Miscarriage or Period Bleeding: What Is the Difference?

Vaginal bleeding can prompt numerous questions: Is it menstruation or a sign of pregnancy? If pregnant, why the bleeding? Does it indicate a potential miscarriage? These concerns are common among women in the reproductive age. Understanding these nuances can provide valuable insight during what is often a stressful time.

Period vs. miscarriage: what are the differences?

Undoubtedly, almost all adults know the rule of thumb: missing periods is most probably pregnancy. While this is a medically correct expectation, a few concepts might be borne in mind.

  • Not all missing periods are pregnancies. As a matter of fact, menstrual irregularities may lead to difficulties in conceiving.
  • Vaginal bleeding can occur in a normally progressing pregnancy. Some women, especially those who have irregular cycles, may discover their pregnancy in the second or third trimester. When asked, some of them also would confirm that they have had vaginal bleeding as heavy as regular periods during their pregnancy.

The embryo first tries to embed itself into the womb wall, which is called implantation. At this stage, some maternal vessels are 'torn,' and a 'pool of blood' is formed between the mother's and embryo's tissues. This is the source of nutrients and gases and a place to deliver babies' metabolic 'wastes.' At this stage, women may experience vaginal bleeding. Sometimes, this is called implantation bleeding.

At the same time, vaginal bleeding might be an indication of a miscarriage when the embryo detaches from the womb wall and gradually leaves the womb. At this stage, vaginal blood might be confusing and worrisome for women, especially if this is their first pregnancy.

Menstrual bleeding

Menstrual bleeding should be expected every 21–35 days. Bleeding usually lasts from three to eight days. The bleeding amount is measured with the frequency one may need to change the pad or tampon. Typically, on heavy flow days, it is expected that pads or tampons will get soaked within at least four hours.

Women with regular menstrual cycles are typically familiar with the frequency, duration, and intensity of their period bleeding. However, it's important to note that period bleeding can vary throughout a woman's reproductive life. Adolescents may experience irregularities in their menstrual cycles initially, which may take several cycles to regulate. Additionally, as women approach the perimenopausal period, both the frequency and intensity of bleeding may change. These fluctuations are normal aspects of the reproductive lifespan.

In between these phases, several factors may affect the usual bleeding pattern of the same woman, such as stress factors, hormonal pathologies, significant weight changes, excessive physical activity, pathologies of the uterus, or blood clotting disease.

Miscarriage bleeding

Bleeding during pregnancy is a possibility. In some cases, the embryo may remain healthy despite the bleeding, and there may be no cause for concern. However, it's also possible that the bleeding could result in a miscarriage.

It's important to note that miscarriage is not only the last phase of expulsion of the fetus. It may start with gradual blood discharge (new and old) and later progresses to expulsion. Most women are alerted to different colors of blood, and it is very important for educational purposes to distinguish the types of bleeding.

Bleeding during pregnancy can range from spotting to heavy bleeding with tissue pieces and clots. The color of the blood may vary, providing potential insights into its timing and origin. Fresh bleeding often appears bright red, akin to the color seen when cutting one's finger. Alternatively, if bleeding occurred earlier and is now being discharged, the blood may appear as dark brown or 'muddy.'

Additionally, when blood mixes with vaginal fluid or significant discharge, it may take on a pink hue. These variations in color and consistency can offer valuable information about the nature of the bleeding episode during pregnancy.

Other symptoms of miscarriage

When a miscarriage occurs, the most common sign is vaginal bleeding. However, accompanying the bleeding symptoms, there may be cramps and pain in the lower belly or above the pubis, along with a feeling of pressure toward the genitals. This can be confusing, especially when the pregnancy is not confirmed, and the woman is uncertain whether these symptoms are related to menstrual cramps or a miscarriage.

In miscarriages, the intensity of cramps tends to be more severe, and the amount of bleeding increases. It is also possible to observe discharged tissue or a 'meatlike' piece, which may be the miscarried embryo. Occasionally, nausea, vomiting, and lightheadedness might be experienced.

What to do if you can't tell the difference?

It is normal to feel confused about the bleeding, especially if your cycles are irregular, you had unprotected sex, or you are planning to conceive, but the pregnancy has not been confirmed. On the other hand, you might have a positive home pregnancy test but haven't had an ultrasound scan. The possibilities are different:

  • If you have irregular cycles and are suspicious of possible pregnancy, it is safe to do a home pregnancy test. Depending on the test results and bleeding pattern, the following steps might be planned.
  • With a positive test, if you experience significant bleeding, cramps, and low back pain, it might indicate a miscarriage or other pregnancy-related conditions. One of them is ectopic pregnancy when the embryo is implanted elsewhere than inside the womb. If you experience these symptoms, make sure to contact your healthcare provider.
  • If you had an ultrasound and it was confirmed that the embryo is inside the womb, the bleeding might be associated with miscarriage risk. Talk to your physician, and depending on the findings, medical guidance might be needed.

What to expect from the appointment?

If you are going to attend an appointment with unusual bleeding symptoms, the first step is exclusion of the pregnancy. Remember, not all bleeding in pregnancy means miscarriage.

During your appointment, tests and examinations may vary depending on your symptoms, complaints, and examination results. However, depending on the healthcare service, a urine or blood pregnancy test would be the first step. In addition to the physical examination, ultrasound imaging might be administered.

With a positive pregnancy test, an ultrasound gives a wealth of information, such as the location of the pregnancy, gestational age (how far it is), and whether there is a blood collection (hematoma) in the womb.

Vaginal bleeding observed during early pregnancy is treated as a sign of miscarriage risk. In selected cases, women are prescribed medication with progesterone, a hormone essential for maintaining the pregnancy. Some literature suggests that progesterone supplementation might be helpful in preventing miscarriage. Also, in selected cases, some anticoagulants (a group of medications that decrease your blood's ability to clot) might be considered.

During your visit, you will also be evaluated for your blood group. If you are an Rh-negative individual and your partner is Rh-positive, you may require an injection to avoid complications associated with Rhesus incompatibility.

Should you be concerned?

It should be noted that not all first-trimester bleeding results in miscarriage. However, if the bleeding increases and you experience significant pain, these might be signs of the start of miscarriage. If you experience these symptoms, you are advised to contact your doctor.

If this period is managed carefully, miscarriage typically does not pose a severe risk to women. However, if you lose a lot of blood (and are already anemic), you may feel dizzy and in severe cases, may pass out. The severity of pain and anxiety of being unprepared might affect you more. Therefore, it is recommended that you contact your healthcare provider with these symptoms.

What comes next?

If you have experienced a miscarriage, it is extremely important to prioritize your well-being, physically and emotionally.

  • Take physical rest to recover. Also, it is advised to avoid sexual intercourse until your symptoms are gone.
  • Allow yourself to grieve. You may experience sadness, guilt, embarrassment, or anger, among many other emotions. Also, remember that your partner might also be grieving. Reach out to your loved ones for support.
  • Periods are expected to start in 1–2 months, but it may vary.
  • If you wish to conceive again, you may try doing it with new cycles. If you do not desire pregnancy, discuss contraception options with your physician.

Vaginal bleeding might be confusing in several cases, especially if you have irregular menstrual cycles. Being familiar with the conditions might be helpful to avoid the anxiety of having unexpected spotting. Remember, timely management may prevent undesired complications of pregnancy.

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