When a pregnancy occurs the first period that should come after the implantation of the ovum is normally suppressed, so that there is no bleeding. Subsequently all the periods that would normally occur are likewise suppressed throughout the pregnancy. This is because a greater amount of the hormone progesterone is being produced.
It occasionally happens, however, that the level of progesterone is not sufficiently high and a certain amount of bleeding occurs when the period would be expected. This usually goes under the heading of a ‘partially suppressed period’. Bleeding at this time is usually comparatively slight and may last for only a few minutes, a few hours or perhaps for one or two days. The loss is much less than usual and the colour is darker. There is no pain.
It is not generally recognized that a woman can have partially suppressed periods while-she is pregnant and it is therefore understandable that although she may feel some of the symptoms of pregnancy she may not realize that she is pregnant, and it is only in retrospect that she will appreciate that the period was both shorter in duration and less in quantity than normal.
Occasionally a small amount of bleeding may occur at the time of the second or even the third period and there are instances in which women have continued to have virtually normal periods for six or more months of what was an otherwise normal pregnancy.
Bleeding at the time of an expected period in early pregnancy may cause some confusion concerning the exact date of conception and therefore the expected date of delivery. If, during your first visit to the doctor or the antenatal clinic, your uterus is found to be slighly more advanced in size than the dates suggest, you may be asked for exact details of your last period in case this was partially suppressed.
The true significance of bleeding at the time of a suppressed period in early pregnancy is not clear, for while in the majority of instances it does not seem to affect the pregnancy it does indicate that the pregnancy is unstable and it is certainly true that miscarriage is more likely in a woman who has had a partially suppressed period than in one who has not. Caution therefore being the watchword, doctors consider it wise for a woman who has bled at the time of her first period to avoid intercourse and rest quietly in bed for a few days when her next period would be expected.
The bleeding at the time of a suppressed period is bleeding from the mother’s uterus, not from the pregnancy or the baby. The baby is not adversely affected by it and if the pregnancy continues to progress satisfactorily the baby will develop normally.
Internal sanitary tampons should never be used during pregnancy.
Bleeding in the early stages of pregnancy may also come from abnormalities or diseases of the cervix.
Cervical erosion is a particular type of very superficial ulceration that occurs on the neck of the womb either before or very often during early pregnancy. It may occasionally become infected and give rise to. a rather profuse yellowish, and sometimes irritating, vaginal discharge. A cervical erosion may bleed but this is usually very slight and may only be a stain. Bleeding may sometimes be provoked by intercourse at any stage of pregnancy. However, a cervical erosion does not usually bleed, even after intercourse, unless it has become infected. It is not treated during pregnancy although when it becomes infected local treatment with cream or pessaries is usual.