Spotting and miscarriage

Spotting means a small amount of blood from the vagina. It may be pink, red or brown and may appear on toilet paper or underwear. Causes can include changes at the cervix, a threatened miscarriage, an ectopic pregnancy, or a miscarriage. The amount and colour do not reliably identify the cause.

A healthcare professional may ask about your last menstrual period, pregnancy test, bleeding pattern and pain. They may arrange blood tests and a [Transvaginal Ultrasound](/treatments/diagnostics-and-imaging/transvaginal-ultrasound/). Very early in pregnancy, a repeat assessment may be needed because one result may not yet show enough detail.

Contact your maternity, early-pregnancy or gynaecology service and describe the bleeding accurately. Record when it started, whether it is increasing, and any cramps or shoulder pain. Use sanitary pads rather than tampons while bleeding, and avoid putting anything in the vagina until a clinician advises you. Do not let reassuring symptoms delay assessment if you feel unwell.

If a miscarriage is diagnosed, care may involve waiting, medication, or a procedure, depending on your symptoms and findings. You can review [Medical Management of Miscarriage](/treatments/medical-gynaecology/medical-management-of-miscarriage/) as preparation for a discussion.

Go to emergency care for heavy or rapidly worsening bleeding, severe pain, pain on one side, shoulder-tip pain, fainting, marked dizziness, fever, chills, or sudden weakness. These signs can occur with heavy blood loss, infection, or ectopic pregnancy. If you know you are pregnant and cannot reach your usual service, use local emergency services.

Ask what bleeding level is expected, whether you need an ultrasound or repeat pregnancy hormone test, and which symptoms mean you should return urgently. Ask about suitable pain relief and whether your blood group requires specific care.