What causes cramping in early pregnancy?

Cramping during early pregnancy can be worrying, but it’s a common pregnancy symptom, and women who cramp often deliver a healthy baby near their due date. Minor early pregnancy cramps may feel like menstrual cramps, and you may also feel bloated or gassy. Some women also describe cramping as a pulling sensation in the pelvic area or similar to low back pain, according to the American Pregnancy Association. Like period cramps, the cramps tend to come and go, and the pain can be uncomfortable but generally manageable without even needing to take over-the-counter pain medication.

Key takeaways:

• Cramping in early pregnancy is a common symptom that may be caused by zygote implantation, uterus expansion, hormonal changes, gas, or bloating.
• Typically, cramping in early pregnancy does not require immediate medical attention.
• Cramping in early pregnancy typically resolves without treatment within a few weeks but may require medical attention in some instances.
• You can manage cramping in early pregnancy with rest, hydration, warm baths, and placing hot water bottles on the abdomen.
• Treatment of cramping in early pregnancy may include pregnancy-safe medications for constipation and gas relief.

What causes cramping in early pregnancy? 

There are several causes of cramping in early pregnancy, and most have to do with what’s happening in your body in the weeks after conception. You might not “look” pregnant yet, but your body goes through significant changes in early pregnancy, both physically and hormonally.

First, you may experience cramping when your fertilized egg attaches to the lining of the uterus, says Shandra Scruggs, a registered labor and delivery nurse and doula, and the founder of Simply Birthed. This is known as implantation cramping. According to the American College of Obstetricians and Gynecologists (ACOG), implantation occurs about one or two weeks after conception, and light bleeding or spotting might accompany the cramps.

Scruggs says that cramping may also happen as your uterus expands to support your growing fetus, adding, “Hormones, especially progesterone, can make the uterus contract a bit, leading to mild cramps. These hormonal changes can slow down digestion, causing gas and constipation, which might bring on belly discomfort.” As the uterus enlarges over time, the ligaments that hold your uterus in place stretch as well, which often causes quick, sharp pains in your abdomen.

While most causes of cramping in pregnancy are related to uterus expansion and hormones, cramping in pregnancy may indicate something more serious. “Causes that could be of concern could include an infection, ectopic pregnancy, or miscarriage,” says Ila Dayananda, MD, an OB-GYN and chief medical officer of Oula Health. However, in these cases, Dr. Dayananda says the pain is usually more intense and is accompanied by other concerning symptoms.

For example, the symptoms of a miscarriage in early pregnancy usually involve bleeding that becomes progressively heavier, along with abdominal or back pain and cramping. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, usually in a fallopian tube. This occurs because the egg usually meets with the sperm in the fallopian tube and then the fertilized egg migrates down the tube and implants on the uterine wall. According to the American College of Obstetricians and Gynecologists (ACOG), symptoms of ectopic pregnancy include cramping on one side of the abdomen, bleeding, shoulder pain, and feeling weak or dizzy. If you have any signs of miscarriage or ectopic pregnancy, you should contact a healthcare professional promptly. An ectopic pregnancy is a medical emergency and needs to be dealt with urgently. Women who have missed a period and have moderate to severe abdominal pain need emergent evaluation in the emergency department.

It’s not clear whether some women are more likely to experience cramping in early pregnancy than others. Still, there may be certain factors that make you more likely to experience this early pregnancy symptom. According to the American Pregnancy Association, early pregnancy cramps may:

• Be more obvious to you when you cough or sneeze
• Manifest when sitting or sleeping in different positions or when moving from one position to another
• Be more likely when gassy, bloated, or constipated
• Be brought on by sex

Should I be worried about cramping in early pregnancy?

The good news is that “Cramping in early pregnancy is common and not necessarily cause for concern,” Dr. Dayananda says. However, she says, every pregnancy is different, and certain kinds of cramps in early pregnancy might be worrying. “If cramping becomes severe or persistent, it’s important to consult your healthcare provider immediately to determine the cause and begin possible treatment.” Dr. Dayananda shares.

How exactly can you tell if your cramps are severe? “If the cramps are really bad, last a long time, or stop you from doing things, you should see a healthcare provider,” Scruggs suggests. The Agency for Healthcare Research and Equality reports that other warning signs include pain that’s located in one particular area, pain that comes on suddenly, and pain that doesn’t go away. When these symptoms are coupled with nausea, vomiting, bleeding, and fever, you should see a healthcare provider immediately. Severe symptoms like these could indicate a miscarriage or ectopic pregnancy.

In particular, ectopic pregnancies can have serious ramifications if not treated promptly. “If you have intense pain on one side of your belly, it could be a sign of an ectopic pregnancy, which is serious and needs medical help right away,” Scruggs explains. Usually, this means a trip to the ER or a call to your on-call OB-GYN or midwife.

Untreated ectopic pregnancies can have serious complications if not addressed quickly. According to the ACOG, an ectopic pregnancy can cause your fallopian tube to burst, leading to severe internal bleeding, which can be deadly even to young, otherwise healthy women. Ectopic pregnancies require prompt surgery to remove the ectopic fetus. 

How is the cause of cramping in early pregnancy diagnosed? 

If you visit your OB-GYN or emergency room physician with concerns about cramps, a few things will likely happen. Your provider will likely start by asking you about your symptoms, date of the last menstrual period, history of pelvic infections or sexually transmitted infections, and history of ectopic pregnancies and miscarriages. “They ask about the cramps, any bleeding, and past pregnancies,” Scruggs says. Then, your provider will likely examine you. This exam may include a pelvic exam to look at the cervix or an ultrasound to check on the status of your pregnancy and rule out issues like ectopic pregnancies, Scruggs describes.

To confirm pregnancy, a urine pregnancy is routinely performed. If there are concerns after this, your provider might order certain blood tests, such as a test to check your human chorionic gonadotropin (HCG) levels. HCG is a hormone secreted in early pregnancy that supports your baby’s growth. They may also check your progesterone levels. “Low progesterone levels might mean a possible miscarriage,” Scruggs explains. “Depending on what they find, more tests like a complete blood count and blood type could be needed to check overall health.” 

How long does cramping last in early pregnancy? 

As the American Pregnancy Association describes it, most cases of early pregnancy cramps—the kind that feel like light menstrual cramps—occur in the early part of your first trimester. “Cramps during early pregnancy differ in length and strength for each person,” Scruggs explains. “Mild cramps can be normal as the body adapts to pregnancy, often coming and going for minutes or even a few days.”

As your pregnancy progresses, the type of cramping you experience will change. For instance, in the second trimester, you are more likely to experience round ligament pain as the ligaments that hold the uterus in place lengthen. This is more like sharp shooting pain, or achy, sore feelings in the lower part of your stomach area. As you near the end of your pregnancy, you may experience back pain and sciatic nerve pain as the weight increases and puts extra strain on your muscles and ligaments, according to the Office on Women’s Health.

How to ease cramping in early pregnancy

So, if your cramps aren’t serious, is there anything you need to do about them? How exactly do you treat cramping in early pregnancy?

The normal causes of cramping in early pregnancy, such as uterine growth, gas, and round ligament pain, do not require treatment, Dr. Dayananda emphasizes. Most of the time, these cramps resolve in a matter of days or weeks.

However, you still may be looking for relief from the discomfort. As the American Pregnancy Association suggests, there are several at-home remedies that will usually get rid of cramping in early pregnancy.

Treatments for cramping in early pregnancy treatments include:

• Trying different sitting and lying down positions
• Taking a warm bath
• Using a hot water bottle on your abdomen or lower back
• Staying hydrated
• Trying relaxation exercises

If your cramping is related to constipation, a common pregnancy symptom caused by increased pressure and pregnancy hormones, consider a few simple lifestyle changes. These may include increasing your fluid intake, adding more fiber to your diet, and exercising daily.

It’s usually recommended that pregnant women avoid pain medication when possible, but if you need medication for your cramps, you can ask your provider whether taking Tylenol (acetaminophen) is right for you. According to the ACOG, acetaminophen is considered safe during pregnancy and is preferred over nonsteroidal anti-inflammatory drugs (NSAIDs) like Aleve (naproxen sodium) and Advil (ibuprofen).

Most importantly, see a doctor if cramping in early pregnancy is severe or is getting worse

Cramping in early pregnancy causes may include implantation, uterus expansion, hormones, bloating, gas, and constipation. The common causes of cramping in early pregnancy usually resolve on their own without treatment. However, if cramping in early pregnancy continues, worsens, or is accompanied by bleeding, fever, vomiting, or one-sided abdominal pain, it could be a sign of ectopic pregnancy or miscarriage and requires emergent medical attention. Only your healthcare provider can rule out infection or other serious health conditions. Visit your healthcare provider to determine the best treatment for cramping in early pregnancy.