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Bleeding with a Missed Period: Implantation Bleeding, Chemical Pregnancy, or Other Causes

Bleeding around the time of an expected period can be confusing. Key possibilities:

1. Implantation Bleeding

  • 10–14 days post‑ovulation (around expected period).
  • Light spotting (pink/brown), lasts hours–2 days.
  • No clots, minimal cramping.
  • Only ~25–30% of pregnancies.

2. Chemical Pregnancy

  • Very early loss (<5 weeks) – hCG rises then falls.
  • Bleeding resembles period (may be slightly heavier/later).
  • Accounts for 50–75% of miscarriages; often unrecognized.

3. Early Pregnancy Bleeding (Threatened Miscarriage)

  • Viable pregnancy with bleeding – 20–25% of pregnancies.
  • May resolve; monitor with serial hCG, ultrasound.

4. Non‑Pregnancy Causes

  • Hormonal fluctuation (anovulatory cycle).
  • OCP breakthrough bleeding.
  • Polyp, fibroid, adenomyosis.
  • Thyroid dysfunction, PCOS.
  • Cervical ectropion, infection.

What to Do

  1. Take HPT if period late (best 1 wk after missed).
  2. If positive → contact OB for dating ultrasound, hCG trend.
  3. If negative but bleeding abnormal → see clinician for evaluation.
  4. Track bleeding pattern (color, amount, duration, clots, pain).

Bleeding ≠ not pregnant; no bleeding ≠ pregnant. Testing and clinical correlation are essential.

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