Your breasts feel tight, coffee suddenly smells strange, and you are already tired by nine in the evening. Am I pregnant? This guide explains which signs there are, when they appear, how meaningful they are, and why many of them occur in exactly the same way before a period.

Data box: When the first signs appear

In a US study, 221 women trying to conceive kept a daily symptom diary. Among the women who later had a baby, half had their first pregnancy symptoms on day 36 after the start of their last period, and 89% by the end of week 8 (Sayle 2002). In a British study, nausea began at a median of day 32 after the start of the last period, that is, a few days after the expected period (Gadsby 2021).

When do the first signs of pregnancy appear?

Most signs begin when you are about 4 to 6 weeks pregnant (NHS signs of pregnancy 2026). This is counted from the first day of your last period. With a 28-day cycle, the next period is due after 4 weeks, so the signs usually appear around this date or in the two weeks after it.

The reason for the timing: the body only produces the pregnancy hormone hCG once the fertilized egg has implanted. This happens 6 to 12 days after ovulation, in 84% of pregnancies on the 8th, 9th, or 10th day (Wilcox 1999). Before that, the hormone balance hardly differs from a cycle without a pregnancy.

Signs before a missed period are possible. The gynecologists’ information site Frauenärzte im Netz writes that first indications can often be noticed before the period is missed (Frauenärzte im Netz 2018). No study has directly measured how many women this applies to. In the study on nausea, it began in about a quarter of women by day 28 after the last period (Gadsby 2021). Before the period, however, most early signs cannot be told apart from PMS, see PMS or pregnant?.

The signs at a glance

Sign Typical onset How meaningful
Missed period after 4 weeks, with a 28-day cycle the most reliable sign, but stress or hormonal disorders can also cause it
Nausea, vomiting weeks 4 to 7 of pregnancy affects 70 to 80% of pregnant women, hardly ever occurs with PMS
Breast tenderness, sensitive breasts early, often around the expected period resembles PMS
Tiredness first weeks resembles PMS
Needing to urinate more often, without pain first weeks not very specific
More discharge first weeks not very specific
Pulling sensation in the lower abdomen around the expected period resembles period cramps
Light spotting around the expected period rare, can be mistaken for a period
Basal body temperature stays high from the expected period meaningful if you measure it
Smell, taste, cravings first weeks common, but nonspecific
Constipation, bloating first weeks resembles PMS
Headaches, dizziness first weeks nonspecific
Mood swings first weeks resembles PMS

Sources: NHS signs of pregnancy 2026, familienplanung.de Am I pregnant 2020, Frauenärzte im Netz 2018, gesund.bund.de 2025, RCOG 2016, Cleveland Clinic 2021.

Missed period

According to familienplanung.de, a missed period is the most reliable sign (familienplanung.de Am I pregnant 2020). Even this is not completely certain: stress, a lot of exercise, or hormonal disorders can delay your period (Cleveland Clinic Am I Pregnant 2026). With an irregular cycle, it is hard to say when it would have been due anyway.

Light bleeding around the time of your period does not rule out a pregnancy, see Spotting.

Nausea and vomiting

Nausea is the best-known sign and, depending on the study, affects 70 to 80% of pregnant women (Einarson 2013, RCOG 2016, NHS morning sickness 2024). It usually begins in weeks 4 to 7 of pregnancy, is strongest around week 9, and is over in 90% by week 20 (RCOG 2016).

Morning sickness is a misleading name. In a Canadian study, the nausea was limited to the morning in only 1.8% of women; in 80%, it lasted throughout the day (Lacroix 2000).

Severe vomiting, where you can hardly keep anything down, is called hyperemesis gravidarum. It affects about 1 to 3 in 100 pregnant women and needs medical treatment (NHS severe vomiting 2023, Einarson 2013). When you should get in touch is explained under When to see a doctor?.

Nausea is one of the few early signs that does not appear in the symptom lists for PMS (IQWiG 2022, NHS PMS 2024).

Breast tenderness

Your breasts become larger and sensitive to touch (Frauenärzte im Netz 2018). The tenderness begins early and usually eases after the first three months of pregnancy (gesund.bund.de 2025). In many women, the breasts feel just as tight before a period, so the feeling alone does not tell the difference (Cleveland Clinic 2021).

Tiredness

Severe tiredness in the first weeks comes from rising progesterone, the hormonal changes, and blood pressure that is often low at the start (Cleveland Clinic 2021, gesund.bund.de 2025). It is most pronounced in the first three months.

Needing to urinate more often

You need to go to the toilet more often, without burning or pain (NHS signs of pregnancy 2026). Early in pregnancy, this is due to increased blood flow to the kidneys and to the hormones; later, the growing uterus presses on the bladder (gesund.bund.de 2025). Burning when you urinate points more to a bladder infection.

Discharge as a sign of pregnancy

The hormones in pregnancy make discharge increase (Frauenärzte im Netz 2018, NHS signs of pregnancy 2026). Normally it is clear or white, can also be creamy, and has no smell.

Have it checked by a doctor if it itches, smells unpleasant, or contains blood (Frauenärzte im Netz 2018). If you use vaginal progesterone after fertility treatment, white to yellow discharge is a known side effect and not a sign of pregnancy (Utrogest Luteal 2026).

Pulling sensation in the lower abdomen

On familienplanung.de, a pulling sensation in the lower abdomen is listed as a possible sign (familienplanung.de Am I pregnant 2020). According to Cleveland Clinic, mild cramps like those before a period, lasting a few days, are common (Cleveland Clinic 2021). Have severe or one-sided pain checked by a doctor, as it can point to an ectopic pregnancy (NHS ectopic pregnancy 2022).

Spotting

Light bleeding can occur around the time of your period even if you are pregnant (Frauenärzte im Netz 2018). Even so, it is rare: in one study, 9% of pregnant women bled in the first 8 weeks, mostly lightly and around the time of the expected period (Harville 2003). Whether implantation bleeding exists, what it looks like, and how to tell it apart from your period is explained in the guide on implantation bleeding.

Basal body temperature stays raised

If you take your temperature in the morning: after ovulation, it rises by about 0.2°C and normally drops again shortly before your period. If you are pregnant, it stays up. If it is still raised 18 days after fertilization, according to familienplanung.de this is almost always a sure sign (familienplanung.de Am I pregnant 2020). How to measure the temperature rise is explained in the section on the temperature shift.

Smell, taste, and cravings

In a Swedish study, 76% of pregnant women reported a changed sense of smell or taste, and 67% perceived smells more intensely (Nordin 2004). When measured, however, they did not smell better, just differently. Typical signs are a metallic taste in the mouth, aversion to certain foods or smells, and cravings (NHS signs of pregnancy 2026, Frauenärzte im Netz 2018).

Other signs

  • Constipation and bloating: progesterone relaxes the bowel muscles, and digestion slows down (gesund.bund.de 2025, NHS signs of pregnancy 2026).
  • Headaches and dizziness: due to the hormonal changes and the rising blood volume (Cleveland Clinic 2021, Frauenärzte im Netz 2018).
  • Mood swings: caused by hormones, as before a period (NHS signs of pregnancy 2026).
  • Heartburn: occurs mainly in the last trimester; as an early sign, it is rather rare (gesund.bund.de 2025).

Diarrhea and cervix: not signs

Diarrhea is not listed as a sign of pregnancy by any of the major health sources, not the NHS, familienplanung.de, Frauenärzte im Netz, or gesund.bund.de. Progesterone tends to cause constipation instead. Diarrhea before a period, on the other hand, is a known PMS symptom (Cleveland Clinic PMS 2025).

Feeling your cervix yourself tells you nothing about a pregnancy. On familienplanung.de, the cervix is described only for determining ovulation: firm after the period, and soft and slightly open during the fertile window (familienplanung.de ovulation 2026). Whether it is hard, low, or high does not indicate a pregnancy. Even the findings from palpation during a gynecological examination are considered only uncertain indications (Cleveland Clinic 2021).

PMS or pregnant?

Before your period, the hormone progesterone is high, whether you are pregnant or not. That is why the symptoms are so similar. Up to 90% of women have at least one symptom before their period, and 20 to 30% have premenstrual syndrome (ACOG 2023).

Sign PMS Early pregnancy
Breast tenderness common common
Tiredness common common
Mood swings common common
Bloating, feeling of fullness common common
Pulling sensation in the lower abdomen common, cramps mild pulling possible
Cravings common common, also aversion to foods
Nausea hardly ever in 70 to 80%
Period starts, symptoms improve does not come
Basal body temperature drops before the period stays high

Sources: IQWiG 2022, NHS PMS 2024, Cleveland Clinic PMS 2025, familienplanung.de Am I pregnant 2020, RCOG 2016.

Before your period is due, you cannot tell the difference by how you feel. Only a pregnancy test gives certainty (familienplanung.de Am I pregnant 2020).

Signs after fertility treatment

After insemination, IVF, or ICSI, many women are given progesterone to support the uterine lining. Breast tenderness, tiredness, dizziness, discharge, and spotting are known side effects of it (Utrogest Luteal 2026, Crinone 2021). They therefore say nothing about whether it has worked.

A trigger shot with hCG can cause a false positive pregnancy test for up to 10 days afterwards (Ovitrelle); in one study, the hCG was detectable for up to 14 days (Damewood 1989). Stick to the test day set by your fertility practice. The section on testing after the transfer in the Due Date Calculator shows which days apply after a transfer.

No signs: is that normal?

Yes. In the study from the data box, about one in nine pregnant women still had no symptoms by the end of week 8 (Sayle 2002). In another study, around 16% had no nausea in week 8 (Hinkle 2016).

In the same study, women with nausea had a miscarriage less often (Hinkle 2016). This is a statistical association from a group of women who had already had one or two miscarriages. A lack of nausea is not a warning sign, and how strong the signs are varies from woman to woman and from pregnancy to pregnancy (Cleveland Clinic Am I Pregnant 2026).

When to take a pregnancy test?

From the day your period is due (NHS pregnancy test, familienplanung.de pregnancy test 2024). Even then, a test finds at most about 90% of pregnancies, and 97% one week later, because some embryos implant late (Wilcox 2001). If you do not know when your period is due, test no earlier than 21 days after unprotected sex (NHS pregnancy test).

The Pregnancy Test Calculator works out the right test day for your cycle. The pregnancy test comparison shows which tests detect a pregnancy early and what they cost.

When to see a doctor?

If the test is positive, make an appointment with your gynecologist. On ultrasound, the pregnancy can usually be seen from week 5 or 6 (gesund.bund.de 2025).

Get checked by a doctor right away or call emergency services if you have (NHS ectopic pregnancy 2022, NHS morning sickness 2024):

  • severe or one-sided abdominal pain, pain in the tip of your shoulder
  • bleeding with pain, dizziness, or fainting
  • vomiting where you cannot keep food or drink down for more than 24 hours
  • very dark urine or not urinating for over 8 hours
  • vomiting with fever, abdominal pain, or blood

These signs can point to an ectopic pregnancy or hyperemesis gravidarum.

Frequently asked questions

What are the first signs of pregnancy?

A missed period, often along with nausea, breast tenderness, tiredness, needing to urinate more often, and more discharge (NHS signs of pregnancy 2026, familienplanung.de Am I pregnant 2020). None of them is certain; a pregnancy test gives certainty.

How soon can you tell you are pregnant?

Usually when you are about 4 to 6 weeks pregnant, counted from your last period, that is, around the expected period or shortly after (NHS signs of pregnancy 2026). In one study, half of the pregnant women had their first symptoms on day 36 after the start of their last period (Sayle 2002).

Are there signs of pregnancy before a missed period?

Yes, in some women, for example breast tenderness, tiredness, or early nausea (Frauenärzte im Netz 2018, Gadsby 2021). Before the period, however, they resemble PMS. Only a test from the day of the expected period gives clarity.

When does nausea start in pregnancy?

Usually from weeks 4 to 7 of pregnancy, strongest around week 9 (RCOG 2016). In one study, the nausea began at a median of day 32 after the start of the last period (Gadsby 2021).

How do I tell PMS and pregnancy apart?

Before the period, hardly at all, because progesterone is high in both cases. Nausea points more to a pregnancy, and so does a basal body temperature that stays high beyond the expected period (familienplanung.de Am I pregnant 2020). Only a test shows it for certain.

Is diarrhea a sign of pregnancy?

No, that is not supported by evidence. None of the major health sources lists diarrhea as a sign. Before a period, on the other hand, diarrhea is common (Cleveland Clinic PMS 2025).

Is it normal to have no signs of pregnancy?

Yes. About one in nine pregnant women still had no symptoms by the end of week 8 (Sayle 2002). Having no signs is not a warning sign.

Which discharge is a sign of pregnancy?

More discharge, clear or white and without a smell (Frauenärzte im Netz 2018). However, it also occurs in a normal cycle. Have itching, an odor, or blood checked by a doctor.

Sources

Studies

Guidelines and product information

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About this article

Fertilio Editorial Team

The Fertilio Editorial Team researches fertility topics using specialist sources such as the German IVF Registry (Deutsches IVF-Register, D.I.R.), medical guidelines, and statutes. The sources are listed at the end of each article. The content does not replace medical advice.