Implantation Cramps: Symptoms and Timing

Spotting, fatigue, sore breasts — these are common (and unpleasant) occurrences for many women in the days leading up to the start of their period.

But these also happen to be early signs of pregnancy. And because they can occur at similar times in the menstrual cycle, it can be tricky to know if your period or a baby is on the way.

Another symptom you may experience very early in pregnancy is mild cramping from implantation. It tends to be milder than period cramps; not everyone will feel it.

Here's what you need to know about implantation cramps and how to distinguish them from those that can accompany your period.

What are implantation cramps?

Fertilization of an egg typically occurs in the fallopian tube. The egg then travels to the uterus, where it burrows into the wall during implantation. Some people may experience mild cramping and spotting from implantation.

"Implantation cramps are often described as a slight twinge or pulling sensation in the lower abdomen and typically last for a few hours to a couple of days," says Rakhee Patel, MD, FACOG, OB-GYN at Pinewood Family Care in New Jersey.

Not everyone will feel implantation cramping or see implantation spotting. If they do, these symptoms tend to be very mild, and they may be confused with the start of a menstrual period.

"These cramps can be distinguished from menstrual cramps or PMS by their timing and milder intensity," Patel says. "Implantation cramps usually occur earlier in the cycle than menstrual cramps and are often accompanied by light spotting or implantation bleeding, which is usually lighter and shorter than a regular period."

What are the signs and symptoms of implantation cramps?

Although not everyone will experience implantation cramps, there are some common early pregnancy and implantation symptoms.

Mild abdominal discomfort

Some people may feel slight pain at implantation in the lower abdomen and back, says Tamara Guichard, M.D., gynecologist at Elite Gynecology in New York.

Light spotting

When a fertilized egg implants into the uterus, the disruption in the uterine lining can lead to very light bleeding or spotting.

Breast tenderness

Breast tenderness is a common early symptom of pregnancy. Hormonal fluctuations can make breasts feel sore and swollen.

Fatigue

It's also typical to feel very tired in the first trimester of pregnancy, likely due to hormonal changes in the body.

Many people experience these same symptoms before or during their period. A positive pregnancy test is the only way to know for sure what you're experiencing is pregnancy or PMS, but there are differences.

"PMS tends to be a little more severe," Guichard says. "PMS occurs at least two weeks before your period starts up to the first day of your period. Menstrual cramps occur when you have your period. That's the actual action of the uterine muscle squeezing out the lining. Your cramps will be a little less intense with implantation cramping compared to PMS cramping."

If a person has uterine fibroids, ovarian cysts, or endometriosis, the pain can be even more severe.

When do implantation cramps typically occur?

Implantation, ovulation, and PMS occur close to one another during a cycle, so it can be hard to know what you're feeling. But if it seems a little early to feel crampy or see a little blood in your underwear, it could mean you're pregnant.

Ovulation happens roughly two weeks before the start of a period. If you've had intercourse, this is when a released egg could become fertilized by sperm.

"When the egg is fertilized, it's fertilized in the fallopian tube, typically, and then it travels down into the uterus over another seven or 10 days, and then it starts to dig into the side of the uterus," says Sara Holt, CNM, MS, a certified nurse midwife at Byenveni Baby in Portland, Oregon. "That's when people can feel the implantation cramps. Sometimes, there's a little bit of spotting at the same time."

Cramping and spotting from implantation typically last no more than a day or two, Holt says.

When should you consult a doctor?

Implantation cramps are usually very mild and shouldn't require any medical attention.

"Typically, they're not to the point where someone would have a lot of pain," Holt says. "So if you're at the point where you're feeling like you really need medication or intervention, that probably is a sign that you would want to call and talk to your provider."

If you begin to experience bothersome pain in the abdominal or pelvic area, see a doctor — particularly if the pain is increasing or is accompanied by other symptoms, such as fever, nausea, or dizziness.

Be sure to seek immediate medical attention if pain is significant and localized in one side of the abdomen or pelvic area, as it could be a sign of an ectopic pregnancy. Ectopic pregnancies require medical intervention, as they are not viable and pose a danger to the mother.

Holt recommends listening to your body and calling your doctor if anything feels "off." If nothing else, a brief evaluation can ease your mind and reduce stress.

How do you manage implantation cramps?

Implantation cramps are usually very mild and may require any OTC pain medication or other treatment. If they do, here are some ways to manage implantation cramps safely in early pregnancy.

Taking over-the-counter pain relievers

Pregnant people should not take ibuprofen or aspirin, the experts say. Acetaminophen (Tylenol) is safe to take if needed.

Practicing relaxation techniques

Breathing exercises, meditation, or other relaxation techniques are a safe way to cope with cramping and other early pregnancy pains.

Experts

• Rakhee Patel, M.D., FACOG, an OB-GYN at Pinewood Family Care in New Jersey
• Sara Holt, CNM, MS, a certified nurse midwife at Byenveni Baby in Portland, Oregon
• Tamara Guichard, M.D., gynecologist at Elite Gynecology in New York