Cramps During Pregnancy: What They Mean and When to Worry
Cramping during pregnancy is often scary, but it's a common symptom throughout all trimesters. Most cramps aren't dangerous; in fact, they're simply the uterus's response to anything that's happening to it. "The uterus is a muscle, and the only thing a muscle knows how to do is contract, and a contraction feels like a cramp," says Holly Puritz, M.D., medical director for Sentara Lee Hospital Group for Women in Norfolk, Virginia.
That means whenever your uterus is stimulated—by a full bladder, vigorous exercise, or something more—its natural response is to contract. The important thing, says Dr. Puritz, is to figure out when cramps during pregnancy are normal and when they're cause for concern. Keep reading for our trimester by trimester guide.
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Cramps During Early Pregnancy
"The majority of pregnancies will have some mild (light) cramping intermittently during the first 16 weeks," says Chad Klauser, M.D., Clinical Assistant Professor of Obstetrics and Gynecology at the Mount Sinai School of Medicine in New York City. Here are some common causes of first trimester cramping.
Implantation Cramping: For some women, cramping is the first sign of pregnancy, as it sometimes happens when a fertilized egg burrows in the uterine wall. This is called implantation cramping, and it can feel like your period is about to start, says Dr. Puritz.
Uterine Growth: Rapid uterine growth in the first two trimesters of pregnancy can also lead to a pulling sensation within the stomach, says Dr. Klauser. Your uterus must stretch and expand to accommodate your growing baby.
Gastrointestinal Issues. Changing hormone levels might cause increased gas, bloating, and constipation during the first trimester. All of these gastrointestinal issues can cause cramping sensations.
Ectopic Pregnancy: In rare cases, first trimester cramping could be caused by ectopic pregnancy (when the embryo implants outside of the uterus—usually in the fallopian tube). Ectopic pregnancy often comes with one-sided cramping, bleeding, lightheadedness, or shoulder pain. Contact your doctor immediately if you have symptoms of ectopic pregnancy.
Miscarriage: Miscarriages often happen because of abnormal development in an egg or embryo (usually caused by chromosomal abnormalities). The cramping associated with miscarriage actually happens when blood and tissue leave the uterus, causing it to contract. Aside from cramping, the most telltale sign of miscarriage is heavy bleeding that doesn't let up. Contact your doctor right away if you suspect miscarriage.
Cramps During the Second Trimester
Women are less likely to experience cramping or other uncomfortable pregnancy symptoms during the second trimester. One exception is for women who are pregnant with multiples, since the uterus grows more rapidly and will reach third-trimester proportions in the second trimester. Here are some other causes of second trimester pregnancy cramping.
Round Ligament Pain: This benign pain occurs around week 13 when the ligaments that support the uterus stretch as the uterus grows upward. Round ligament pain is usually quick, sharp, and one-sided.
Urinary Tract Infections. Mild UTIs can also cause cramps during pregnancy in the second trimester. Other symptoms include painful urination, the frequent need to pee, and lower abdominal discomfort. Contact your doctor if you think you have a UTI.
Uterine Fibroids: A more serious, but rare, cause is uterine fibroids. These harmless overgrowths of tissue can start breaking down in the second trimester (usually between 15 and 18 weeks of pregnancy) because there's not enough blood to sustain their growth. The pain is pretty severe. Any woman who has a history of uterine fibroids should watch for pregnancy cramps at this point, because she may need hospitalization to manage the pain effectively until it passes.
Cramps During the Third Trimester
It's very common for women to experience cramping in the third trimester—often in the form of Braxton Hicks contractions. These "false contractions'' don't actually progress into labor, but they help prepare your body for delivery. While Braxton Hicks contractions only last between 30 seconds and two minutes, you can relieve symptoms by drinking some water and resting.
Of course, if third trimester cramping doesn't quickly subside, you could be experiencing preterm labor. Call your doctor right away and express your concerns; they might want to evaluate you right away.
Other serious causes of cramps during the third trimester include placental abruption (when placenta separates from the uterine wall) and preeclampsia (a condition characterized by sudden high blood pressure). Call your doctor for cramping accompanied by bleeding, severe headaches, shortness or breath, swelling, or vision changes.
Is My Cramping Normal During Pregnancy?
Sometimes cramping is normal during pregnancy. According to experts, you shouldn't worry about cramping after sex. "Intercourse is one of the most common causes of cramping," says Dr. Puritz. That's because semen contains prostaglandins that stimulate the uterus. She adds that it's completely fine to have sex, and if you have cramps afterwards, try getting off your feet and hydrating.
It's also a good sign if changing position makes cramps better or worse. This generally means you're experiencing cramps related to stretching of the uterus or its supporting ligaments, which is completely normal during pregnancy. Finally, if you feel better after passing gas, the pain is likely related to a gastrointestinal problem instead of the uterus, says Dr. Klauser.
On the other hand, certain scenarios indicate that something more serious could be happening. Watch out for the following red flags and inform your doctor ASAP if you notice them.
You have six or more contractions in an hour, which could be a sign of preterm labor. Also watch for other symptoms of preterm labor, including changes in vaginal discharge, pelvic pressure, and dull backaches.
Cramping comes with dizziness, lightheadedness, or bleeding—especially if you haven't yet confirmed your pregnancy with an ultrasound. This can be a sign of an ectopic pregnancy. Bleeding can also be a symptom of miscarriage or placenta previa, a condition in which the placenta covers the cervix.
You have persistent cramping when you are pregnant with multiples (which increases your risk of preterm labor), have a history of preterm labor or ectopic pregnancy, or have been diagnosed with a shortened cervix.
You have intense back or abdominal pain that's associated with nausea, vomiting, and/or fever. Back cramping and/or pain in your abdomen area could be symptoms of appendicitis, kidney stones, or gallbladder disease.
Your cramping isn't improving over time. It's also important to get checked out if changes in physical position don't alleviate the cramping sensation.
You have signs of preeclampsia, which include pain in the upper-right side of the stomach, headaches, swelling, vision changes, and sudden weight gain. These usually show up in the third trimester.
How to Relieve Cramps During Pregnancy
If you have pregnancy cramps that don't seem worrisome, Dr. Puritz advises getting off your feet, resting, drinking fluids, and taking acetaminophen (Tylenol) if needed for pain relief. Don't use a heating pad on your abdomen because raising your core temperature is dangerous during pregnancy, especially in the first trimester. (Using one on your extremities is fine, Dr. Puritz says.)
Dr. Klauser recommends that his patients try a warm shower. They might also benefit from stretching and sitting breaks throughout the day, particularly if their cramping is worse after long periods of being in one position.
Most importantly, always contact your doctor for unusual cramps or ones that don't go away. "I always tell my patients that I love a false alarm," says Dr. Puritz. "I'm happy to see you and say you're fine rather than miss something where I could have intervened."