Am I pregnant? – early signs and symptoms before a missed period

By (gynecologist), (embryologist), (embryologist) and (biochemist).
Last Update: 05/22/2023

Feeling the initial symptoms of pregnancy is very complicated for the woman, since the embryo is only a few days old and the pregnancy hormone (beta-hCG) is still at very low levels.

For this reason, the most obvious symptoms of pregnancy do not appear until after embryo implantation, in the fourth week, when there is an increase in hormones.

However, some women may notice some early symptoms related to an incipient pregnancy, which we will discuss throughout this article.

Symptoms occuring before the missed period

During the first days of gestation, the fertilized embryo begins its development in the Fallopian tube as it moves toward the uterus.

At this time, the woman does not yet know that she is pregnant. Only those who are actively trying to get pregnant or those undergoing assisted reproduction treatments are alert to identify any signs or symptoms that indicate success.

These first signs of pregnancy appear at the earliest around the third or fourth week, keeping in mind that weeks of pregnancy are counted based on the date of the last menstrual period (LMP) and not intercourse.

The first symptoms of pregnancy are very similar to premenstrual symptoms and can therefore be easily confused.

We will now discuss the first symptoms of pregnancy before the delay of the menstrual period:

    • Breast changes: become bigger and more sensitive. The areolas may darken and small rashes can appear around them (Montgomery glands).
    • Increase in vaginal discharge (leukorrhea): This is due to an increase in estrogen. This vaginal discharge is white, slightly thick and odorless. The cervical mucus will form the mucus plug, whose function is to protect the pregnant woman's uterus from the entry of harmful microorganisms.
    • Spotting: sometimes a light pinkish or brownish bleeding may appear between 7 and 10 days after fertilization. This light bleeding is due to the implantation of the embryo in the uterine walls.
    • Fatigue: It is normal to experience some minor discomfort during the first days of pregnancy due to a rise in the basal body temperature and the heart rate, lower blood pressure and an increased sense of being sleepy. The woman´s body is preparing for the gestation.
    • Changes in olfactory perception: The sense of smell becomes more sensitive, and some smells which had previously gone unnoticed will now be perceived. It is also possible to feel revulsion to smells that she didn´t before.
    • Nausea and vomiting: The woman may not feel nausea until at least one month after conception. However, there are some lucky ones who never feel it, and also others who notice it early.

    Having only one symptom before the missed period doesn´t mean the woman is pregnant. However, if several symptoms are present at the same time, the probability of pregnancy will be higher.

    Finally, the lack of menstruation and a positive pregnancy test are the key to confirming the pregnancy.

    First signs of pregnancy

    The appearance of typical pregnancy symptoms may vary from one woman to another. Some women have the first symptoms a few days after the embryo is implanted in the uterus, others take longer to notice them, and there are even women who hardly have any typical symptoms of pregnancy.

    The most obvious sign of pregnancy is the missed period, which is common to all pregnancies.

    After implantation, hormones released by the woman and by the embryo itself, especially progesterone, are responsible for the appearance of the common symptoms of pregnancy.

    The symptoms of a possible pregnancy usually start in the 15 days after the skipped period and are as follows:

    • Abdominal bloating: due to hormonal changes, it is not uncommon for the abdominal area to become swollen, since estrogen causes fluid retention.
    • Frequent urination: During the early stages of pregnancy, estrogen and progesterone levels increase. The hCG hormone, which is used to detect pregnancy, is also responsible for increasing the blood flow to the pelvic region and the constant urge to urinate during early pregnancy. Later, during the last trimester of pregnancy, it will be caused by the size of the uterus, which puts pressure on the bladder.
    • A rise in the basal body temperature: During pregnancy, the basal body temperature increases by at least one degree.
    • Mood swings: are also due to hormonal changes. Each woman responds differently, some may feel euphoric and others more depressed or anxious.
    • Food cravings and aversions: The hCG hormone is responsible for sensory changes which can make food more appealing or conversely repulsive. It can also cause an increase in saliva production.
    • Constipation: the increase in progesterone causes a slowing down of bowel activity and hence constipation. It is important for pregnant women to drink plenty of water, eat fruits and vegetables, and take daily walks to counteract it.
    • Tiredness and fatigue: are also associated with the hormone progesterone. In addition, frequent awakenings to urinate or nausea also contribute to fatigue.
    • Nausea: usually starts a little later than the other pregnancy symptoms. Some women feel it from the start of the pregnancy due to the hormonal changes.

    It is important to repeat that the absence of symptoms does not mean that there is no pregnancy or that the pregnancy is not evoliving as it should. As we have discussed, there are women who have intense symptoms and others who do not notice any special changes at all.

    FAQs from users

    Is it possible to notice symptoms of pregnancy before a missed period?

    By Rut Gómez de Segura M.D. (gynecologist).

    Yes, sometimes a woman may feel more tired (asthenia), with nausea, breast tenderness, mild abdominal pain, and may even have a little bleeding (implantation bleeding). However, no symptom can be associated 100% with pregnancy, and likewise, if the patient has no symptoms it does not mean she is not pregnant. Each woman will react differently.

    In the case of assisted reproduction treatment, these symptoms can also be related to the medication the patient is taking.

    The important thing in this case is to follow the guidelines of her doctor and wait about 12-15 days after the embryo transfer or insemination to do the pregnancy test which should preferably be done by blood test.

    Can you be pregnant if you have a few symptoms?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    Not necessarily. Having a few pregnancy symptoms does not mean you are pregnant by default. As we explained earlier, the most typical pregnancy signs are akin to those of the PMS. The only way a woman can be sure if she is pregnant or not is by taking a pregnancy test, which measures her hCG levels. Keep in mind that hCG is only present in your body if you are pregnant.

    Does missed period always mean pregnancy?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    Actually, a missed period is one of the most important early signs of pregnancy, yet your period being late does not always mean you are pregnant. It might be caused by hormonal imbalances, which influence your menstrual cycle by preventing ovulation and subsequently menstruation.

    If a woman wtih a possilibty of being pregnant has a late period they should do a pregnancy test. If you get a negative result, our advice is that you take another one after 4 to 5 days. If it is negative again, it means that you are not pregnant.

    Should your period be missing the following month too, it is strongly recommendable to visit your gynecologist, so that you can have your hormonal levels evaluated with a blood test. If the presence of hormonal alterations is confirmed, your doctor will decide what is the best treatment to regulate your cycles.

    Can I do a pregnancy test before my period is due?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    It is not recommended. If a pregnancy test is done prematurely, it is very likely to result in a false negative because it is very difficult to detect very low levels of the beta-hCG hormone that indicates pregnancy.

    For a pregnancy test to be reliable, it is necessary to wait for the menstrual delay or 15 days after intercourse.

    How can I know if I am pregnant before menstruation?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    There is no way to know for sure if a woman is pregnant before she can take a pregnancy test.

    Occasionally, some women who have been mothers several times are able to accurately detect the changes and symptoms that their body undergoes in the first days of pregnancy, but this is something that is very complicated in first time mums.

    Can I have pregnancy symptoms if I have not had vaginal penetrative sex?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    First of all, it is important to emphasize that pregnancy cannot be caused by genital rubbing or anal sex, since vaginal penetration is necessary. Therefore, if the woman notices any bodily change, discomfort, discomfort or other symptoms similar to those of pregnancy, it will be due to another cause, such as the proximity of menstruation, a hormonal imbalance or an illness.

    What are the symptoms of pregnancy in the first days?

    By Silvia Azaña Gutiérrez B.Sc., M.Sc. (embryologist).

    In the first days of pregnancy, the woman will not notice any symptoms, since it must be taken into account that the weeks of pregnancy are generally counted from the date of the last menstrual period (LMP) and not from the moment of conception.

    Once conception has occurred, in the first few days the woman may not notice anything special either, since the embryo is still very small and the hormonal changes typical of pregnancy have not yet occurred.

    Therefore, it will not be until approximately the fourth week of pregnancy when the embryo implants in the uterus and the woman may begin to notice certain symptoms. Among them, the most characteristic is the absence of menstruation, but you may also notice changes in the breasts, leucorrhea (increased vaginal discharge), implantation bleeding, tiredness, dizziness and nausea...

    Will pregnancy increase my breast size?

    By Zaira Salvador B.Sc., M.Sc. (embryologist).

    Yes, all pregnant women experience a significant change in their bra size. Breasts become swollen and enlarged as early as during the first trimester because of an increase in the levels of estrogen and progesterone. The growth normally continues throughout your entire pregnancy.

    If you suspect you could be pregnant because of the appearance of the symptoms discussed in this article, it is advisable to take a pregnancy test to confirm if it is indeed positive. You can read more about this here: When to take a pregnancy test.

    We have discussed implantation bleeding as an initial symptom of pregnancy prior to a late period. You can get more detailed information about this in the following post: Implantation bleeding.

We make a great effort to provide you with the highest quality information.

🙏 Please share this article if you liked it. 💜💜 You help us continue!


Breeze C. Early pregnancy bleeding. Aust Fam Physician. 2016 May;45(5):283-6. PMID: 27166462. (View)

Lowe SA, Steinweg KE. Review article: Management of hyperemesis gravidarum and nausea and vomiting in pregnancy. Emerg Med Australas. 2022 Feb;34(1):9-15. doi: 10.1111/1742-6723.13909. Epub 2021 Dec 6. PMID: 34872159. (View)

Matthews A, Haas DM, O'Mathúna DP, Dowswell T. Interventions for nausea and vomiting in early pregnancy. Cochrane Database Syst Rev. 2015 Sep 8;2015(9):CD007575. doi: 10.1002/14651858.CD007575.pub4. PMID: 26348534; PMCID: PMC7196889. (View)

Negro A, Delaruelle Z, Ivanova TA, Khan S, Ornello R, Raffaelli B, Terrin A, Reuter U, Mitsikostas DD; European Headache Federation School of Advanced Studies (EHF-SAS). Headache and pregnancy: a systematic review. J Headache Pain. 2017 Oct 19;18(1):106. doi: 10.1186/s10194-017-0816-0. PMID: 29052046; PMCID: PMC5648730. (View)

Pontius E, Vieth JT. Complications in Early Pregnancy. Emerg Med Clin North Am. 2019 May;37(2):219-237. doi: 10.1016/j.emc.2019.01.004. PMID: 30940368. (View)

Sapra KJ, Joseph KS, Galea S, Bates LM, Louis GM, Ananth CV. Signs and Symptoms of Early Pregnancy Loss. Reprod Sci. 2017 Apr;24(4):502-513. doi: 10.1177/1933719116654994. Epub 2016 Sep 27. PMID: 27342274; PMCID: PMC5933199. (View)

FAQs from users: 'Is it possible to notice symptoms of pregnancy before a missed period?', 'Can you be pregnant if you have a few symptoms?', 'Does missed period always mean pregnancy?', 'Can a virgin get pregnant without penetration?', 'Can I do a pregnancy test before my period is due?', 'When do common pregnancy symptoms start before BFP?', 'How can I know if I am pregnant before menstruation?', 'Which hormones are secreted during pregnancy?', 'Can I have pregnancy symptoms if I have not had vaginal penetrative sex?', 'When do hormones in pregnancy level off?', 'When does pregnancy sense of smell start?', 'What are the symptoms of pregnancy in the first days?', 'Why do women have an increased sense of smell during early pregnancy?', 'Will pregnancy increase my breast size?' and 'What does progesterone do in early pregnancy?'.

Read more

Authors and contributors

 Rut Gómez de Segura
Rut Gómez de Segura
Graduation in Medicine and Surgery from the University of Alcalá de Henares. Specialization in Obstetrics and Gynecology at the Hospital Costa del Sol in Marbella. Dr Rut Gómez de Segura currently works as medical director in the fertility center ProcreaTec in Madrid. More information about Rut Gómez de Segura
Licence number: 28/2908776
 Silvia Azaña Gutiérrez
Silvia Azaña Gutiérrez
B.Sc., M.Sc.
Graduate in Health Biology from the University of Alcalá and specialized in Clinical Genetics from the same university. Master in Assisted Reproduction by the University of Valencia in collaboration with IVI clinics. More information about Silvia Azaña Gutiérrez
License: 3435-CV
 Zaira Salvador
Zaira Salvador
B.Sc., M.Sc.
Bachelor's Degree in Biotechnology from the Technical University of Valencia (UPV). Biotechnology Degree from the National University of Ireland en Galway (NUIG) and embryologist specializing in Assisted Reproduction, with a Master's Degree in Biotechnology of Human Reproduction from the University of Valencia (UV) and the Valencian Infertility Institute (IVI) More information about Zaira Salvador
License: 3185-CV
Adapted into english by:
 Michelle Lorraine Embleton
Michelle Lorraine Embleton
B.Sc. Ph.D.
PhD in Biochemistry, University of Bristol, UK, specialising in DNA : protein intereactions. BSc honours degree in Molecular Biology, Univerisity of Bristol. Translation and editing of scientific and medical literature.
More information about Michelle Lorraine Embleton

Find the latest news on assisted reproduction in our channels.