Are my first trimester symptoms normal?
You're googling a symptom you're slightly embarrassed to google. Or you're googling the absence of one.
Most first trimester symptoms are normal, and so is having very few. They usually start somewhere between four and ten weeks, they're strongest around five to eight, and they turn up in whatever order they like. What matters is a short list of signs that mean get checked. They're all on this page, and there's a summary near the end.
When do pregnancy symptoms start?
For most women, somewhere between four and ten weeks. They're usually at their strongest between five and eight weeks.
They don't arrive as a set. Sore breasts are often first, around four to six weeks, and feel like the tenderness before a period. Nausea affects about seven in ten pregnancies. Tiredness tends to peak around seven or eight weeks.
If you're six weeks and nothing much has happened yet, that doesn't mean anything is wrong. Try not to hold yourself to a schedule. The window is wide and most women fall outside it somewhere, in their own way.
One exception. If nausea starts brand new after about ten or eleven weeks, and you've had none before, that's unusual enough to mention to your midwife or doctor.
Is it normal to have no symptoms?
Yes. About three in ten women never get any nausea at all. Having no symptoms isn't a good sign or a bad sign. It's just what your body is doing.
Nausea is linked to a slightly lower chance of miscarriage. It doesn't work the other way round, though. No nausea doesn't mean something is wrong.
What does a heartbeat on the scan tell you?
This is the reassurance that actually counts.
An Australian study followed nearly 700 women who had a scan showing a heartbeat between six and eleven weeks, and no bleeding or pain. Here's how many went on to miscarry, by the week the heartbeat was seen:
Heartbeat seen atMiscarried afterwards6 weeksabout 9 in 1007 weeksabout 4 in 1008 weeksabout 1.5 in 1009 weeksabout 1 in 200
So once you've seen a heartbeat at eight weeks, with no bleeding and no pain, the chance of miscarriage is around one and a half per cent.
Miscarriage is something a lot of women worry about at the start of pregnancy, and it's still treated as something we don't talk about. I don't want to frighten you, and you shouldn't be frightened. But women who've had a loss often say nobody around them ever discussed it. I'd rather give you the real numbers.
What if my symptoms suddenly stop?
Symptoms come and go. Most of the time that means nothing at all.
But if you're worried, that is reason enough to be seen. A scan will settle it in about ten minutes. Nothing else will. Not a symptom diary, not Google, not waiting to see.
Why the first weeks feel so long
Early pregnancy might be the first time you've been in your body, waiting, with no way of knowing what happens next.
That in-between can be lonely. It doesn't always mean you're worried enough to ring someone, and it doesn't mean anything is wrong. It just seems to last forever.
It doesn't help that so many women feel they can't tell anyone until twelve weeks or later. Worry grows best in the dark. If you want to tell a few people early, so you're not carrying this alone, you're allowed to.
Exhaustion in the first trimester
It peaks around seven or eight weeks. For most women, energy is at its best around 21 weeks.
This is deep, full-body tiredness. The kind where you want to crawl under your desk at lunchtime and sleep. Studies put it at somewhere between half and three-quarters of women, depending on how the question is asked.
Your body is working incredibly hard. By about eight weeks your heart is pumping around 20% more blood than before. Your blood volume is climbing and your whole circulation is being rebuilt.
You'll hear two other explanations. Progesterone gets blamed, but nobody has shown that the women with the highest progesterone are the most tired. It's a reasonable guess, not a proven one. You'll also hear it's because you're building a placenta. The timing doesn't fit. You're most tired when the baby is the size of a blueberry, and most women feel better in the second trimester, when the baby is growing fastest.
One thing does hold up. How well you sleep early in pregnancy predicts how tired you'll be later on. So take sleep seriously, especially if it's never been your strong point. This is real, and your rest is a priority now.
When should tiredness be checked?
You'll usually have a blood test at your first appointment and again around 28 weeks.
One thing we look for is anaemia, when your blood isn't carrying enough oxygen, most often because your iron is low. We can also check your ferritin, which is the iron your body holds in reserve. Under 30 is considered low. If you're exhausted, it's reasonable to ask for it.
For most women, early exhaustion is a normal part of pregnancy rather than a nutrition problem.
Thyroid is the other one you'll read about. Most Australian guidance doesn't recommend testing everyone, only women with a reason to. So don't panic if nobody has offered it.
For most women it's simply hard work being pregnant. You deserve the rest your body is asking for.
Sore breasts, and when it eases
Often the very first thing you notice, from around the time your period is due. It feels like pre-period tenderness, turned right up. Even clothes or a bra can feel like too much. About three-quarters of women get it.
Over the pregnancy your nipples and the skin around them get darker. That happens to about nine in ten women and is more noticeable if you have darker skin. It doesn't completely fade afterwards, which surprises people.
You'll also see little bumps on the darker skin around your nipple. Those are glands. They're meant to be there and they're doing a good job.
Your breasts will grow, roughly 350 grams each across the pregnancy.
When does the soreness ease? Honestly, nobody has measured it properly. Most women say around twelve weeks. It's usually worst early and settles, but your breasts keep changing the whole way through pregnancy, and after.
Vaginal discharge: what's normal?
More discharge is normal in pregnancy. It's one of the earliest changes, and I talk about it with most women in my care. If you haven't been around pregnancy much, it can feel like a strange thing to bring up. It isn't. We discuss it several times a week.
Normal discharge is clear or milky, thin, with no smell, no itch and no pain.
It increases because oestrogen and progesterone bring more blood flow to your uterus, vagina and vulva. Your cervix also makes more mucus, which forms a protective layer between the outside world and your growing baby.
How much there is doesn't really matter. What matters is whether it changes. It keeps increasing right through pregnancy. If the amount is unusual for you, or you're not sure, ask.
Thrush, BV and when to get checked
This is overly simple, but it helps you work out what might be going on.
If it itches, it's often thrush. The discharge is usually thick, white and can be lumpy. Thrush is twice as common in pregnancy, because the hormonal changes shift the balance in your vagina. Around three in ten pregnant women get it at some point.
Thrush in pregnancy is treated with creams or pessaries, and for longer than usual. Use the six- or seven-day course, not the three-day pack. The tablet you swallow isn't the first choice in pregnancy. MotherSafe's thrush factsheet (linked below) covers what's recommended.
If it smells and doesn't itch, it might be bacterial vaginosis (BV). The discharge is thin and grey, and the smell can be fishy, often worse after sex. See your midwife, GP or a sexual health clinic.
If it's green or frothy, smells bad and you're sore, get it checked properly, and soon.
Cramping and twinges
Mild cramping that's brief, comes and goes, and feels like it's on both sides is very common. Your womb is growing and doing something it's never done before.
Pain on one side that stays or gets worse is different. Get that checked.
You'll hear about round ligament pain. These ligaments hold your womb in place and stretch a lot as it grows, from very small to all the way up under your ribs. That pain is sharper, like a stitch, and it's mostly a second trimester thing. In the first trimester, the sensations are usually just your womb growing, and the unfamiliar feeling of a baby inside you.
Implantation bleeding and cramping
Implantation is when the pregnancy embeds into the wall of your womb. Some women say they feel it, the way some women feel ovulation.
The best study on this followed 221 women with daily diaries from before they conceived. Nine per cent had some bleeding in the first eight weeks, and 12 of those 14 went on to have healthy babies. But the bleeding clustered around when their period would have been due, not around implantation. The researchers found no evidence that implantation causes bleeding.
For implantation cramping there is no research at all. Not a single study. (It comes from fertility websites.)
So you don't have to decode any of it. If you're bleeding or cramping, we check. We don't need the label.
Shoulder tip pain and ectopic pregnancy
This is the one I most want you to remember.
Pain right at the very tip of your shoulder, where it meets your neck. It's strange because it's nowhere near your pregnancy. It can mean blood is irritating the big muscle under your lungs, which shares a nerve with your shoulder.
It can be a sign of an ectopic pregnancy, a pregnancy growing outside the womb, usually in a fallopian tube. That happens in about one in a hundred pregnancies, usually between four and twelve weeks.
Go to emergency or call 000 if you have:
pain at the tip of your shoulder
pain on one side of your tummy
heavy bleeding
feeling faint or dizzy
Pressure in your bottom, or pain when you open your bowels, is also worth getting checked.
Most ectopic pregnancies don't look dramatic. They look vague. If you think something is wrong, get checked rather than waiting for it to get worse.
Some bleeding in early pregnancy is common, and most women who have it go on to have healthy babies. It still gets checked.
Bloating, constipation and heartburn
Meet progesterone. It does a lot of good work helping your body hold a pregnancy, and because it's a hormone it works everywhere at once. Nine times out of ten, when you tell your midwife about a strange new symptom, the answer is "that's the progesterone".
Progesterone relaxes smooth muscle all over your body, including your gut and the valve at the top of your stomach. Food moves through more slowly, partly so you absorb as much as possible, and the valve doesn't always close as well.
Constipation affects about one in five women in the first trimester. It gets more common as pregnancy goes on, about a third of women in the second trimester, because your growing baby adds to what the hormones are already doing.
Heartburn, or indigestion, is acid sitting in your stomach or rising up your oesophagus. About one in four women get it in the first trimester and more than half by the third.
What helps with constipation
Normal bowel habits vary a lot between people, and pregnancy changes them again. Constipation usually means fewer than three bowel motions a week. What we most want to avoid is pushing and straining, because that can lead to haemorrhoids (piles) or small tears around the anus called fissures. If you do get haemorrhoids, treating the constipation comes first.
Constipation is uncomfortable, but it won't harm your baby.
What to try first:
Go to the toilet as soon as you feel the urge.
Put your feet on a small stool, so your knees are above your hips. It helps you go without straining.
Eat a variety of high-fibre foods: whole grains, fruit, vegetables, legumes. Kiwi fruit can help. You can add psyllium husk.
Increase fibre slowly, or you'll swap constipation for bloating and wind.
Drink 1.5 to 2 litres a day, more in hot or humid weather. Water is best. Herbal tea and fruit juice count, and prune juice can help.
Cut back on caffeine.
Move. Activity gets your gut moving too.
My go-to: first thing in the morning, or after a rest, have a glass of warm water and go for a gentle walk. Come back, sit on the toilet with your feet up, and take your time without straining.
If that doesn't help, there are medicines you can try, some of them over the counter. MotherSafe's constipation factsheet (linked below) lists which are suitable in pregnancy, or ask your midwife, GP or pharmacist.
What helps with heartburn
Heartburn can feel like burning in your chest, a sour taste in your mouth, or food coming back up. MotherSafe estimates up to 80% of women get it at some point in pregnancy. It can get worse later on, when your uterus is pressing up against your stomach. It can also make nausea and vomiting worse.
See your midwife or doctor if you're vomiting blood, losing weight, or have pain or trouble swallowing. If you're otherwise well, it's reasonable to start with diet and lifestyle changes.
What to try:
Drink between meals rather than with them.
Eat small meals often, six to eight small ones rather than two or three big ones. It keeps your energy up without overloading your gut.
Notice your triggers. Common ones are spicy or fatty food, tomatoes, dairy, chocolate, citrus and acidic fruit like pineapple, caffeine, alcohol and cigarettes.
Sit up while you eat and don't lie down soon after.
Avoid eating in the couple of hours before bed or exercise.
If it's bad at night, prop yourself up to sleep. A lot of women end up doing this.
Medicines. Antacids from the pharmacy are the first option and are safe in pregnancy at the recommended dose. Your pharmacist can help you choose. Proton pump inhibitors reduce the amount of acid your stomach makes. Some are preferred in pregnancy over others, so ask before you start one. MotherSafe's heartburn factsheet has the detail.
The metallic taste, smell and food aversions
About a quarter of women say their sense of taste changes in pregnancy. About two-thirds say their sense of smell changes, and that's far more common than people expect. A lot of women describe a kind of super-smell.
(I couldn't stand the smell of bread in my first pregnancy. My husband had to leave it outside the front door.)
Cravings and aversions. Somewhere between half and nine in ten women get cravings, and a similar number go right off foods they used to like. About three-quarters have cravings by 13 weeks. Savoury tends to come first, sweet in the second trimester, salty later on.
Nobody really knows why aversions happen. Generally it's fine to follow your cravings and eat what you can manage.
If you can keep up some protein and plenty of fruit and vegetables, that's ideal. But a lot of women can only manage bland food, or a few particular foods, early on. That's okay. The weeks of crackers and toast don't undo everything else you're doing for your body.
Crying, mood and anxiety
Crying a lot in early pregnancy is common. Honestly, it's a reasonable response to an enormous thing happening inside your body.
You've got rapid rises in oestrogen and progesterone, changes in your brain and how you regulate emotion, first trimester exhaustion wearing down your ability to cope with ordinary stress, and a major life change. You might also just feel unwell. And that's assuming the pregnancy was planned and wanted. Mixed feelings are common even in pregnancies that were longed for, and it's okay to feel ambivalent.
Crying won't hurt your baby. It's okay to feel what you feel.
I'd also encourage you to listen to it. It's easy to wave a feeling away as hormones. Hormones can lower your tolerance, but there's often something underneath that you're working hard to process. If something is coming up for you, pregnancy is a good time to look at it. You have months to work through it, so you can meet your baby in the best state of mind you can.
How common is it? Anxiety affects somewhere between one and two in every ten women during pregnancy and after. Depression affects around one in ten. Anxiety is the more common one, and the one people talk about least.
You don't have to wait until it's bad. If the feelings are hard to shift, or they're getting in the way of your days, talk to your midwife or GP. Perinatal anxiety and depression are common and treatable, and they don't usually lift on their own. You don't have to struggle through your pregnancy.
You can also ask to be screened. There's a short questionnaire, the Edinburgh scale, that takes a couple of minutes. You don't have to wait to be offered it.
The support services for your emotional wellbeing are listed further down this page.
Weeing more often
Weeing more than usual? Yes, that's the pregnancy. You have about 20% more blood to process, so your kidneys are working harder, and that means more wee.
Please don't drink less because of it. If night-time trips are the problem, try getting most of your fluids in earlier in the day rather than just before bed.
Urinary tract infections are more common in pregnancy, and needing to wee often is one of the symptoms. If frequency is your only symptom and you're not prone to UTIs, it's probably normal. If it stings or burns, or there's blood in your wee, get it checked. A fever, back pain or vomiting alongside those symptoms needs to be seen the same day.
Bloating
There's a stretch of early pregnancy where you genuinely can't tell whether you're bloated or showing. The same slowing of your gut that causes constipation causes the bloating too, along with some cramping.
Headaches, backache and a blocked nose
These are common early on too.
Progesterone increases mucus production all over your body, not just in your cervix, so a blocked or runny nose is normal. Changes in blood flow can make you achy, much like before a period, in your legs or your lower back. And big hormonal shifts can trigger headaches.
Paracetamol is the medicine generally recommended for pain in pregnancy. Use it at the recommended dose. If a headache doesn't go away with rest, water and paracetamol, get in touch with your midwife or doctor.
When to get checked: the short list
Go to emergency or call 000:
pain on one side of your tummy
pain at the tip of your shoulder
heavy bleeding
feeling faint or dizzy
Contact your midwife, GP or maternity service soon:
any bleeding or cramping that worries you
pressure in your bottom or pain opening your bowels
symptoms that suddenly stop, if you're worried
nausea that starts new after about 10 or 11 weeks
discharge that itches, smells, is green or frothy, or you're sore
stinging or burning when you wee, or blood in your wee
vomiting blood, losing weight, or pain or trouble swallowing
a headache that doesn't ease with rest, water and paracetamol
feelings that are hard to shift or getting in the way of your days
Resources
MotherSafe factsheets
MotherSafe is a free service run from the Royal Hospital for Women in Sydney. It gives information about medicines and other exposures in pregnancy and breastfeeding. You can ring them on (02) 9382 6539, or 1800 647 848 from regional NSW.
Nausea and vomiting in pregnancy
Constipation in pregnancy and breastfeeding
Haemorrhoids in pregnancy and breastfeeding
Heartburn in pregnancy and breastfeeding
Urinary tract infection in pregnancy and breastfeeding
Migraine in pregnancy and breastfeeding
Your emotional wellbeing
If you're struggling, or not sure whether what you're feeling is normal, any of these is a good place to start. You don't need a referral and you don't need to be in crisis.
Treat yourself the way you'd treat a friend in the same spot. The 3am thoughts, "something's wrong" and "I can't do this", are thoughts, not facts.
PANDAPerinatal Anxiety & Depression Australia
For when you're struggling, or unsure whether what you feel is normal.
Ready to COPECOPE
Free weekly emails through pregnancy, timed to your week, about how you're feeling and what's normal.
Emotional health in pregnancyCOPE
Plain information on mood in pregnancy, including mixed feelings about being pregnant.
Gidget Foundation
Emotional support in pregnancy and early parenthood.
ForWhen
Help finding perinatal mental health support near you. Monday to Friday, 9am to 4.30pm.
MotherSafe
Questions about medicines in pregnancy, including for anxiety and depression.
This is general information about pregnancy, not advice about you. It doesn't replace the care of your own midwife, GP or maternity service, and it can't account for what's particular about your pregnancy.
If you're worried about yourself or your baby, contact your maternity service or go to your nearest emergency department. Don't wait to be sure.
Sources referenced on this page
Tong S et al. Miscarriage risk for asymptomatic women after a normal first-trimester prenatal visit. Obstetrics and Gynecology 2008;111(3):710–714
Hinkle SN et al. Association of nausea and vomiting during pregnancy with pregnancy loss. JAMA Internal Medicine 2016;176(11):1621–1627
Prevalence and course of pregnancy symptoms using self-reported pregnancy app symptom tracker data. npj Digital Medicine 2023
Fan Z et al. Longitudinal association between sleep quality and fatigue during pregnancy. BMC Psychiatry2025;25:159
RANZCOG, Routine Antenatal Assessment in the Absence of Pregnancy Complications (C-Obs 3b), 2022
RCPA, The Use of Iron Studies, Ferritin and Other Tests of Iron Status, 2020
Harville EW et al. Vaginal bleeding in very early pregnancy. Human Reproduction 2003;18(9):1944–1947
healthdirect, Ectopic pregnancy; Warning signs during pregnancy
Salari N et al. Global prevalence of constipation during pregnancy. BMC Pregnancy and Childbirth 2024;24:836
Nordin S et al. Self-reported abnormal smell and taste perception in pregnant women. Chemical Senses2004;29(5):391–402
Orloff NC, Hormes JM. Pickles and ice cream! Food cravings in pregnancy. Frontiers in Psychology 2014;5:1076
COPE, Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline, 2023
MotherSafe factsheets: Thrush in pregnancy (July 2024); Constipation (November 2025); Heartburn (March 2021); UTI (June 2022); Migraine (June 2022)
