Nosebleeds and Bleeding Gums in Pregnancy

What is actually happening

These two symptoms sit together because they share a mechanism. Pregnancy increases the volume of blood moving around your body, and hormonal changes make small blood vessels and mucous membranes swell. The lining of your nose and the tissue around your teeth are both thin, well supplied with blood, and easy to damage.

The NHS lists pregnant women among those more likely to get nosebleeds, and lists nosebleeds among the ordinary symptoms of the second trimester. The HSE's explanation of why they happen at all is blunt: "The inside of your nose is delicate and nosebleeds happen when it's damaged" — by blowing, picking, dry air, or nothing identifiable at all.

Gums have a slightly different story. The HSE explains that in pregnancy "hormone changes can cause a build-up of plaque which leads to bleeding gums", and the NHS states that "gum disease is caused by a build-up of plaque on your teeth". Tommy's names it: "Bleeding gums in pregnancy could be a condition called gingivitis." So plaque is doing the damage, and hormones are making your gums respond to it far more dramatically than they used to.

The NHS's framing of how common this is helps: "Swollen, painful and bleeding gums are common during pregnancy."

What is normal

Nosebleeds: blood from one or both nostrils, heavy or light, lasting anywhere from seconds to several minutes. They can happen while you are asleep. A blood clot coming out of your nose afterwards is, in the HSE's words, "normal and nothing to worry about". Many people also notice their nose feels more blocked than usual throughout pregnancy.

Gums: the HSE describes early gum disease as "red and swollen gums" and "bleeding gums after brushing or flossing your teeth" — and notes that gingivitis "improves with better brushing". A little pink on the brush, improving over a fortnight of careful cleaning, is the expected course.

What is not normal

For nosebleeds the thresholds are specific rather than vague, which is unusually helpful. The NHS says to go to an emergency department if a nosebleed lasts longer than 10 to 15 minutes, if the bleeding is heavy, if you have swallowed a large amount of blood and it has made you vomit, if it started after a head injury, or if you feel weak or dizzy or are having difficulty breathing.

See a GP rather than waiting if you are getting nosebleeds regularly, if you have symptoms of anaemia, if you take a blood-thinning medicine such as warfarin, or if you have a bleeding disorder such as haemophilia.

For gums, the warning sign is progression rather than bleeding itself. The HSE lists what untreated gum disease turns into: bad breath, an unpleasant taste in your mouth, loose teeth that make eating difficult, and gum abscesses. The NHS says to see a dentist if your gums bleed when you brush your teeth or eat hard foods, or if they are painful and swollen.

When to call someone

• Emergency department for a nosebleed lasting more than 10 to 15 minutes, heavy bleeding, bleeding after a head injury, vomiting swallowed blood, or feeling weak, dizzy or breathless (NHS).
• GP for repeated nosebleeds, nosebleeds while taking blood-thinning medication, or symptoms of anaemia (NHS).
• Dentist for gums that bleed when brushing or eating, or that are painful and swollen (NHS).
• Midwife or maternity unit for any bleeding from the vagina, which is a different matter entirely and always worth reporting.
• Call your local emergency number (999 in the UK and Ireland, 911 in the US and Canada, 000 in Australia, or 111 in New Zealand) if bleeding cannot be controlled or you feel faint.

What actually helps

Stopping a nosebleed

The HSE's three steps are the ones that work, and most people get at least one of them wrong:

• Lean forward, head tilted forward and mouth open — not back. Tipping your head back sends blood down your throat.
• Pinch the soft part of your nose just above your nostrils for 10 to 15 minutes, without letting go to check. Checking restarts the clock.
• Breathe through your mouth.

An ice pack or a bag of frozen peas wrapped in a towel is sometimes suggested — the NHS is candid that the evidence for it is weak. For the next 24 hours the HSE advises not blowing or picking your nose, avoiding hot drinks and alcohol, skipping heavy lifting and strenuous exercise, and leaving any scab alone.

Looking after bleeding gums

The counter-intuitive part is that the answer to bleeding gums is more cleaning, not less. The NHS advice is to brush with fluoride toothpaste at least twice a day and to "spit after brushing, do not rinse", and to clean between your teeth every day with floss or interdental brushes. For pregnancy it adds using a soft toothbrush and brushing gently in small circles, avoiding sugary food and drink, not smoking, and using alcohol-free mouthwash to help reduce plaque.

One pregnancy-specific tip: if you have been sick, the NHS advises rinsing your mouth out with water "to flush away harmful acid in your vomit" rather than reaching straight for the toothbrush.

The dental care you may be entitled to

In the UK, NHS dental check-ups and treatment are free while you are pregnant and for a year after you give birth. You need a maternity exemption certificate — the NHS says to "ask your midwife or GP about the maternity exemption (MATEX) certificate", which also gives free NHS prescriptions. This is one of the pregnancy entitlements that most often goes unclaimed, and it is worth the five-minute conversation. If you are outside the UK, ask your maternity service what dental cover applies where you are, because it varies a great deal by country.

The short version

Both symptoms are common, both are usually harmless, and both have a specific technique that resolves them: pinch and lean forward for the nose; brush better and see a dentist for the gums. The lines that matter are a nosebleed past 15 minutes, nosebleeds that keep coming back, and gums that are getting worse rather than better.