When to Worry About Cramping in Early Pregnancy

Concerned Pregnant woman worried
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When you're pregnant, it's natural to notice—and fret about—every ache, pain, and tiny twinge you feel in your body, including vaginal pain know as lightning crotch. This goes double for sensations in your lower abdomen that feel like cramps or contractions that may cause you to worry that you're having a miscarriage.

But cramping during the first 20 weeks of pregnancy is surprisingly common and more often than not doesn't indicate an impending pregnancy loss. A 2016 study of nearly 350 women published in the journal Human Reproduction found that although 85 percent of them experienced abdominal cramping at some point during their first 20 weeks of pregnancy, only 28 percent miscarried.

Read on to learn about the many reasons you might experience cramping during early pregnancy that are quite normal and ways to relieve the discomfort, as well as how to recognize when lower abdominal pain might indicate a problem that requires a call or visit to your doctor.

Common Causes of Cramping in Early Pregnancy

There are quite a few reasons you might experience cramping during your first or second trimester of a healthy pregnancy. Most are perfectly normal and completely benign:

  • Implantation. As a fertilized egg burrows itself into the walls of the uterus, it can set off a sensation known, not surprisingly, as implantation cramping. Not all women experience this sensation as cramping: Some describe it as a pricking, pulling, or tingling feeling. In any event, implantation cramping is sometimes accompanied by bleeding or spotting (brownish or light-colored blood on your underwear or toilet paper) that appears around the same time you'd expect to get your period anyway—six to 12 days after you ovulate. As your pregnancy continues, both the spotting and the cramping will abate.
  • Uterine changes. As this powerful, muscular organ begins to expand (which will happen early on, long before you start to show), you may experience what feels like cramping. You'll likely notice it most when you sneeze or a cough, or when you change positions.
  • Round ligament pain. Around week 13 of pregnancy, just as you enter your second semester, you may experience a particular type of abdominal pain caused by the rapid expansion of a specific ligament that supports the uterus called the round ligament. When this particular structure stretches you may feel a sharp, stabbing pain in your lower abdomen or a dull ache.
  • Gastrointestinal symptoms. Changing hormones during pregnancy can wreak habit with digestion, causing it to slow down considerably. This can lead to gas, bloating and constipation, all of can cause abdominal discomfort and cramping.
  • Sexual intercourse. Semen contains large amounts of hormones called prostaglandins, which are released naturally during labor to help the cervix ripen and dilate in preparation for childbirth. Since this process is associated with contractions, it stands to reason that small amounts of prostaglandins might, for some women and in some cases, lead to cramping after intercourse during early pregnancy.

Relief for Early-pregnancy Cramps

Whatever might be causing you to have cramps or lower abdominal pain during early pregnancy, once you've ruled out a serious problem (see below), there are several things you can try to ease your discomfort, according to the APA, which recommends:

  • Changing your position. If you're sitting, lie down or take a gentle stroll, for example. If you're lying down, sit up or go for a walk.
  • Run yourself a bath. Relaxing in warm (not steamy hot) water can help to relax all your muscles and joints—including those supporting your uterus. If you don't have time to soak, try standing in a warm shower for a few minutes.
  • Make sure you're well-hydrated. This will be particularly helpful if the source of your abdominal pain is gas or constipation: Fluids can get things moving along in the digestive tract. If you're really irregular, talk to your doctor about other safe solutions for constipation, such as eating more dietary fiber or taking a stool softener or mild laxative.
  • Try a relaxation exercise. This yoga pose, called reclining bound angle pose, may help: Lie on the floor and bring the soles of your feet together, allowing your knees to relax out to the sides. This will open out your pelvis. Close your eyes and breathe naturally for five to 10 minutes. You can place pillows under your head and low back if you need to.

Do not take aspirin or a non-steroidal anti-inflammatory drug (NSAID) such as Tylenol (acetaminophen) or Advil or Motrin (ibuprofen) without checking with your doctor first. Research has found that these medications may not be safe during pregnancy. One recent study, published in 2018 in the American Journal of Obstetrics & Gynecology, for instance, found that NSAIDs taken during early pregnancy was associated with an increased risk of miscarriage.

When to Worry

Most of the time, cramping in early pregnancy is caused by any of many of the changes that naturally take place as a woman's body changes and adjusts to accommodate a growing baby. But you should always let your caregiver know if you're experiencing cramps that really concern you or that are accompanied by other symptoms, such as:

  • Contraction-like cramps that occur regularly. If you experience six or more in an hour, it could be a sign of preterm labor; call your doctor or go immediately to an emergency room.
  • Dizziness, lightheadedness, or bleeding. During early pregnancy, this combination of symptoms can be a sign of an impending miscarriage. If also can indicate an ectopic pregnancy (a sometimes life-threatening condition in which the fertilized egg implants outside of the uterus)—particularly if the pain is limited to one side.
  • Back pain. It's not unusual for your back to feel achy during early pregnancy, but severe back pain along with nausea, vomiting, and/or fever, or painful urination, can be signs of a serious illness such as appendicitis, kidney stones, or gallbladder disease.
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  2. Cochrane. Sexual Intercourse for Cervical Ripening and Induction of Labour. Apr 23, 2001.

  3. American Pregnancy Association. Cramping During Pregnancy. Feb 21, 2017.

  4. Li, D-K, Ferber, JR, Odouli, R, et al. Use of Nonsteroidal Antiinflammatory Drugs During Pregnancy and the Risk of Miscarriage. Am J Obstet Gynecol 2018;219:275.e1-8. doi:10.1016/j.ajog.2018.06.002.