Your TTC Strategy 8: Recognize Early Pregnancy SymptomsDeborah Metzger, MD
If you’re tuned in to your body, you might suspect that you’re pregnant within the first few days of pregnancy. But some women do not have any early pregnancy symptoms and others may not notice anything unusual because they do not know what to look for. To make it even more confusing, the onset and degree of pregnancy symptoms varies among women and the same woman can have different symptoms in each pregnancy. Let’s look at the most common early pregnancy symptoms and your options regarding pregnancy testing.
Missing your period is the most clear-cut indication of possible pregnancy. But it is not definitive, particularly in women with irregular periods or unusual stress, where ovulation may occur much later than expected.
Abnormal bleeding is also common and although it is not a sign of pregnancy, it is a common reason to miss the early signs. Around the time of implantation (six to 10 days after ovulation), as the embryo burrows into the lush lining of the uterus, bleeding and cramping can occur. This bleeding can be mistaken for an early period or a normal period. However, this type of bleeding is usually much lighter than a period and may be accompanied by other early pregnancy symptoms.
Breast tenderness, swelling, or pain are also commonly associated with early pregnancy, and are sometimes similar to the sensations in the breasts in the days before an expected menstrual period, only more so. Women may also describe a feeling of heaviness or fullness in the breasts, extreme nipple sensitivity, darkening of the nipples, or enlarged veins visible on the chest. (A good support bra to fit your enlarging breasts may help.)
Pelvic or abdominal pain can occur in early pregnancy and is a symptom that should be reported to your doctor immediately. While usually due to something non-life threatening such as an ovarian cyst or constipation, it can also be the earliest sign of an ectopic pregnancy, which is a medical emergency.
Nausea and vomiting may come as early as a week into the pregnancy. Often referred to as “morning sickness,” it can occur any time during the day or night and affects about two thirds of all pregnant women. The symptoms can vary from a mild queasiness to uncontrollable vomiting. It is thought that high levels of estrogen and progesterone overstimulate the normal nausea triggers. Doctors have long known that morning sickness is actually a good sign of a healthy pregnancy, despite the discomfort it brings.
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Morning sickness is usually triggered by the sight, smell, or taste of meats and strong-tasting vegetables, which historically were likely to contain bacteria or birth-defect inducing chemicals. Also, in women who experience morning sickness, symptoms peak precisely when embryonic organ development is most susceptible to chemical disruption, between week six and week 18 of pregnancy. This all suggests morning sickness serves a useful function, evolving to protect mothers and embryos from foods that may endanger the pregnancy.
A woman in the early stages of pregnancy may also feel she has to urinate frequently, especially at nighttime, and she may leak urine with a cough, sneeze, or laugh. Pregnancy causes the uterus to swell soon after implantation, which puts pressure on the bladder, making you feel the need for more frequent urination.
Constipation is a problem experienced by women throughout their pregnancies. It can begin around the time of a missed period and usually gets worse as the pregnancy progresses. It is important to address this problem aggressively with plenty of fluids, fiber, and physical activity.
A persistently elevated basal body temperature (the oral temperature measured first thing in the morning, before arising from bed) is another characteristic sign of early pregnancy. An elevation in the basal body temperature occurs shortly after ovulation due to the release of progesterone and persists until menstruation occurs. Persistence of the elevated basal body temperature beyond 14 days is a sign of early pregnancy. Likewise, if you are using an ovulation predictor kit, failure to have a period 14 days after the luteinizing hormone (LH) surge is another sign.
Fatigue and utter exhaustion are very common early signs of pregnancy. Fatigue is a result of high levels of the hormone progesterone, which in high enough doses can put you to sleep. At the same time, lower blood-sugar levels, lower blood pressure, and increased blood production may team up to sap your energy. Fatigue tends to lessen after a few weeks, but it is a sign that you need to get as much rest and sleep as possible.
Women may also experience dizziness and lightheadedness, particularly when standing for long periods of time or when getting up from a sitting position. While common and often not a cause for concern, it is important to determine what is causing the dizziness. Dizziness can be caused by low blood sugar (hypoglycemia), low blood pressure (due to relaxation of the walls of the veins and arteries), fatigue, becoming overheated, anemia, and high blood pressure. Other causes of dizziness can be allergies, hyperventilation (breathing too fast), or health issues that have nothing to do with pregnancy. Persistent dizziness or dizziness accompanied by blurred vision, headaches, abdominal pain, or palpitations can be a symptom of serious illness that could affect your pregnancy. Contact your doctor immediately.
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Newly-pregnant women may experience extreme levels of emotion, and other symptoms similar to premenstrual syndrome or PMS (bloating, cramps, backache, irritability, depression). Rapid changes in hormones are the cause of this … along with having to put up with all the other symptoms. This symptom usually resolves by the second trimester.
Records of attempts at pregnancy testing have been found as far back as the ancient Greek and Egyptian cultures. Hippocrates suggested that a woman who had missed her period should drink a solution of honey in water at bedtime: Resulting abdominal distention and cramps would indicate the presence of a pregnancy.
We have come a long way since then. By far, the most common testing today determines the presence of hCG (human chorionic gonadotropin), which is secreted by the placenta when implantation takes place (six to 10 days after ovulation). Initially hCG levels are very low and may not be detectable by any pregnancy tests. However, the amount of hCG doubles every 36 hours and quickly reaches very high levels. Urine tests are quick (one to three minutes) but detect the presence of hCG only once it reaches a certain levels in the urine. On the other hand, blood tests (available through your healthcare provider) can take several hours, but can give the exact amount of hCG. Blood tests are often used to assess the status of the pregnancy by the rate at which hCG levels rise.
Home pregnancy tests (HPT) have become increasingly popular since their introduction in the 1970s. Most women now get confirmation of their pregnancy with home testing. As convenient as they are, there are some issues with these tests that women should be aware of so that they get the most reliable information from them.
- In a 1998 study, accuracy of the tests was determined by how well women followed the instructions in the kits. Laboratory technicians were 97.4 percent accurate, while consumers had an accurate result only 75 percent of the time.
- The best tests are capable of detecting low levels of hCG-usually, 15-25 IU/ml.
- In women who were pregnant, HPTs were positive only 90 percent of the time on the first day of the missed menstrual period. Even a week after a missed period, only 97 percent of the tests were positive. The delay in the detection of hCG is thought to be due to later implantation. Therefore, if you suspect you are pregnant, retest!
- A woman who has been given an hCG injection as part of infertility treatment may test positive on pregnancy tests that assay hCG, regardless of her actual pregnancy status.
“One-step” kits are generally considered the most convenient to use. Most can either be held briefly in the urine stream or dipped into a collection cup. Be sure to use a first morning urine sample. This is when the urine has the highest concentration of hCG. Once you start drinking water, the urine becomes dilute and testing may give a false negative result.
Once you put urine on the testing device, make sure you read it in the recommended time. If the test is read too early or too late, false negative or false positive results can occur.
Hopefully, this information will contribute to an enjoyable pregnancy!