19 August 2019

Is bleeding normal after implantation?

implantation bleeding
Medical Director
Cesar Diaz-Garcia
MD PhD Assoc Prof
IVI London


This is considered to be one of the easier signs to detect of early pregnancy as bleeding can occur after implantation in approximately 3 out of every 10 women.   However, this phenomenon doesn’t always happen because of the implantation and it’s not normally associated with any problem with the pregnancy. 

So why does it happen?  How does bleeding, after implantation, differ from that of a normal period?

When the egg is fertilised, it joins with the sperm, and the process of cell division begins that will produce an embryo.  At that time, the embryo, that begins to develop, travels from the fallopian tubes to the uterus, where implantation occurs. This process takes between six and ten days once fertilisation has taken place, and when this happens, the embryo is made up of a mass of cells that stick to the lining of the uterus.

This area of the body is irrigated by a complex system of arteries, veins and blood vessels as the tissue is especially prepared to sustain the embryo and promote its healthy development. For this reason, due to the embryonic implantation, some of the vessels can be broken in the process resulting in some blood loss and consequent spotting. This is what we call implantation bleeding which can happen between 10-14 days after conception, which is the time it takes for the embryo to reach the uterus.

How does implantation bleeding occur?

Bleeding after implantation usually occurs in the early stages of pregnancy as the uterus is well supplied by blood vessels and is therefore more prone to bleed easily. When the embryo sticks to the inner lining of the uterus, it breaks small veins and arteries of the endometrium, which can cause bleeding.

So this bleeding doesn’t occur because the process is “violent.” The embryo must be perfectly connected with the endometrial tissue to ensure the exchange of nutrients in the delicate gestation process that will occur in the following months. Therefore, the embryo breaks the superficial capillaries of the endometrium with the intention of forming some new ones that will join it and serve to feed the embryo through the future placenta.

The blood lost in this process is what we identify as implantation bleeding, and for this reason it is slightly different from menstrual blood.  Although not always indicative, because the endometrial tissue is well supplied by blood vessels and losses could occur for other equally natural reasons.

What colour is the blood?

Bleeding can take place between six and ten days after fertilisation, a time that usually coincides with the date scheduled for menstruation.  This bleeding is identified by being normally lighter in colour and finer in texture with a less intense colour and not so dark.  Although it’s not uncommon to experience bright red or pink colour. However, this will be lighter in colour than blood during menstruation.

Implantation bleeding does not follow a fixed pattern, and can occur in a single pregnancy or in all, interchangeably. Spotting may also occur coinciding during the luteal phase, which is due to a hormonal issue and is not directly related to implantation, although it can be confused with it.

Losses due to embryonic implantation can last from one to three days, and are identified by the intensity of bleeding which is less than that which occurs with normal menstruation, although this can vary greatly among women but generally speaking it’s easy to observe the difference.

How is implantation bleeding different from menstruation?

The main confusion with these two types of menorrhagia is that they coincide around the same time.  However, the essential difference lies precisely in the intensity of staining, which is much less than that of normal menstruation.  Its duration is also a sign of implantation bleeding which can last a few hours or, sometimes, can be prolonged over several days as slight and intermittent spotting that is different from the more regular pattern of menorrhagia.  Additional signs, together with the implantation bleeding, include a subsequent menstrual delay, pain similar to menstrual pain, a slight swelling of the breasts, or even slight nausea, tiredness, etc.

However, it is important to understand that this is not always indicative of a pregnancy, because these symptoms are common of many other physical and mood states, so they are not infallible indicators to differentiate menstruation from implantation bleeding.

Does it put the pregnancy at risk?

No. There is no evidence that relates implantation bleeding with a problematic or, for example, an ectopic pregnancy

Furthermore, you can’t relate this type of bleeding to a miscarriage or another danger to the baby.

It’s true that gestational problems, especially those related to miscarriage, may be associated with bleeding. But in this event, as with menstruation, it’s noticeably more intense and is usually painful and comes with other identifiable symptoms.

On the other hand, ectopic pregnancies or miscarriages can often occur without any bleeding, so there is no reason to associate one phenomenon with the other.

What should I do if bleeding occurs?

Although there is no reason to take special measures, if you are in any doubt, it’s always advisable to consult your gynaecologist.  He/she can confirm whether the bleeding is associated with the implantation of the embryo or not.  If necessary, your gynaecologist will give you guidelines to follow to proceed in the best way possible.

However, in most cases, bleeding after implantation normally causes no more than slight discomfort so generally it does not usually require any additional attention.  Even so, proper assessment of the symptoms and assistance can help patients understand that this is part of the normal pregnancy process.


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