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The Real Truth Behind Implantation Bleeding

With experts debating whether implantation bleeding actually occurs, we take a look at the evidence to help you understand what your body is trying to tell you.

If you were to look at my internet search history during my 18-month journey to pregnancy, "implantation bleeding" would rank highly, along with "flights to New York" as I tried to make the most of child-free living.

My irregular periods were a serious mindf**k and I'd often get spotting that would have me praying it was this "implantation bleeding" I'd heard about and not just my period again.

Hollywood tells you that the obvious sign of pregnancy is realising you haven't had a period, however that fails to take into account the fact that between 20 and 40 percent of women will actually experience bleeding in early pregnancy.

So it felt like spotting was no longer enough to declare my period was back and start the tedious task of ovulation patrol again.

The "implantation bleeding" theory goes that about two weeks after you've ovulated, you may experience some spotting as the embryo burrows into the uterus lining to get ready to become a baby. But opinions are divided about whether it actually occurs, creating even more confusion for women trying to conceive.

So what's really going on with bleeding during pregnancy?

Dr Joseph Sgroi, obstetrician, gynecologist and fertility specialist, is doubtful that it's "implantation" as such that can cause bleeding in early in pregnancy.

"It's not as if we can specifically see what is happening at the time the embryo is implanting," he explains.

"One study looked at whether they thought implantation bleeding was likely to occur and there was no evidence to support the [theory] that implantation could cause vaginal bleeding."

Dr Sgroi says there are many reasons why some women bleed during pregnancy, ranging from ingrown pubic hairs and pimples, to internal irritation from the use of progesterone pessaries in fertility treatment, to cervix or uterus polyps, to a simple side effect of the huge increase in blood vessels and blood flow necessary to support the growing baby. Bleeding can also signal an ectopic pregnancy or miscarriage.

"[The idea of implantation bleeding] is perpetuated by social media and doctors," Dr Sgroi says.

"It's a way of nicely explaining why you have a little bit of bleeding without causing too much anxiety. [But] the reality of the situation is that it probably doesn't exist and there are a whole range of reasons why you get bleeding at that time."

Confusion around the topic

The obvious way to confirm if it's your period or a pregnancy-related sort of bleeding is to do a pregnancy test, however, speaking from experience, that can be emotionally taxing if you don't want to face a disappointing "single line" result.

And if I'm honest, the confusion often had to do with whether or not I could have a wine that weekend. Spotting would generally suggest my period was on its way again, which would open the door for a couple of consolatory rosés with my girlfriends as I tried to keep up my social life, lest motherhood wasn't going to happen.

But if the spotting was some kind of perverse pregnancy sign, then I wanted to know immediately, so as not to do anything to jeopardise a budding baby. So if wine was going to be on the table, I just took a pregnancy test, which invariably made me feel quite silly when it would come back as negative and prove that another period was on its way.

Dr Sgroi says that if you are bleeding but think – or know – you might be pregnant, it's a good idea to speak to your healthcare team who can monitor you until you have a scan after the six-week-two-day mark when the heartbeat can be detected.

"If you find yourself in a situation where you are having a bit of bleeding early on in pregnancy, some doctors will [test] progesterone levels," he says.

"Progesterone is the pregnancy hormone that is a key driver of pregnancy [and] it the levels are quite low, it can lead to a bit of spotting and the pregnancy may not continue. There is some evidence to suggest that in women where the progesterone level is low, supplementing with additional progesterone [could] potentially decrease the risk of miscarriage."

For this reason, Dr Sgroi suggests not googling your fertility and pregnancy questions.

"We heavily rely upon media and social media but the source of information for your worries and concerns would be better addressed by an appropriate health professional," he says.

"[It's a good idea to] develop a good relationship with a local doctor or an obstetrician, even before you become pregnant."

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