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Content note: This article contains mentions of pregnancy loss.

You’re pregnant — yay! You expect Aunt Flo to pack her bags and hit the road for at least the next 9 months. So what’s the deal if you’ve got some light spotting?

Take a deep breath. Spotting isn’t totally uncommon during pregnancy — about 25 percent of women report spotting in the first 20 weeks. In many cases, it’s completely harmless.

Just a reminder: Spotting is a light amount of vaginal bleeding, less than would fill a panty liner. The spots may be pink, red, rust-colored, or dark brown.

Since you may already have a few weird things going on down south during pregnancy, here’s the lowdown on spotting, what it means, and when to call your doctor.

Light spotting can happen throughout your pregnancy. If you’re in your first trimester, a few spots aren’t usually anything to worry about.

But it’s still best to let your healthcare provider know about this and any other symptoms — like fever or cramping — that come along with it. Women with certain medical conditions may require closer monitoring or a physical exam to make sure everything’s in working order.

If you notice spotting in your second or third trimester, don’t wait to call your healthcare provider. The chances of a more serious problem are higher as you get further along in your pregnancy.

Just so we’re clear, spotting is not heavy bleeding. If you’re bleeding enough to go through pads or tampons, get your healthcare provider on the phone ASAP. Heavy bleeding during pregnancy should be addressed immediately.

Spotting is most likely to happen during the first 12 weeks of pregnancy. According to a 2010 study, women experience some funky hormone changes around week 6 or 7. If you check your calendar, you might see that you’re in prime spotting time.

If spotting comes earlier or later than that, it’s still completely normal. Any of the following could be the culprit behind your unpleasant surprise:

Pelvic exam or intercourse

If anything’s been poking around or near your cervix, there could be bleeding. That includes a standard pelvic exam or intimate time with your partner.

Implantation spotting

The fertilized egg starts burrowing into your uterus 1 to 2 weeks after fertilization. As the egg gets comfortable, it can cause light bleeding. This is nothing to worry about and should pass in a day or two.

Ectopic pregnancy

Sometimes — and doctors aren’t exactly sure why — an egg implants outside the uterus, resulting in an ectopic pregnancy. The fallopian tubes are the most common landing sites, and the ovaries are the second most common.

Spotting could be a sign of ectopic pregnancy if it comes with:

  • abdominal or pelvic pain
  • rectal pressure
  • weakness
  • dizziness
  • fainting

An ectopic pregnancy is no joke. If that list sounds familiar, give your healthcare provider a call.

Miscarriage

No one wants to talk about the M word, but it’s a possibility. Miscarriage is the spontaneous death of a fetus before the 20th week of pregnancy. Most miscarriages happen in the first trimester.

A 2010 study that involved a whopping 4,510 women found that light spotting didn’t increase the chances of miscarriage, especially if it stopped after 1 or 2 days.

If your spotting gets heavier and comes with cramping in your abdomen or back, and you’re passing fluid or tissue, call your doctor.

Other possible causes

There are some less common possibilities, such as a bladder infection or physical trauma that leads to bleeding.

Stay in touch with your doctor. They’ll have your full medical history (and a whole lot of experience and education) to help them determine if there’s anything to worry about.

Once you head into weeks 13 through 27, you’ve hit your stride. Your chance of miscarriage goes way down, as does your chance of spotting. But there are a few more reasons you could be spotting at this point in pregnancy.

Cervical polyps

Cervical polyps are small growths on the cervix that kinda look like fingers. They aren’t cancerous, but if they get irritated, you could see bright red spotting. Your doctor can check and easily diagnose them during a routine pelvic exam.

Intercourse or a pelvic exam

Yes, these were possible causes of spotting in the first trimester too. Really, they can lead to spotting throughout pregnancy. They may also cause light cramping as you get closer to your due date.

Placenta previa

Placenta previa is when the placenta covers part or all of the cervix. Spotting may come and go, and cramping is also possible. Your doctor can diagnose the condition after doing an ultrasound.

If your bleeding is light, you’ll most likely be put on bed rest and advised to avoid intercourse and exercise. Your doctor will keep a close eye on you to watch for increased bleeding, which could lead to hospitalized bed rest.

Premature labor or miscarriage

If your bleeding is more than spotting at this point in your pregnancy (like, if you need a pad to contain it all), call your healthcare provider immediately.

Heavier bleeding could be a sign of late miscarriage or premature labor. Either one may come with abdominal pain, cramping, and passing of mucus or tissue.

All the potential causes in the first and second trimester still pertain to the third trimester, though many are less likely by this point. But there are a few other potential causes of spotting late in pregnancy.

Prepping for birth

If you’re nearing your due date and the blood has some mucus in it, it may be vaginal discharge known as bloody show. Bloody show may have a gross name, but it’s a good sign that your body is prepping for labor.

Placental abruption

Placental abruption is when the placenta pulls away, either partially or totally, from the wall of the uterus. It comes with bleeding and cramping.

Your healthcare provider has several ways to diagnose a placental abruption, including a physical exam, an internal exam, blood tests, and/or an ultrasound.

At this stage in pregnancy, those symptoms are pretty easy to confuse with labor. When in doubt, call your doctor to determine the best course of action.

Vasa previa

Painless bleeding that’s dark burgundy could be a symptom of vasa previa. This is a condition in which the umbilical cord blood vessels cross the cervical opening, where they aren’t protected by the umbilical cord or placenta.

Without protection, there’s a chance of the blood vessels rupturing. In worst-case scenarios, that can lead to stillbirth.

Vasa previa is incredibly rare, occurring in only 4 in 10,000 pregnancies. Your chances of vasa previa are higher if:

  • you’ve had a previous cesarean delivery
  • you’ve had in vitro fertilization
  • you’re carrying multiple babies
  • you’ve had uterine surgeries
  • you have a low-lying placenta

Most miscarriages happen in the first trimester. Spotting could be a sign of miscarriage, but it alone doesn’t mean a miscarriage is imminent.

While spotting (and light cramping) is common in early pregnancy, if the bleeding and cramping increase and come with back pain or any of the other symptoms we’ve discussed, call your healthcare provider.

It might mean an extra office visit, but peace of mind is worth the time and gas money.

When did the bleeding start? First thing in the morning? After exercise or intercourse? Take note of when and how much spotting you’ve had. Needing just a panty liner is different from soaking a super-plus pad.

Also take notice of the color: pink, light red, dark brown, or burgundy. All this information gives your healthcare provider clues to help with the diagnosis.

And really, any time you’re worried, call your provider’s office. They are there to help safely guide you through pregnancy. It’s always better to check in if you’re worried than to let stress and anxiety take over.

tl;dr

  • Spotting occurs in roughly 25 percent of pregnancies and is often harmless.
  • Your chances of miscarriage go down significantly after your first trimester.
  • Take note of when spotting happens, how much blood there is, and its color. This info can give your healthcare provider a better idea of what’s going on.
  • If the spotting comes with cramps, back pain, fever, or any other symptoms, call your healthcare provider.