Wondering what's causing cramps during pregnancy? We break it down by trimester

• Cramping during pregnancy might seem worrisome, but it's normal as your uterus adjusts.
• Cramping can also happen due to constipation and pregnancy-related changes in your body.
• Contact your doctor right away for sudden or severe cramping that’s accompanied by vaginal bleeding.

Experiencing cramping during pregnancy can be scary, but it's often not a cause for concern.

"Cramping is common throughout pregnancy and can be normal. The vast majority of cramps are the uterus adjusting and accommodating the growing pregnancy," says Yaakov Abdelhak, MD, a high-risk perinatologist, maternal fetal medicine specialist, and host of True Birth podcast.

Read on to find out what can cause cramping in pregnancy and when cramps could suggest a more serious problem.

Cramping in the first trimester

Cramping is possible during any stage of a pregnancy, including very early on.

"Cramping is more common as a woman gets closer to her due date, but some women will experience cramping from the minute they miss their period (or even slightly before) and all the way up until the moment of birth," says Kristin Mallon, a board certified nurse midwife and co-host of True Birth podcast.

Cramping in the first trimester might happen due to:

• Normal side effects of pregnancy, like the stretching of your uterus as it grows.
• Implantation bleeding, which happens around 10 to 14 days after conception, can also be accompanied by mild cramping. You might also notice some light bleeding or spotting, which should go away on its own within 2 or 3 days.
• Constipation: As a matter of fact, a 2020 study found women are more likely to suffer from constipation during pregnancy than at any other point in their lives. Hormonal changes, like increasing progesterone, relax your intestines and bowels. This can slow digestion, resulting in stool that's harder to pass and subsequent constipation cramps.
• Not getting enough dietary fiber can also cause constipation and associated gas and cramping.

It's best to call your doctor or midwife when cramping is severe, accompanied by vaginal bleeding, or doesn't improve after a bowel movement or lying down for a bit.

Severe cramping during early pregnancy can also be a major concern when it's an ectopic pregnancy.

Ectopic pregnancy

An ectopic pregnancy happens when a fertilized egg grows outside of the uterus, most often in a fallopian tube. As the pregnancy grows, the fallopian tube can rupture. This is a medical emergency.

The symptoms of ectopic pregnancy, which typically develop between weeks 4 and 12, can feel a lot like a typical early pregnancy: Common early symptoms include tender breasts, mild cramping on one side of the pelvis, and nausea.

As the pregnancy grows, symptoms will become more severe, especially if the fallopian tube ruptures. A rupture will usually occur around the sixth week of pregnancy.

Let your doctor or midwife know about any vaginal bleeding or severe pain right away.

Important: Call 911 or head to the nearest emergency room if you experience signs of a ruptured fallopian tube, including sudden and severe pain in your abdomen or pelvis, shoulder pain, or general weakness.

Cramping in the second trimester

Again, constipation is a possible cause of discomfort and cramping during any trimester. Outside of that, you may be experiencing something called round ligament pain.

"Round ligament pain can be confused with cramping and that is most likely to happen in the second trimester," says Abdelhak.

The round ligaments run along both sides of the pelvis and help support your uterus. As your pregnancy progresses the ligaments stretch, causing pain when they tighten or spasm.

Round ligament pain:

• Can occur on either or both sides of the abdomen or pelvis, but is typically felt on the right.
• Often happens during sudden movements, like when rolling over in bed, standing up quickly, or coughing.
• Is temporary and nothing to worry about.

A less likely, but still possible cause of second trimester abdominal pain is preeclampsia. This serious hypertensive disorder usually develops after 20 weeks of pregnancy.

Symptoms of preeclampsia include:

• Upper abdominal pain that might feel like heartburn
• An ongoing headache
• Confusion
• Blurred or spotty vision
• Swelling of the hands and feet
• Nausea and vomiting

It's best to connect with your care team right away if you experience any of these signs.

Cramping in the third trimester

Cramping in the third trimester of pregnancy is most often caused by Braxton-Hicks contractions, also known as false labor pains.

"You can think of Braxton-Hicks contractions as the uterus revving its engine and getting ready for the race ahead. Braxton-Hicks contractions do little on their own. Think of them as a pre-labor tune up," says Abdelhak.

Unlike true labor pains, which will get stronger and closer together, Braxton-Hicks are more sporadic and might change or stop with rest or movement. The discomfort they cause usually isn't as intense as a true labor contraction.

Timing your contractions for an hour can help you determine which type you're experiencing.

Call your care team or head to the hospital if:

• Your contractions are five to seven minutes apart
• Your water breaks
• You're less than 37 weeks pregnant

How to get relief from pregnancy cramping

Hoping for ways to get some relief from pregnancy cramping? These tips may help:

• Drink water. Dehydration can increase the risk of uterine contractions and cramping. Plus, drinking more water can help prevent constipation. So, whether you're experiencing pregnancy cramps or Braxton Hicks contractions, drinking water can often bring relief.
• Take a warm shower. "A warm shower can do wonders," Mallon says. Taking a warm, but not hot, shower can relax tense muscles and help soothe pain, so it may help ease other types of pregnancy pain along with cramps.
• Tylenol. If you're looking for an over-the-counter pain reliever for pregnancy cramps, Adelhak recommends Tylenol (acetaminophen).

Note: Research has linked anti-inflammatories, ibuprofen, and aspirin to a higher risk of birth defects. Always check with your care team before trying any medication or supplement.

Insider's takeaway

Cramping during pregnancy can be normal, but simple remedies like rest and hydration can help you get relief.

If you experience persistent or concerning cramping that doesn't improve, it's always a good idea to reach out to your doctor or midwife for more guidance.