Episode 5 : Am I pregnant?

Dr. Sophia:
Hello everyone. Welcome to the Doctor Sophia podcast. I'm an ObGyn practicing for over 15 years in my native New York City, and I love to help women learn about their bodies, empower them, and embrace themselves. On this podcast, we will talk openly and with heart about all things affecting women from pregnancy, menopause periods, sexual health, fertility, and so much more. Disclaimer, this is general medical information based on my professional opinion and experience. For specific medical advice, please refer to your physician. Hello everyone. Welcome to the Dr. Sophia Podcast, episode five. Am I pregnant? I'm joined today by my co-host and good friend Touseef Mirza.

Touseef Mirza:
Hi, everybody. So we wanted to really talk about the first things that happen when you think you're pregnant or not pregnant, and how can we just talk about all the different facets of when you're asking yourselves this question. So Dr. Sophia, I'm just gonna ask you a few questions that maybe some of your patients have asked. So I'll start there. What would you say is the earliest point that I could consider that I'm pregnant? Like when I could start to think, oh, am I pregnant? Like, what would be the earliest time frame that I could start thinking even that?

Dr. Sophia:
Most women actually could take a pregnancy test even a few days before they've missed their period. But I would say to be 100% on the safe side if you are expecting your period, and it doesn't come, probably within just a few days, you could take a pregnancy test and that pregnancy test if you're
positive, if you are in fact pregnant would be positive.

Touseef Mirza:
So let's say that I'm just feeling a little off and it's been three days since I had a sexual encounter, so would I even after like three days, is that something that people could sense even after three days that I'm pregnant? So when does our body or sensibility or feelings start to change that we might start to wonder whether or not we're pregnant regardless of the period?

Dr. Sophia:
Interestingly, I like to tell women, you know, again, this is all about knowing your body. And though three days after you, you know, may have been impregnated, maybe too soon, but for someone who's incredibly in tune, I don't know that it's too soon. Certainly, you know, two weeks after you are pregnant, I think women do start to have some sensations that are consistent with early pregnancy. The difference though is that those are the same things that may be happening when we're expecting our periods. So we may have some breast tenderness or sensitivity. We may have a headache, we may have some cramps, we may have fatigue. And so all of those things are early signs of pregnancy, but those are early signs of pregnancy that are very much the same signs as, oh, my period's coming.

Touseef Mirza:
So when you say cramping, are the types of cramping different due to pregnancy versus if you're getting your period? Or is there a distinct type of feeling?

Dr. Sophia:
They're very similar. If not the same because kind of something is happening that pregnancy is kind of burrowing itself into your uterus, and the act of doing that is, is part of what causes the cramping. So I would really say that it's very similar or the same to the kind of cramping feeling that you would feel when you're gonna get your period. In terms of what my patients have told me, the crampiness kind of feels like it's kind of all-day cramping. They feel it all the time, which may be a little bit different from the cramps that women tend to feel with their periods that kind of can be intermittent or comes and goes. But otherwise, the cramping itself feels very, very similar if not the same.

Touseef Mirza:
So, for example, if I have periods during my periods, I usually don't get fatigued and all of a sudden I'm fatigued all the time. That could be maybe a delineation of saying, oh, something's different than how I usually feel.

Dr. Sophia:
Absolutely. If anything, I would even say that the fatigue that's associated with early pregnancy can be so debilitating. It feels like I just need to sleep all the time. Or like you kind of wake up and you feel like I, I feel like I can't move. And though some women may feel that way on the first or second day of their period or you know, a day or two before their period, it certainly doesn't last for days on end the way that it would with a pregnancy.

Touseef Mirza:
Okay. Is it possible that some women don't have any of those symptoms?

Dr. Sophia:
Actually, it is. I've had patients who come in and they say that they missed their period, and so that prompted them to take a pregnancy test, but they have no symptoms of pregnancy. They feel the same, they are not fatigued. They don't necessarily have any breast tenderness or soreness. They are, you know, not having any headaches or cramping. So it can vary, but I would say for the most part, women have some signs.

Touseef Mirza:
So then in terms of the, what would you say are the three to five main signs for women who do experience early symptoms of pregnancy

Dr. Sophia:
In the first four to five weeks? I think the earliest sign is cramping, fatigue, breast tenderness, or soreness. And some women can have one, all three, two, like it varies by which ones are the most significant, and later, more like around maybe five or six weeks do they start to experience things like nausea or what we call morning sickness, for example, which is a big one. And actually, another one that happens, some women experience something called ptyalism, which is spitting. It's an interesting one actually.

Touseef Mirza:
I never heard of that. What is that?

Dr. Sophia:
Some women experience like, and I think it really comes from the fact that they have weird tastes in their mouths or like their, their mouth just feels like it's watering all the time. And so they experience this feeling of having to, you know, like they have so much secretions in their mouth all the time. And actually, that can be one of the first signs that they're pregnant.

Touseef Mirza:
That's so nondescript.

Dr. Sophia:
I know.

Touseef Mirza:
How do you connect that with pregnancy? It’s very weird. And so that's interesting that you're saying that nausea and morning sickness really happen five to six weeks into the pregnancy.

Dr. Sophia:
A little bit later. It's definitely not the first thing that happens, that's for sure.

Touseef Mirza:
Because of that, I would say aside from the symptoms that we just talked about before, like the cramping and the fatigue, the morning sickness is really sort of like the signal ingrained.

Dr. Sophia:
Yeah. I'm pregnant, something's happening.

Touseef Mirza:
Yeah, but that only happens five to six weeks after, so you're, that's not sort of the, the litmus test to know whether you're pregnant or not. So we talked about the women who do have symptoms. For those who don't have symptoms, how would they know that they're pregnant in the first few weeks?

Dr. Sophia:
They'd have to take a test. They've missed their period. They were expecting some perhaps to be pregnant because they were trying. And then for those who were not trying, and then it's a surprise typically, you know, you've missed your period. And it's, even if it's super late, like, and when I say super late, most women's periods are somewhere between, you know, 24 and 30 days or 35 days depending. And you know, usually, I would say about five to six weeks since your last period, you start to think, hey, wait a minute, where's my period? Unless you're one of those women who have a very irregular period, and then that really can throw everything off. But overall, if you are not having any symptoms, but you have a regular period, then that one's kind of key.

Touseef Mirza:
So the moment that, and when we say that you're not getting your period, are we literally saying, let's say that it's just late or if you're not having it at all?

Dr. Sophia:
So here's an interesting thing. There is a pretty good subset of women who may experience what we call implantation bleeding. So implantation bleeding is when the pregnancy, as I said, is kind of borrowing itself into the uterine lining or into the uterus or the womb. And sometimes that causes a bleeding episode. And of course, we also talked about the fact that the uterus is having some cramping. And as we're in the early stages of pregnancy or during the time of your cycle when we get pregnant, your uterus or the inner lining is actually very nice and thick and fluffy and waiting to get pregnant, like that is the whole point of your period cycle.

Touseef Mirza:
That sounds so welcoming.

Dr. Sophia:
It's like this, it's like this feathery pillow basically waiting for this pregnancy. And so that can shed a little bit. And so in that, that shedding oftentimes happens right around the time that you would've gotten a period often. So some women actually, they're like, well, I had my period. And then it's when you dig a little deeper and you say, well, was it a really normal period? Did you feel like you were having the same kind of bleeding that you normally would when you have your period? And then that's when you dig a little deeper and you realize, well, it was a little bit lighter, or it was a little bit more spotty, or it only lasted for three or four days when my period usually lasts for seven. And then that's when they also start to let you know that, and I was particularly more tired or I was particularly more crampy. You know, the concept of just missing a period even is not necessarily the end all be all because some women have bleeding in early pregnancy that could resemble an actual period and why it can totally throw them off.

Touseef Mirza:
So, that's really interesting. So you're saying that we might think it's a period. If I'm pregnant, I might think it's a period, but it's actually not a period, it's just the inner lining of my uterus that is shedding and that's what's creating the spots because I'm pregnant.

Dr. Sophia:
That is correct

Touseef Mirza:
That is the body playing a trick on you.

Dr. Sophia:
The ultimate trick. It's the ultimate trick.

Touseef Mirza:
It's like, you think you know me, well, here's another one for you. Figure that one out. But to your point, the period or the non-period, the spotting is usually different than normal.

Dr. Sophia:
For most women, yes, they experience some type of bleeding episode that's very different than their usual period, but because they're having some form of bleeding, oftentimes in our brains, we simply just file that away as, oh, thank God my period came if that's how you were feeling. Or, like pregnancy was totally not the thing you wanted. Or you know, you're just so used to your day-to-day life that you just again file it away and say, oh, well yeah, okay, it's a little weird. Maybe I'm a little bit stressed. We're very good at rationalizing, as human beings. And so even when we observe a change, we oftentimes are able to rationalize and give a reason for why that change happened. That's why it's so easy sometimes to have an experience where you do have a bleeding episode and it, and then you say, oh, that must have been my period. And so sometimes it's not until you've missed the second month. Now you're not, you've not had a period or a real period per se for two months. Do women then realize, oh wait, let me check?

Touseef Mirza:
So let's take those two scenarios. So let's say we take the first scenario, I'm not sure if I'm pregnant, but I'm having all the signs, the cramping, the headache, the fatigue in that situation. Should I say, oh, maybe I'm pregnant and take a test right away, or should I wait until seeing whether or not I'm gonna get my period?

Dr. Sophia:
I would say it can be different for each individual woman. A woman who is planning a pregnancy, meaning they are really excited, and trying to have a baby, and they recognize these changes happening in their body and it doesn't quite feel the same as when they would normally get their period, meaning they're kind of like PMS symptoms, then it's fair to take a pregnancy test and, and know right away. And hopefully, the answer is gonna be that the test is positive. For some women, it makes more sense because of the fact that they have such a regular period to wait until they've missed their period to say, hey, what's going on? I should have had my period by now. I'm five days late and you know, you've been having unprotected sex or just regular sex and there's a possibility. And, then for other women, I would say, if there's any question because oftentimes we simply forget that there's that one time and not realizing that that one time for the month was the peak ovulation time for you.

Touseef Mirza:
That one time that you had sex.

Dr. Sophia:
Had sex, that is, yes. And you know, that happened to be peak ovulation time, and boom, you could definitely be pregnant. So I think if there's a thought in your mind that it's a possibility, then with all fairness, taking a pregnancy test, I would say four weeks after you've had your last period is totally fair.

Touseef Mirza:
So four weeks after your last period, because I think, so let's say that I am having all the symptoms. It's only been like, I don't know, five, six days I'm having these symptoms. If I take the pregnancy test right away, will it show me that I'm pregnant? Will it actually activate the test the way it's supposed to?

Dr. Sophia:
That's a great question. In all honesty, they keep coming out with commercial urine pregnancy tests that are what we call ultra-sensitive and can therefore detect pregnancy earlier and earlier. But to be safe, I would say that the earliest I would take, you know, the test as being true would be four weeks after your period after you've missed your period. Yes, there are tests that can detect a pregnancy up to two weeks before you've missed your period. I'm a little hesitant unless you're gonna take a blood test, meaning you go to the doctor and you do a blood test in order to see if you're pregnant. Because what's happening, those tests are checking for something called HCG or human chorionic atropine in the urine sample or even in the blood. But for the urine sample, it has to reach a certain number of concentration in order for it to show positive in the urine test. And so given that fact, that's the reason why I say, you know, sometimes it's better to just wait and most times it's going to get to that level or that concentrated point in the urine when you've gotten to that four-week mark. It can be that your hormone levels double at such a rapid rate that the concentration is there even sooner, or that the test itself detects a lower concentration. But I don't wanna use that as the, you know because all the tests are so different. There are so many different ones on the market. There's no one that I would say, oh yeah, definitely do this one or definitely do that one. If you needed to know right away, and let's say you're two weeks out, I would go to your doctor so that you could have a blood test that's confirmation.

Touseef Mirza:
Okay. Because yeah, if you're saying that for the ones that you buy, like over the counter at the drugstore, I have to wait four weeks after my period. So let's say I just finished my period or around my period. So that's like I have to wait at least four weeks. And for some women, depending on their situation, that will drive them crazy, right? Because they want to know. So if they really need to know just because of whatever their life situation is and whatever choices they want to do, then at that point it would make more sense to go to the doctor to get a test.

Dr. Sophia:
To get a blood test.

Touseef Mirza:
To get a blood test.

Dr. Sophia:
So let's say it's January 1st, you started your period and you are expecting your period again on January 28th, and your period doesn't come. I would say it's safe to say that you could on January 29th, if you still haven't seen your period and you know, there's a possibility of pregnancy, you could take a pregnancy test,

Touseef Mirza:
But not the one over the counter. Going to the doctor?

Dr. Sophia:
No. Even the one over the counter.

Touseef Mirza:
So it's not four weeks after your first period?

Dr. Sophia:
It's four weeks after your last period.

Touseef Mirza:
Your last period, not the following period. That's where I got confused.

Dr. Sophia:
No.

Touseef Mirza:
Okay. So it's not four weeks after your next period that you missed.

Dr. Sophia:
No

Touseef Mirza:
So, you know, we're talking a lot about periods. So just to scale it back a little bit, can we just talk about what is even a normal period? Let's just start there.

Dr. Sophia:
Given the context of talking about, am I pregnant, starting with the concept of what is your normal period and what does that signify, I think is a great starting point. When you get your period, that in and of itself typically signifies that you are not pregnant.

Touseef Mirza:
So are you saying that I cannot have a period and be pregnant at the same time?

Dr. Sophia:
That is correct.

Touseef Mirza:
Okay, perfect. We are clear on that.

Dr. Sophia:
If you are bleeding, it just so happens to be around the time you expected your period and you have a positive pregnancy test. It is therefore no longer your period.

Touseef Mirza:
It is the implantation that we talked about.

Dr. Sophia:
If you have bleeding and you take a pregnancy test and that test is positive, then you are pregnant. It may look like a period, but it's not. And the reason why I say this is to understand the concept. Let's start with the first day of a period, and I'll just take you through the period cycle. Every month you'll start your period. Then let's say, and these are very rough, I just want people to understand the concept. Let's say two weeks after you've gotten your period is when you ovulate and after you ovulate, your uterus is waiting for sperm, it's waiting for you to get pregnant, meaning for that sperm to meet the egg, and then for your body to say, whew, I'm pregnant. But when that does not happen, first of all, ovulation, it happens and then it's gone. So within a few days of releasing an egg, if that egg does not get fertilized and that egg is lost, and it's not even that that egg is lost and it's waiting for your next period, no, that egg is, that egg is gone. Your period happens before.

Touseef Mirza:
When you say it's gone, it's gone out of your body?

Dr. Sophia:
It is gone. It is out of your body within a few days. And after it's lost is when you're, and there's no generation of the fertilization and the hormones that go with fertilization is when your body then gives a signal to the uterus, I did not get pregnant. And that signal typically happens 10 to 14 days after you've ovulated and your body gets the signal, I did not get pregnant. And so, therefore, I no longer need this lining that I was building all month long to welcome a pregnancy, by shedding or getting rid of that lining is in fact your period. So your period happens because you did not get pregnant. That is the reason why we get our periods. When we are pregnant, that lining or that thickening that's happening all month long, it stays nice and thick and fluffy because it now has to feed this pregnancy.

Dr. Sophia:
And so that's why we no longer get the shedding. We don't get a period. Instead, it keeps, it grows and feeds and, you know, cuddles this pregnancy. And so that's why we don't get a period, there's nothing to shed because the thing that we should have been shedding is now feeding our pregnancy. And so that's why if you do have a bleeding episode in early pregnancy, oftentimes women will think that they had a period. But let's just be clear, the term having your period means that you did not get pregnant. If you are bleeding in early pregnancy, you are pregnant just with a bleeding episode.

Touseef Mirza:
I really appreciate all of that. I think somebody needs to make a movie out of this because we don't understand, you know. We see diagrams and we see all that. But to really connect all these pieces together, really also marvels at, you know, how everything works in your body, which is quite amazing. But, thank you for that, Dr. Sophia.

Dr. Sophia:
Can I just tell a funny story? Mom, I'm sorry I have to tell this story. And I think actually it's not just her. It resonates with a lot of people. I'm at a pretty young age and you know, my mom and I are talking about periods for some reason. And she's, she mentions to me, well, you know, when you lose your period happens when you lose your egg. And in her mind it was like, it's during the actual period that, and probably in, you know, a small clot or something that this egg has now been released. And that is not what's happening at all. When you ovulate, first of all, the egg is like a pinpoint. It's so insanely small that we cannot see it with our naked eye. That's number one. And number two, it is gone. There is such a small fraction of time when we say that we are one in a million, we really are. And the possibility of getting pregnant every time you have your cycle or you ovulate is really only about 20%.

Touseef Mirza:
What does that mean exactly? 20%?

Dr. Sophia:
Like we only have a 20% chance out of all of our, you know, sexual encounters over the month of actually getting pregnant.

Touseef Mirza:
Even if it's during ovulation?

Dr. Sophia:
Now you certainly increase your chances of being pregnant during ovulation. But it has to be so specific that the sperm is there waiting basically for this egg to erupt. Because that's basically what it is. It's like an eruption happening at the level of your ovaries. Your ovaries are where you ovulate from. And then that egg has to travel down the fallopian tube and the sperm actually meets the egg typically in the tube and then keeps traveling down until it gets to that fluffy pillow called the uterus or the womb. And so when that fertilization doesn't happen, that egg keeps traveling and it is gone, it is out of your body way before you actually ever get the period.

Touseef Mirza:
So when you say it's gone, it is leaving the body through your vagina.

Dr. Sophia:
It has not even left your body through the vagina. It has disintegrated. It’s probably not even-

Touseef Mirza:
Zapped. Like, 'cause it's so small.

Dr. Sophia:
It's so small and minuscule. It has gone and disintegrated, probably before it even got to your vagina.

Touseef Mirza:
As we're talking about, am I pregnant? What's really interesting to me is how much we've talked about periods and bleeding and blood and sort of very casually like, you know. But you’re an obgyn so this is normal talk for you, but I think as just like myself, just a woman with a lot of friends and talking, we don't talk about that as much. And I think that that is something that really we should just be able to talk more freely about. Like even, you know, talking with you and you're my friend, so, you know, we talk about these things and you're an obgyn, but just in general, if we can talk about am I pregnant, then, you know, we should also be as comfortable to talk about periods. Do you know what I mean?

Dr. Sophia:
I agree with you 100%. And as a woman who is an obgyn, it's the funniest and most interesting thing that I could never talk about my period. It was such a hard conversation. And even that conversation with my mom, it was probably after I had like a biology class that I came home and I was asking questions. I was a kid. But I have to admit that it wasn't until I became an obgyn that I even became comfortable in my own body to verbalize to another human being. Oh, I happen to be on my period. And the funny thing is, is that that even happened with me in intimate relationships with my husband. I just never said anything. You know, it would just be the kind of thing where he might pat my butt and see that I have a pat on. Oh, okay. It's that time of the month.

Touseef Mirza:
Yeah, we need to do-

Dr. Sophia:
It's a whole other episode.

Touseef Mirza:
We're gonna do another episode just for periods.
So now that we know much more about figuring out if I am even pregnant or not, we're gonna do another episode in the near future that's gonna be about like, once you know you're pregnant, now what? Now what else do you need to do now? On that note, are there any, like, final words you wanna say about people who don't know that they're pregnant?

Dr. Sophia:
Embrace your body. Know your body, and understand some of the changes that can be happening in your body. And I think if people pay enough attention, then they will notice when something is different. And pregnancy kind of knocks you over the head. So if you are questioning whether or not you're pregnant, you're having signs of early pregnancy. And don't forget, they can be very similar to PMS signs like you're gonna get your period. If there's any chance, if you think there's any possibility, then take a pregnancy test. As Maya Angelou simply said, today is a beautiful day. I've never seen this one before. Thank you for joining us on the Dr. Sophia podcast. We'll see you next time.

Touseef Mirza:
Bye.