Sexually Transmitted Infections (STIs): Sexually Transmitted Diseases (STDs)
Should You Take A Pregnancy Test? 11 Signs
Many early signs of pregnancy can be nonspecific and easily mistaken for other causes. Therefore, it may be difficult for someone to know when or whether they should take a pregnancy test.
In this article, we list 11 early signs that can indicate a person should take a pregnancy test.
A pregnancy test will not show positive as soon as a person becomes pregnant. It takes time for the body to release enough of the hormone human chorionic gonadotropin (hCG) to show up on a test. This will be around 12–15 days after ovulation if a person has a 28-day cycle.
Some medical bodies suggest taking the test on the first day a period should have occurred. However, the Food and Drug Administration (FDA) notes that the results on this day may not be accurate for 10–20% of people. Instead, they suggest taking a test 1–2 weeks after missing a period. Some tests are more sensitive, however, and a person can use them earlier.
Another option is to wait at least 21 days after having sex without birth control.
Blood tests take place in a medical office, and they can show if a person is pregnant around 6–8 days after ovulation.
What are homemade pregnancy tests, and do they work?
If a person is pregnant, it is best to find out as soon as possible. Not only can they start planning the next steps, but there may also be health considerations and lifestyle changes to address.
Some people notice early signs of pregnancy, such as fatigue or breast tenderness, before they miss a period.
The early signs include:
Often, the earliest and most reliable sign of pregnancy is a missed period.
There are many reasons for missed periods, but if a person is sexually active, a missed period can signal pregnancy.
Most pregnancy tests are very accurate when taken after a missed period, but sometimes the hormone levels might not be high enough to trigger a positive result.
If someone misses a period and a pregnancy test is negative, they should repeat the test after a few days.
2. Breast changesBreast changes are common in early pregnancy. These are due to hormonal changes that eventually prepare the body for lactation.
Common changes are:
Which breast changes are a sign of pregnancy?
3. Light bleedingAround 25% of people experience implantation bleeding, which is light bleeding that happens when the embryo attaches to the uterine wall.
Implantation bleeding tends to be lighter and shorter than a menstrual period.
Implantation bleeding happens around 6–12 days after conception, but light spotting is not uncommon during the first 12 weeks of pregnancy.
4. CrampsCramps are common before or during a menstrual period, but some people also get cramps when implantation occurs.
If cramps occur around or before a period is due, but there is no bleeding, or the bleeding is much lighter than usual, it may be a good idea to take a pregnancy test.
How do I know if cramps are a sign of a period or pregnancy?
5. Nausea and vomitingMorning sickness, or nausea and vomiting associated with pregnancy, may start 2–8 weeks after conception.
Nausea does not just happen in the morning. It may occur at any time during the day or night.
If nausea happens for no apparent reason, especially with other possible signs of pregnancy, it may be a good idea to take a pregnancy test.
6. FatigueFatigue is a common symptom of early pregnancy, and a person may feel the need to rest or nap for no apparent reason.
It is typically due to changes in the hormone progesterone.
Fatigue typically eases in the second trimester, and the person may find they have more energy again.
7. HeadacheHormonal changes may also trigger headaches in early pregnancy. They typically ease over time.
A person can take paracetamol for a short time to treat a headache, but it is best to check with a doctor or midwife first. Other pain relief drugs may not be safe to take.
From week 20 of pregnancy and after, headaches can be a sign of preeclampsia, a potentially life threatening condition that needs urgent medical attention.
What does headache mean in pregnancy, and how can I manage it?
8. Food aversions or cravingsUnusual cravings and food aversions are common in the first trimester, though they sometimes persist through the entire pregnancy.
Some people crave nonfood items, such as dirt or ice. This is known as pica. Anyone who craves things that are not food should consult a healthcare professional.
A person may also find they no longer enjoy foods they previously enjoyed or that their taste and smell become more sensitive.
Do food cravings only happen during pregnancy?
9. Changes in bathroom habitsBowel and bladder symptoms can appear in early pregnancy. A person might experience frequent urges to urinate during the day and night. They may also have constipation, which affects 11–38% of people at some time during pregnancy, according to 2012 research.
In the early stages of pregnancy, the rise in hCG levels boosts blood flow to the pelvic area, increasing the need to urinate.
Learn more about frequent urination in pregnancy.
10. Feeling "different" and mood changesAnecdotal evidence suggests many pregnant people report feeling "different" early in pregnancy, with some feeling an awareness that they are pregnant before taking a test. However, there is no scientific evidence to confirm this.
Physiological and hormonal changes during pregnancy may cause a person to feel different. Feeling different may also be due to mood changes, which can begin within a few weeks after conception.
Anyone who believes that they may be pregnant should take a test for confirmation.
Is it premenstrual syndrome or pregnancy?
11. Missed birth controlA person should consider taking a pregnancy test if they are sexually active and have not used birth control within the last month.
Many birth control options effectively prevent pregnancy, but a broken condom or missed birth control pill can increase the chance of conception.
Pregnancy tests work by detecting the hormone hCG, which the body starts producing after conception. According to 2014 research, hCG is detectable in the blood around 8 days after conception. As the pregnancy progresses, levels rise by around 50% a day. HGC is detectable in urine a few days later than in the blood.
Tests for home use are urine tests. A person will need to go to a healthcare facility for a blood test.
A range of pregnancy tests are available for home use, and some are more sensitive than others. This means they can detect hCG at lower levels.
Many tests claim to be 99% accurate, but experts note that not all of them undergo rigorous scientific testing. A person may also get a false-negative result if they take the test too early, do not follow the instructions precisely, or do not handle the test as the manufacturer intended.
Some medical bodies suggest taking a test on the first day of a missed period, but many people do not know when their period should arrive, for example, if they experience irregular menstruation.
When taking a test, a person should:
The FDA notes that a positive test is usually but not always accurate. If a test is negative, they suggest avoiding alcohol and other substances that may be harmful to a fetus and repeating the test at a later date or seeking medical advice.
Why might a person get a false-positive pregnancy test result?
Some people experience menstrual irregularities, breast changes, and other pregnancy-type symptoms without being pregnant. These can happen for a variety of reasons.
Possible biological factors include hormonal changes due to another health condition. Psychological and social factors can sometimes play a role.
In rare cases, a person can have pseudocyesis, sometimes called false pregnancy, where they firmly believe themselves to be pregnant and have signs of pregnancy without being pregnant. This condition is not well understood and can happen for various reasons.
Anyone who has signs of pregnancy but is unlikely to be pregnant, for example, because of menopause, should seek medical advice. They may have a health condition that needs medical treatment.
If a pregnancy test result is positive, a person should contact a midwife or doctor. They can confirm the result with a blood test or schedule an early ultrasound.
If the person is pregnant, they should start prenatal care or discuss other options as early as possible.
If a person misses a period but is not pregnant, a healthcare professional can help diagnose any underlying cause.
The earliest sign of pregnancy is often a missed period, but breast changes, fatigue, headaches, and other changes can also appear within the first few weeks.
Anyone who has had sex without birth control and experiences early signs of pregnancy should do a test.
Anyone who has signs of pregnancy but is sure they cannot be pregnant should seek medical advice. The healthcare professional may wish to rule out other health conditions or provide treatment if required.
New Prenatal Genetic Testing Could Predict Your Baby
I have two children. At the moment, all I know about their genes is that they both have 46 chromosomes, and one is XY and one is XX.
I try to treat them equally, to assume equal potential. But what if I knew my daughter carried a "smart" gene and my son did not? When he came home from school with a B, would I assume it was just his genes, and not push him to try harder? And what if I could have known this before he were born, at a time when he was just a little blip on an ultrasound? Frankly, I'm not sure I would trust myself with this information.
Such knowledge isn't, of course, possible yet. For one thing, we haven't yet found many genes that can reliably predict intelligence. And at the moment, even if we did know what genes we were looking for, we wouldn't be able to find them very early in pregnancy. But thanks to a new kind of fetal genetic testing this may be starting to change.
Once upon a time, everything about your baby was a surprise until the moment of birth. Is it a boy or a girl? Does he (or she!) have all 10 fingers and 10 toes? And, most important: is the baby healthy? Genetic disorders—Down Syndrome, Trisomy 18 and others—were often a surprise in the delivery room.
We may still engage in the ritual counting of fingers and toes on our new baby, but it's all for show: really, we checked for those months ago in an ultrasound. And for many women, genetic testing during pregnancy has ruled out—or all but ruled out—the possibility that their child has a genetic abnormality.
Recently, the introduction of "cell-free fetal DNA testing" has altered the landscape of prenatal genetic testing further. You may have heard of these tests by their brand names: Harmony or MaterniT21, among others. The technology for each is broadly the same: they rely on a sample of maternal blood with no risk to the fetus, and they have accuracy rates approaching those of fetal diagnostic test like amniocentesis or Chorionic Villus Sampling (CVS), but without any risk to the fetus. In other words, these new tests provide the best of both worlds—and a recipe for moral fission.
The Evolution of Fetal Screening
Prenatal genetic testing, imperfect though it has been, is not new. Beginning in the 1970s, amniocentesis allowed doctors to identify genetic disorders in utero, typically mid-pregnancy. Within the following decade, CVS provided an alternative to amniocentesis that could be performed earlier in pregnancy—in the first trimester rather than the second—and provide similar information. These two procedures provide complete genetic information on the fetus—labs can literally sequence its entire genome.
This means that although these are most commonly used to detect the most common genetic disorders—Down Syndrome, for example—they could, in principle, be used to detect more minor genetic abnormalities, or even to identify normal genomic variations, such as a predisposition for having red hair. (Such uses are rare, mind you, since both procedures are invasive and carry some small risk to the fetus.) Historically, the alternative has been prenatal screening that relied primarily on an ultrasound, which isn't risky to the fetus but also cannot concretely diagnose a problem, thus, they must be followed up by one of the invasive procedures if a problem is suspected.
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The fact that we can determine characteristics of a baby in utero, combined with the availability of abortion, has always made some people nervous. It suggests eugenics, or a future of "designer babies." This is not all fanciful concern: in some countries prenatal sex determination and sex-selective abortion have altered the overall sex ratios in the population (for example, in recent years in China, 120 boys are born for every 100 girls). But the fact is that, in general, and in the U.S. In particular, prenatal screening has been effectively limited to serious genetic disorders—the risk of harming the fetus has outweighed the value of the information for other uses.
But the new prenatal screening tests are a game changer. They represent a significant technological breakthrough because the key to identifying problems or genetic risks is being able to see the baby's DNA. Amniocentesis and CVS accomplish this with amniotic fluid or placental material, both of which contain fetal cells and, hence, fetal DNA. But that means going inside the womb—with a needle, typically—and actually taking some cells. And that's what carries the risk.
Some fetal cells also circulate in the maternal bloodstream during pregnancy—that's not news—it's just that the volume of fetal cells in maternal blood is very low, making them difficult to use in a practical way. The technological breakthrough was the recognition of "cell-free fetal DNA"—that is, fetal DNA outside of cells.
When cell-free DNA is isolated in maternal plasma, 10% to 20% of it is fetal in origin. In lay terms, this means that researchers can be confident that a large share of what they are extracting comes from the fetus. In principle, if one could simply separate the maternal and fetal DNA, it would be possible to sequence the full fetal DNA using this procedure.
Technology is still not quite there yet, but this procedure currently works by looking for things in the cell-free DNA which wouldn't be there if the DNA it were just the mother's.
Think about it in terms of gender: Women have two X chromosomes; men have one X and one Y. Imagine you look in mom's cell-free DNA and you find a bunch of Y chromosomes. The baby will be a boy, right? If you don't see any Y chromosomes, a girl.
Similarly, a fetus with Down Syndrome has three copies of chromosome 21, rather than two, but two copies of all of the other chromosomes. So if you look at a mix of fetal and maternal DNA together, from a genetically normal mother, and see relatively more copies of chromosome 21, you would suspect the baby has Down Syndrome. If any chromosomal imbalance is striking enough, the test results will flag a potential problem.
At the moment, these tests fall short of what is possible with amniocentesis or CVS testing. One way in which they fall short is they focus on only the three most common trisomies: Down syndrome (trisomy 21), Trisomy 18 and Trisomy 13. Invasive testing will detect other trisomies, and can detect other types of chromosomal problems as well. Another shortcoming: both false negatives and false positives are possible.
This procedure relies on a statistical threshold test: Sufficiently imbalanced, and the test pings "positive." Not sufficiently imbalanced, it comes up negative. However, sometimes the imbalance in the chromosome counts isn't striking enough to flag as a positive test, even when the baby does have a chromosomal abnormality. This is what is called a "false negative." And on the other side, sometimes the chromosomes look imbalanced in the sample but the baby is fine. This is what is called a "false positive."
False negatives are pretty rare in these new blood tests—for a woman in her early 30s with a negative result on this screening, the chance of a baby with a chromosomal abnormality is about 1 in 90,000. False positives on this test are also limited, but they matter more. For that same woman in her early 30s with a positive test result, the chance of having a baby with a chromosomal problem is about 66%. In other words, one out of three women who receive results indicating abnormalities will actually have a baby who is genetically normal.
Answering—and Raising—More Questions
Experts agree that consequential decisions about a pregnancy should not be made without an invasive test as a follow-up. But this is likely to be a temporary issue. Effectively, the problem is one of genetic sequencing capacity and statistics. Already these tests are close to perfect on detection of gender. And the precision with which genetic predictions can be made will also improve. It seems unlikely we are more than a few years away from the ability to use these tests as diagnostic.
As these tests improve, so too will the range of conditions they can detect. Researchers last year reported on a case in which they used a version of this test to detect a small genetic issue called a microdeletion. The impact of this microdeletion, which was passed on from the mother, is an increased risk for nearsightedness and mild hearing loss. The mother in the study learned that she was passing on her poor eyesight and bad hearing to her child.
In principle, this technology could be used to detect anything for which we have a known genetic link. Researchers engaged in Gene-Wide Association Studies (GWAS) have, in the past few years, made progress on identifying a few genes which code for intelligence. Imagine you've tested yourself and you know you carry one of these intelligence genes but, sadly, your spouse does not. Now imagine you can easily learn if your fetus got your smart genes, or your spouse's not-so-smart ones. Or your genes for height, your risk for obesity, and your spouse's gene for stubbornness (okay, we haven't found this one yet).
Now take it a step further. Fetal DNA begins to circulate in the mother's blood at the very start of pregnancy. At the moment, these tests wait until 10 or 11 weeks of pregnancy so the concentration of fetal DNA is high enough to use for accurate detection. But as the sequencing and statistics improve, we may find that it is possible to do the same testing at 8 weeks. Or six.
What if you could know, at six weeks of pregnancy, whether your child would inherit your height, or hair color, or IQ? As I mentioned earlier, early gender testing is already used for gender-selective abortion, largely outside the U.S. This was true even when gender detection was not possible until 18 or 20 weeks.
These technologies will raise questions far beyond gender. Many people terminate a pregnancy when they learn the fetus has Down Syndrome. What about learning that the child will have autism? Or simply that their IQ is likely to be below average? We are holding Pandora's box. Once we open it and let the information out, we lose control over what it is used for.
I would argue there are further implications. Let's say I find out my fetus has an increased genetic risk for obesity, and I ultimately have that child. How will I treat her? Will I obsess about everything she eats, every ounce of baby fat that doesn't immediately melt away? Will she grow up to be obese, or have an eating disorder I was party to with my worry? Could this actually make things worse rather than better? The idea that more information is better relies on our ability to ignore it. But is this something that, as a parent, you could ever really ignore?
I'm trained as an economist, and one of our general principles is that more information is better. Information helps us make better—more optimal—decisions. And, crucially, more information cannot make you worse off, since you can always just ignore it. Under this theory, these advances in genetic testing should be welcomed without reservation.
In many dimensions, the improvements in testing bring only good. The ability to more accurately detect serious genetic conditions earlier in pregnancy allows women and their partners to make difficult decisions about pregnancy termination earlier in the pregnancy when the medical complications are less significant.
The balance between the values of information and the possibility of mis-use is a difficult one. It would be a shame to fail to pursue technologies that are likely to deliver great gains. At the same time, it is naïve to pursue them without thinking about their consequences. And we should start thinking about these now.
Ready or not, the future is coming.
Emily Oster is a professor of economics at Brown University and the author of Expecting Better
Early Pregnancy Tests Are Giving Too Many False Results
We found:
The consequences of both can be enormous.
Getting a false positive pregnancy testFalse positives are rare – but our research shows they happen more frequently than many health professionals realise. When using an early pregnancy test, the most likely (and heartbreaking) reason for getting a 'false' positive is that you've naturally lost your pregnancy in the very early stages.
This means they're not really 'false' in an incorrect way, but they do give women the false hope that they have an established pregnancy.
"We don't know how common these 'pre missed-period miscarriages' are," explains Neil McClure, Professor of Obstetrics and Gynaecology at Queen's University Belfast, "but we believe it happens as part of the body naturally selecting only the healthiest embryos. It doesn't mean there is anything wrong fertility-wise or that anything needs investigating medically."
"Early pregnancy tests pick up these 'pre missed-period miscarriages' causing a lot of distress for women who understandably feel that they have 'lost' a baby," explains Professor McClure. "This could be avoided if women waited to test until the first day of the missed period."
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And that's one of the key issues. An early pregnancy test may detect that your egg has been fertilised but sadly this doesn't mean it will lead to an established pregnancy. This is called a 'chemical pregnancy' – an early miscarriage, which is only detected by a (chemical) pregnancy test.
So this is the question you have to ask yourself. How would you feel if you found out you'd been in the very early stages of pregnancy but then lost the pregnancy? Many women understandably grieve for their miscarried baby, and some have told us it's made them much more anxious in the early weeks of a subsequent pregnancy. Would you rather know - or not know? Taking a pregnancy test early might reveal this to you.
On our forum, milliepop explained how she got her bfp (big fat positive) result one Sunday but then started bleeding on the Friday and a second test proved negative. "It really doesn't matter how early it was, it still hurts. I was OK when it actually happened and found comfort it was so early, but it hit me when I got my letter through for my booking-in appointment. I then realised what I'd lost and what could have been."
Getting a false negative pregnancy testAs well as being distressing, a false negative can lead to unintentional harm to your unborn baby through lifestyle choices you make because you think you're not pregnant.
One mum told us, "I took a test and truly trusted the negative result. It was Christmas and so I had a few drinks. I would never have had a drop of alcohol if I'd known I was pregnant. The pregnancy ended in miscarriage and for a long time I had a huge amount of guilt and blamed myself, wondering if the drinks had anything to do with it."
Why early pregnancy tests are confusingSince they first went on sale over 10 years ago, early pregnancy tests have becoming a substantial part of a booming industry that sells around 12.5 million home pregnancy tests in the UK each year.
But we think there's way too much confusion around using these early tests.
Firstly, there's the packaging. They're marketed with two bold claims on the packaging: firstly that you can use them from 3 to 6 days before the first day of your missed period, and secondly that they are more than 99% accurate.
However, what's not clear is that these two statements are mutually exclusive. In fact, most early tests only claim to be more than 99% accurate when you use them from the day your period is due. In other words, that's when normal pregnancy tests are taken.
If you take an early test before this date then the accuracy rates drops significantly. For example, a First Response Early Result will only detect a pregnancy in 62% of women when used 6 days early as advertised – that's a 1 in 3 chance of being wrong. Yet this vital information is only written in small print - on the outside of the box and then again in small print within the instructions that are 1000 words long.
Not only is the small print too small – it's also confusing. Different brands describe the day from which you count in different ways:
The results of our research make a strong case that better industry standards are required. At the very least, let's have an agreed consistent day from which to measure.
In addition, there's competition between the early test brands for just how early you can start testing. First Response claims "Six days before the day of your missed period" while Clearblue says "Four days before your period is due". Given they're measuring from two different days, you can use First Response five days before your period is due and Clearblue four days before - so there's only a day between them. Confused? We certainly are!
"Manufacturers of pregnancy tests need to write information in a way that's very clear and is easy to read," says GP Dr Rob Hicks. "Just like with medicines, doctors will always advise that patients read the instructions and information but how many people actually do?"
So how important is an accurate result?Very important – so you tell us. Our survey showed that 95% believe a 99% accurate result is more important than taking a pregnancy test as early as possible.
Yet, we found that only 47% of you took your pregnancy test during the 99% accuracy window - suggesting that most of these tests are used early. This is understandable as we know how important it is to know as soon as possible whether you're pregnant or not. That two week wait can feel like an eternity.
In other words, we crave accuracy first and foremost, but the conflicting information on these tests is making it difficult for us to be sure when the test is accurate and how much we can trust the results we get.
"We know we should wait till our period's due but it's so hard to resist testing early. Nobody knows about all this - unless you're trying for a baby, it's a secret world of raised hopes and disappointment," one woman told MFM who then revealed that she's stopped using the early tests because of the distress that they can cause.
What Clearblue saysWe asked the two leading early pregnancy test manufacturers, Clearblue and First Response, for a reaction to our findings. Clearblue replied almost instantly, saying, "Our own extensive research in the field agrees with your finding that accuracy is the number one most important attribute every women demands in a pregnancy test.
"We run a large study every few years with women across 5 countries, at very different stages of the life, and that view is consistent. However, what this research also tells us is that up to 40% of women want to test before their expected period. Their result is so potentially life-changing that they don't want to have to wait."
Why this issue mattersHome testing kits are now the standard way of testing to see if you're pregnant, often used long before a visit to the GP.
And as most mums will testify, knowing whether or not you're going to have a baby is the moment at which your life changes forever. These tests are often taken in a state of anxious expectation, and so confusing instructions and tiny small print is not what we need.
It's especially true for the many women who are desperate to become pregnant having experienced multiple failed attempts in the past. On the other side of the equation, accurate test results are equally vital to women who really don't want to be pregnant at this point in their life.
Why early tests are less reliablePregnancy kits test for the hCG (human chorionic gonadotrophin) hormone - sometimes called the pregnancy hormone. If you are pregnant, the day after your period is due the levels of hCG are likely to be around 100 milli-international units per millimetre (100mIU/ml). Early tests measure at a lower hormone level (as low as 25mIU/ml for Clearblue while the Predictor test claims to detect hCG at 12.5mIU/ml), which allows for a much earlier response. For most women, the strength of this hormone doubles every two to three days in early pregnancy.
"When pregnancy tests are taken on the first day of your missed period, as long as you have a regular monthly cycle, they pick up pretty much 99 percent of pregnancies accurately," explains Professor McClure.
"If however, you test earlier than this, when levels of hCG are much lower, your results may be less accurate."
Dr Luke Koupparis, GP from Westbury-on-Trym near Bristol, also has concerns about the reliability of early tests. "The message is that you can't rely on these tests until the pregnancy is fully established with adequate hCG levels and that this is not the same in all women. However, it is more likely in the days after your period is due."
As well as testing too early, another likely culprit for false negative results is that so many women have irregular cycles. "If a negative test later becomes positive you've probably just ovulated several days later than you thought and tested too early," says Prof McClure.
"My advice to women would be to try and resist the impatience to find out early and wait until the first day of their missed period. This way you'll avoid unnecessary grief at what is already an emotional time."
Should you wait to wee?While medical experts like Professor McClure will naturally encourage women to wait, we understand that early pregnancy tests have their place. There will always be women who want to know as soon as possible.
Our argument is that you need to know all the facts before you decide to take an early test.
If you do take a test earlier than the day after your period is due, you can't be sure the result is correct. If you're happy knowing this, and can wait for a few days before taking another test to be sure, then an early test should work for you. However, if you know you'd be devastated if a test shows positive and then you find out you're not pregnant a few days later – it's so much better to wait.
And if you're someone who will take a test every day, just to see if the negative will turn positive – is it really worth the emotional strain?
The results of our survey make it clear that these early tests need to have clearer labelling on the packaging and standard instructions inside – so you have all the information before using them.
In short, for millions of women, eager to use these early tests correctly, we need more clarity and less false hope.
That's why we're launching our #WaitToWee campaign – if you want to be sure if you're pregnant or not, wait until the day AFTER your period is due.
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