should take any bleeding that happens in pregnancy seriously,” Dr. Boyle stresses.

If your pregnancy bleeding is accompanied by certain other symptoms, it might be a sign of an ectopic or tubal pregnancy, which is a dangerous health condition in which a pregnancy grows in the wrong location. In an ectopic pregnancy, other symptoms may include:

• Cramps in the lower abdomen, sometimes on one side
• Lower back pain
• Lightheadedness, nausea, and vomiting
• Shoulder pain

“Bleeding that is heavy, has pain, or doesn’t go away quickly is always a reason to get medical care right away,” Dr. Boyle advises.

Implantation bleeding vs miscarriage: The takeaway

While bleeding in early pregnancy isn’t all that uncommon, there are things to look out for that can help you determine whether any bleeding you’re experiencing is implantation bleeding vs miscarriage. 

Implantation bleeding is a light spotting that lasts up to a couple of days and tends to occur when your period might be expected. Miscarriage (or ectopic pregnancy), on the other hand, typically occurs after four weeks of pregnancy and may be accompanied by additional symptoms like cramping and tummy pain. If you are experiencing a miscarriage, surround yourself with all the love and support you need and be kind to yourself: whatever emotions you are feeling are completely natural. 

Hopefully, having more knowledge on these causes of early pregnancy bleeding might help you to feel calmer in the situation. But the main thing to remember is that if you’re unsure about any bleeding you’re experiencing, contact a medical provider right away. It’s always the right thing to do for your health.