Pregnancy tests are very sensitive so it is common to find out that you are pregnant before you develop any signs or symptoms of pregnancy. However, as your pregnancy continues you are likely to experience various symptoms and signs.
How do I know I am pregnant?
Pregnancy tests are available from chemists and supermarkets and are very sensitive. They test for the presence of a hormone called beta human chorionic gonadotrophin (beta-hCG) in your urine. Beta-hCG is produced by your body when an egg (which has been fertilised by a sperm) attaches and fixes itself (implants itself) into the wall of your womb (uterus).
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Different makes of pregnancy tests vary in how sensitive they are. The more sensitive ones can become positive when you are only a few days pregnant. However, a negative test does not mean that you are not pregnant; it may just mean that the levels of this hormone are not high enough to be detected by the test.
As pregnancy tests vary in how you use them, it is important to read the instructions carefully before you do the test.
If your first pregnancy test is negative but you think you may be pregnant then you should repeat the pregnancy test one week later. If you have a positive pregnancy test, this does not need to be repeated by a doctor or a midwife.
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What are the common symptoms and signs of early pregnancy?
The symptoms of early pregnancy vary tremendously between women. Some women hardly have any symptoms, whereas others have very severe symptoms. It is impossible to predict which women will have more severe symptoms. However, in general, if you are expecting twins or triplets then it is likely that your symptoms will be more severe.
Extreme tiredness is often the most common sign of an early pregnancy. Although it is common to become more tired in the later stages of pregnancy, this extreme tiredness and lack of energy (lethargy) usually last for the first twelve weeks (first trimester). The symptoms usually then improve.
You may notice that you need to pass urine more frequently than you used to. This is actually due to the effect of the beta-hCG hormone which makes your kidneys work harder to produce more urine. This is different to the reason you will need to pass urine more often in the later stages of pregnancy, which is due to the baby's head pressing on your bladder.
Note: if you experience any burning, stinging or a high temperature (fever) with these urinary symptoms, contact your doctor or midwife. Urine infections are common when you are pregnant. Your doctor or midwife will arrange to test your urine for an infection.
Constipation is more common in the early stages of pregnancy. This is due to the chemical (hormone) progesterone making your bowel more relaxed and sluggish. It is important to have a healthy diet throughout your pregnancy. If you do become constipated then you should eat more foods with lots of fibre in them, like wholemeal bread, fruit and vegetables. Make sure you are drinking enough fluids, especially water.
Another very early sign of pregnancy is breast tenderness. You may find that just the water from your shower on your breasts makes them feel uncomfortable and very tender. You may also find that you wake in the night when you roll on to your front because your breasts are tender. Your breasts may tingle at times or even have stabbing pains in them. You may also notice that your breasts become bigger and more swollen over the first few weeks of pregnancy. As your pregnancy develops it is common to notice some veins under the surface of your skin over your breasts. This is entirely normal.
After a few weeks you may notice that the coloured skin around your nipples (the areolae) becomes darker.
Feeling sick (nausea)
Although most women think that feeling sick is the first sign of being pregnant, it is more common to develop other symptoms first. Feeling sick usually starts around the sixth week of your pregnancy. This can, however, vary between pregnancies in the same woman as well as between different women. You may find that you are being sick (vomiting) as well as feeling sick. The amount and frequency really does vary between women and can also be different (worse or better) in later pregnancies.
This sickness is commonly referred to as morning sickness. It is more common to experience feeling sick only in the mornings. However, you may find that this feeling continues throughout the afternoons and even into the evenings.
You may find that you crave certain foods during your pregnancy or even go off some foods. Some women experience a metallic taste in their mouth. You are likely to have a heightened sense of smell during your early pregnancy. This may make any feelings of sickness that you have worse.
The changes in hormone levels in early pregnancy may make you feel more moody and irritable than usual.
Although this has always been the most obvious sign of pregnancy, many women now find out they are pregnant before they miss their first period.
Many women may have a small amount of bleeding (spotting) at the time of their missed period. This is sometimes called an 'implantation bleed'. It happens when the fertilised egg attaches and fixes itself (implants itself) in the wall of your womb (uterus). It is harmless.
However, if you have any spotting or heavy bleeding when you are pregnant then you should let your doctor or midwife know. In some cases further tests (for example, a scan) are necessary. This is because bleeding can sometimes be a sign of a miscarriage.
Less commonly it can be the first symptom of an ectopic pregnancy. 'Ectopic' refers to a pregnancy which occurs outside the womb.
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What should I do when I find out that I am pregnant?
Once your pregnancy has been confirmed by a pregnancy test then you should contact your doctor's surgery. They will arrange for you to see your doctor or midwife. Usually you will be seen by a midwife at around twelve weeks of your pregnancy. They will see you at your surgery, at a children's centre or at home. It is rare nowadays to have to go to a hospital to see a midwife.
It is important to have a healthy lifestyle during your pregnancy. This includes healthy eating and taking folic acid and vitamin D supplements.
Further reading and references
Antenatal care for uncomplicated pregnancies; NICE Clinical Guideline (March 2008 - updated February 2019)
Antenatal care - uncomplicated pregnancy; NICE CKS, February 2019 (UK access only)
Al-Memar M, Vaulet T, Fourie H, et al; Early-pregnancy events and subsequent antenatal, delivery and neonatal outcomes: prospective cohort study. Ultrasound Obstet Gynecol. 2019 Oct54(4):530-537. doi: 10.1002/uog.20262.