Early Pregnancy Symptoms: The First Signs and When to Take a Test

Medically reviewed by: Prof. Dr Snežana Rakić, specialist in gynecology and obstetrics.

Are fatigue, tender breasts and nausea a sign of pregnancy, or just PMS? In the first weeks the difference really can be unclear, because early pregnancy symptoms and premenstrual complaints have a great deal in common. In this article Prof. Dr Snežana Rakić, specialist in gynecology and obstetrics, explains which signs appear earliest, when a pregnancy test becomes reliable and when to book the first ultrasound examination.

When do the first signs of pregnancy appear?

Most women notice the first symptoms only around the time of a missed period, that is, 4 to 5 weeks from the first day of the last cycle. A smaller number of women feel changes earlier, 7 to 10 days after conception, when the fertilized egg implants in the lining of the uterus. It is important to know that the absence of symptoms does not mean there is no pregnancy, as many women feel nothing at all in the first weeks.

The most common early symptoms of pregnancy

• A missed period, the most reliable early sign in women with a regular cycle and a reason to take a test straight away.
• Tender, swollen breasts and darker nipples, among the first changes, from week 4 to 6.
• Nausea, with or without vomiting, typically begins around week 6 and is most pronounced between weeks 8 and 11; despite the name "morning sickness", it can last all day.
• Fatigue and drowsiness, the result of a sharp rise in progesterone; often a surprisingly pronounced symptom.
• Frequent urination, appears early because of increased blood flow through the kidneys.
• Implantation bleeding, scant spotting 10 to 14 days after conception, which is easily mistaken for the start of a period; it is lighter, shorter and paler in color.
• Mild cramps in the lower abdomen, similar to menstrual cramps.
• A heightened sense of smell and a change in taste, aversion to certain foods, coffee or tobacco smoke, sometimes a metallic taste in the mouth.
• Bloating and constipation, progesterone slows the work of the bowel.
• Mood changes, tearfulness and irritability similar to PMS.
• Increased vaginal discharge, whitish, without an unpleasant odor.
• A slightly raised basal body temperature that does not fall even after the expected day of the period.

PMS or pregnancy, how to tell them apart?

Honestly: symptoms alone often cannot tell you reliably. Both PMS and early pregnancy can bring tender breasts, bloating, fatigue and mood changes. The practical difference: PMS complaints subside once the period starts, whereas in pregnancy the period does not arrive and the symptoms continue or intensify. Only a test gives the final answer.

When should you take a pregnancy test?

Home urine tests detect the hormone hCG (human chorionic gonadotropin), which is produced after implantation and whose concentration in early pregnancy doubles roughly every two days.

• A urine test from the pharmacy: reliable from the first day of a missed period. Take it with morning urine, which is more concentrated; if the test is negative and the period is still missing, repeat it in 2 to 3 days.
• Beta hCG from blood: the most reliable early confirmation, positive as soon as 10 to 11 days after conception, so even before a missed period. The analysis is performed in the laboratory, and tracking the rise in values at 48 hour intervals also gives the first indication of whether the pregnancy is progressing normally.

At Miren Medic Polyclinic you can have beta hCG done in the laboratory without an appointment, with the result the same day.

The test is positive, what now? The first ultrasound

Congratulations! The next step is a gynecological examination with an ultrasound. The optimal time for the first ultrasound is week 6 to 8 of pregnancy (counted from the first day of the last period), when the gestational sac is visible in the uterus and, as a rule from week 6, the heartbeat of the fetus.

The first ultrasound answers three key questions: whether the pregnancy is in the uterus (ruling out an ectopic pregnancy), whether it corresponds to the number of weeks and whether it is developing normally. With Prof. Dr Rakić, whose area of focus is perinatology, the monitoring and management of pregnancy including high risk pregnancies, you also receive at that very first appointment a plan for further check-ups and advice on nutrition, supplementation (folic acid) and habits.

When is special monitoring of the pregnancy needed?

Special, closer monitoring is recommended for women who are over 35, who have chronic conditions (high blood pressure, diabetes, thyroid disease), a twin pregnancy, as well as for those who have previously had miscarriages or complications in pregnancy. Prof. Dr Rakić spent decades managing the most complex pregnancies at the "Narodni front" Clinic for Gynecology and Obstetrics and is part of the Miren Medic clinic team precisely for expert ultrasound examinations and the monitoring of such pregnancies.

What if the test is negative and the period still has not come?

A missed period does not always mean pregnancy. The most common other causes are stress, sudden changes in body weight, intensive training, polycystic ovary syndrome and thyroid dysfunction. If the period is absent for more than 2 to 3 months (and the tests are negative), a gynecological examination with an ultrasound and hormone tests is needed, and if necessary a consultation with an endocrinologist, which at Miren Medic clinic is available in the same place.

Examination prices at Miren Medic clinic

Service	Price
Gynecological examination (Prof. Dr Snežana Rakić)	12.000 RSD
Gynecological ultrasound (Prof. Dr Snežana Rakić)	10.000 RSD
Expert ultrasound (Prof. Dr Snežana Rakić)	12.000 RSD
CTG	7.000 RSD
Beta hCG (laboratory)	according to the laboratory price list

Frequently asked questions about the early signs of pregnancy

How early can the first symptoms of pregnancy appear?

At the earliest 7 to 10 days after conception, at the time of implantation. Most women, however, notice the first signs only around the time of a missed period.

Does every pregnant woman have nausea?

No. About two thirds of pregnant women experience nausea, and its absence says nothing bad about the pregnancy.

When is a pregnancy test reliable?

A urine test from the first day of a missed period; beta hCG from blood as soon as 10 to 11 days after conception. A test taken too early can be falsely negative.

Can a period be missed without there being a pregnancy?

It can, because of stress, weight loss, intensified training, polycystic ovaries or a thyroid disorder. If this happens repeatedly, an examination is needed.

When should you book the first appointment with a gynecologist?

Ideally in week 6 to 8 of pregnancy, and immediately if you have severe abdominal pain, heavier bleeding or have previously had an ectopic pregnancy.

Book an appointment

Do you suspect that you are pregnant, or have you just had a positive test? Book an ultrasound examination with Prof. Dr Snežana Rakić on +381 64 9510 000. Miren Medic, Vojvode Stepe 250, Voždovac, laboratory, gynecology and endocrinology all in one place.

About the author

Medically reviewed by: Prof. Dr Snežana Rakić, specialist in gynecology and obstetrics. Full professor at the Faculty of Medicine in Belgrade; for many years head of obstetrics and acting director of the "Narodni front" Clinic for Gynecology and Obstetrics; areas of focus: perinatology, infertility and menopause.