Cramping in the First Trimester

The Question:

I found out a couple of days ago I’m 3-4 weeks pregnant, but I’m scared I might lose the baby as this is my first pregnancy and I’m experiencing a lot of pain in my lower left side of the stomach. This has been going on for about five days; it feels like extreme cramping and my stomach is really bloated and sore… I am being sick and peeing a lot [and] I’m also tired and everyday I feel I’m on my period, but I’m clearly not. I also have really sore breasts; I’m scared please help with some advice.

The Answer:

Clearly you are worried! 

For some women, the first trimester of pregnancy can be filled with worry.  This is especially true if you have ever experienced a loss or miscarriage. It can be a long wait till you hear the baby’s heart beat at around 10-12 weeks and even longer till you feel the baby reassuringly move inside you between 16-20 weeks gestation.

We worry, yet many of the symptoms you are experiencing are very normal and even encouraging!  This includes fatigue, nausea, increased peeing, sore breasts and bloating. Even some feelings of cramping can be normal when the egg is implanting and your uterus is growing!

However, there are some pains that are not normal and need immediate attention. 

This is especially important if the pain is constant or increasing as there are some serious concerns that need to be ruled out. When women have pain they are immediately most concerned about miscarriage. This is fair, since 25% of pregnancies can lead down that road. However, as I said above, some menstrual-like cramps CAN be ok as long as there is no bleeding. In fact, some bleeding WITHOUT cramping can also be normal. We get more alarmed when women are cramping AND bleeding. Serial blood work measuring the placental hormone, HCG and an early ultrasound can be ordered by your care-provider to monitor the pregnancy and rule out a miscarriage.

When to Seek Help

That being said, throbbing or sudden pain that is increasing and located on either the left or right side needs to be investigated ASAP – especially if there is bleeding.  These are symptoms of ectopic pregnancy (or tubal pregnancy) where the egg has implanted in the Fallopian tubes – which can rupture as the pregnancy progresses causing potentially life-threatening bleeding! Getting an ultrasound and blood work to test the pregnancy hormone HCG is the best way to rule this complication out. If the pain you were describing is getting worse or you start having some bleeding you should seek help immediately – even heading into Emergency at your local hospital if things suddenly get really bad.  

Another thing that can cause pain on your left side is your bowels. Progesterone is the hormone in pregnancy that slows down your digestion making you bloated, and likely – constipated. Slowing your digestion down allows extra time for you to absorb nutrients from your food. However, the side effects can be unpleasant if your system gets really backed up and can cause some serious discomfort. Bowel pain can be sharp and tends to move around your abdomen a bit. It does, however, tend to get better after passing gas or having a bowel movement. If you think this is your issue, increase your water and fibre intake significantly. Eat more fruits and veggies and foods good for bowel health: Consider whole oatmeal for breakfast. Good old fashioned dried prunes also can work wonders – three a day seems to be a healthy number.  


Pain across your pubic bone can also be a bladder infection. Progesterone can also relax the muscles of your uterus from your kidneys putting you at increased risk of bladder and kidney infections.  Bladder infections can start by feeling pressure above your pubic bone. Women can also have burning sensations when they pee and a sense of “incomplete” emptying of their bladder and feeling like they still have to pee right after they went pee.  

Untreated infections can cause cramping and increase the risk of preterm labour or kidney infection.  If you get a fever or pain in your back you should have your urine tested to rule out infections.

Obviously, I am hoping your pregnancy is uncomplicated and your baby is well.  Please know though, if you are experiencing a loss (and it really can be profound) at this gestational age there is nothing you did or could do to prevent it from happening.  The vast majority of miscarriages in the first trimester are due to chromosomal incompatibility and not caused by anything you did.  

Seek out support from others.  It is unfortunate that so many grieve silently.  By talking about your loss with people you trust, you can find support from people who have experienced similar pain. Remember to take care of your body and heart by being gentle to yourself and giving yourself time to heal.

PregnancySarah Cosman