How soon can you experience early pregnancy symptoms. What are the most common signs of early pregnancy. Can you have pregnancy symptoms before a missed period. How reliable are early pregnancy symptoms.

Understanding Early Pregnancy Signs and Symptoms

Recognizing the early signs of pregnancy can be crucial for those trying to conceive or concerned about an unplanned pregnancy. While a missed period is often considered the most obvious indicator, there are numerous other symptoms that may appear even before this classic sign. Let’s explore the 13 most common early pregnancy symptoms and when they typically occur.

When Do Early Pregnancy Symptoms Start?

Early pregnancy symptoms can manifest as soon as two to three weeks after ovulation if conception has occurred. However, the timing and intensity of these symptoms can vary significantly from person to person. Dr. Charlsie Celestine, an obstetrician and gynecologist, notes that most women start to notice signs around the four- to five-week mark, counting from the first day of their last menstrual period.

Can you experience pregnancy symptoms before a missed period?

Yes, it is possible to experience some early pregnancy symptoms before a missed period. These may include subtle changes like breast tenderness, fatigue, or mild cramping. However, many of the more noticeable symptoms tend to appear after a missed period or around the time it would be due.

The 13 Most Common Early Signs of Pregnancy

1. Missed Period
2. Nausea and Vomiting
3. Food Aversions and Cravings
4. Breast Tenderness
5. Fatigue
6. Frequent Urination
7. Mood Swings
8. Mild Cramping
9. Bloating
10. Constipation
11. Heightened Sense of Smell
12. Light Spotting
13. Dizziness

Missed Period: The Classic Early Pregnancy Sign

A missed period is often the first sign that prompts many women to consider pregnancy. Dr. Celestine explains, “That’s usually around what we call four weeks pregnant. Even though it might seem like less than that, we count it from the first day of your last period.” Using a period tracker like Flo can help you accurately determine whether you’ve missed a period.

Why does a missed period occur in early pregnancy?

A missed period occurs because the fertilized egg has implanted in the uterus, triggering hormonal changes that prevent the uterine lining from shedding. This process is essential for maintaining the pregnancy and supporting the developing embryo.

Nausea and Vomiting: The Infamous “Morning Sickness”

Nausea and vomiting, often referred to as “morning sickness,” are experienced by a significant majority of pregnant women. A study found that 87.8% of women reported these symptoms during early pregnancy. Dr. Celestine notes that these symptoms typically appear around seven to eight weeks of pregnancy.

Is morning sickness always a sign of pregnancy?

While morning sickness is a common pregnancy symptom, it’s not exclusive to pregnancy. Other conditions, such as food poisoning, gastrointestinal disorders, or stress, can also cause nausea and vomiting. However, persistent morning sickness, especially when combined with other pregnancy symptoms, warrants further investigation.

Food Aversions and Cravings: Unexpected Dietary Changes

Sudden changes in food preferences are another hallmark of early pregnancy. Approximately 54% of women experience food aversions, while 61% report new food cravings. These changes can occur as early as three weeks after conception.

What causes food aversions and cravings during pregnancy?

The exact cause of food aversions and cravings during pregnancy isn’t fully understood. However, hormonal changes, particularly increases in human chorionic gonadotropin (hCG) and estrogen, are thought to play a significant role. These hormones can alter taste perceptions and smell sensitivity, leading to sudden likes or dislikes for certain foods.

Breast Tenderness: A Common Early Pregnancy Symptom

Many women report breast tenderness as one of the earliest signs of pregnancy. This symptom can manifest even before a missed period, often described as a feeling of fullness, heaviness, or increased sensitivity in the breasts.

Why do breasts become tender during early pregnancy?

Breast tenderness in early pregnancy is primarily due to hormonal changes. The increased production of estrogen and progesterone stimulates the growth of milk ducts and causes the breasts to retain more fluid. This results in swelling and increased sensitivity. As the body adjusts to these hormonal changes, the tenderness often subsides later in the pregnancy.

Fatigue: Unexplained Tiredness in Early Pregnancy

Feeling unusually tired or fatigued is a common early pregnancy symptom that many women experience. This overwhelming sense of tiredness can start as early as one week after conception and may persist throughout the first trimester.

What causes fatigue in early pregnancy?

The primary cause of fatigue in early pregnancy is the surge in progesterone levels. This hormone is essential for maintaining the pregnancy but can also have a sedative effect. Additionally, the body is working hard to support the developing fetus, which requires extra energy. Other factors contributing to fatigue include increased blood volume, lower blood sugar levels, and lower blood pressure.

Frequent Urination: An Early Sign of Hormonal Changes

Needing to urinate more frequently than usual is another early pregnancy symptom that can start as early as two to three weeks after conception. This increased urge to urinate often continues throughout pregnancy.

Why does frequent urination occur in early pregnancy?

The primary reason for frequent urination in early pregnancy is the increase in the hormone human chorionic gonadotropin (hCG). This hormone stimulates increased blood flow to the pelvic area, which in turn leads to more frequent urination. As the pregnancy progresses, the growing uterus puts pressure on the bladder, further contributing to this symptom.

Mood Swings: Emotional Changes in Early Pregnancy

Experiencing sudden mood swings or feeling more emotional than usual can be an early sign of pregnancy. These changes can begin within the first few weeks of conception and may fluctuate throughout pregnancy.

What causes mood swings in early pregnancy?

Mood swings in early pregnancy are primarily attributed to hormonal changes, particularly the rapid increase in estrogen and progesterone. These hormones can affect neurotransmitters in the brain, influencing mood and emotions. Additionally, the physical and lifestyle changes associated with pregnancy can contribute to emotional fluctuations.

Mild Cramping: A Subtle Sign of Implantation

Some women experience mild cramping as an early sign of pregnancy. This cramping, often described as similar to menstrual cramps but milder, can occur around the time of implantation, typically 6-12 days after conception.

Is cramping normal in early pregnancy?

Mild cramping can be normal in early pregnancy and is often associated with implantation or the uterus expanding to accommodate the growing embryo. However, severe or persistent cramping, especially when accompanied by bleeding, should be evaluated by a healthcare provider to rule out complications.

Bloating: An Early Digestive Change in Pregnancy

Feeling bloated or experiencing increased gas is a common early pregnancy symptom. This can start soon after conception and may persist throughout pregnancy.

Why does bloating occur in early pregnancy?

Bloating in early pregnancy is primarily caused by hormonal changes, particularly the increase in progesterone. This hormone relaxes smooth muscle tissue throughout the body, including the digestive tract, leading to slower digestion and increased gas production. Additionally, the growing uterus can put pressure on the intestines, contributing to bloating and constipation.

Constipation: A Common Digestive Issue in Early Pregnancy

Constipation is another digestive symptom that can occur early in pregnancy. Many women notice changes in their bowel habits within the first few weeks of conception.

What causes constipation in early pregnancy?

Like bloating, constipation in early pregnancy is primarily caused by the increase in progesterone. This hormone slows down the digestive process, leading to more water absorption from the stool and resulting in harder, more difficult-to-pass stools. Additionally, prenatal vitamins containing iron can contribute to constipation.

Heightened Sense of Smell: A Surprising Early Pregnancy Sign

Many women report a heightened sense of smell as one of their earliest pregnancy symptoms. This increased sensitivity to odors can start soon after conception and may persist throughout pregnancy.

Why does sense of smell change during early pregnancy?

The exact mechanism behind the heightened sense of smell in early pregnancy is not fully understood. However, it’s believed to be related to hormonal changes, particularly the increase in estrogen. This hormonal shift may enhance the brain’s ability to process odors, making smells seem more intense. Some researchers suggest this heightened sense of smell may have evolved as a protective mechanism, helping pregnant women avoid potentially harmful substances.

Light Spotting: Potential Sign of Implantation

Light spotting, often referred to as implantation bleeding, can occur in some women about 10-14 days after conception. This spotting is typically light pink or brown in color and much lighter than a normal period.

Is spotting always a sign of pregnancy?

While light spotting can be a sign of implantation and early pregnancy, it’s not exclusive to pregnancy. Spotting can also occur due to hormonal fluctuations, ovulation, or various other reasons. If you experience any unusual bleeding, it’s always best to consult with a healthcare provider for proper evaluation.

Dizziness: An Often Overlooked Early Pregnancy Symptom

Feeling dizzy or lightheaded can be an early sign of pregnancy for some women. This symptom can start as early as the first few weeks after conception.

What causes dizziness in early pregnancy?

Dizziness in early pregnancy can be attributed to several factors. The primary cause is the dilation of blood vessels due to increased progesterone levels, which can lead to a drop in blood pressure. Additionally, the body’s increased blood production to support the growing fetus can sometimes lag behind the body’s needs, potentially causing anemia and dizziness. Fluctuations in blood sugar levels can also contribute to this symptom.

While these 13 signs are common early indicators of pregnancy, it’s important to remember that every woman’s experience is unique. Some may experience multiple symptoms, while others may have few or none at all. If you suspect you might be pregnant, the most reliable way to confirm is through a pregnancy test and a visit to your healthcare provider. Remember, many of these symptoms can also be caused by other factors, so it’s essential not to jump to conclusions without proper confirmation.

Very early signs of pregnancy: Are you pregnant?

Updated

15 December 2022

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Published

09 November 2018

Fact Checked

Medically reviewed by Dr. Jennifer Boyle, Obstetrician and gynecologist, Massachusetts General Hospital, Massachusetts, US

Written by Isabelle Aron

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What are the very early signs of pregnancy? From a missed period to discharge and cramps, we take a closer look at some of the signals your body might give you when you’re pregnant.

A missed period is one of the most common early signs of pregnancy, but it’s not the only one. If you think you might be pregnant, it’s important to listen to your body and know what to look out for. 

The two-week wait between trying to conceive and taking a pregnancy test can be understandably anxiety inducing, and it’s perfectly normal to be scanning your body for signals you could be pregnant. On the other hand, perhaps you’ve noticed some unusual symptoms, and you’re feeling worried it might be a poorly timed pregnancy. Either way, being equipped with as much knowledge as possible can hopefully help to reassure you.  

Below, an obstetrician and gynecologist explains the early signs of pregnancy to be aware of, as well as when to take a pregnancy test or what else could be causing your symptoms. So whether you’re in the midst of anxiety over the two-week wait or feeling concerned about any symptoms, here’s all the information you need to know. Don’t forget you can also use our pregnancy test calculator to help you decide whether it’s time to take a pregnancy test or not.

How early can you show the first signs of pregnancy? 

First things first: how early can you show signs of pregnancy? The answer will vary from person to person, but women and people who menstruate can expect to experience very early pregnancy symptoms around two or three weeks after ovulation if conception occurred. Some people may experience the signs earlier, while others might not experience a single symptom until a missed period. “Sometimes it could be a little earlier or a little later, but most of the time it’s around the four- to five-week mark [since the first day of your last period] that you start to feel signs,” explains Dr. Charlsie Celestine, obstetrician and gynecologist, New Jersey, US.

Most common early signs of pregnancy

Of course, everyone is different, but there are some symptoms that many women experience when pregnant. As well as a missed period, some of the very early signs of pregnancy can include nausea, breast tenderness, and spotting.

A missed period

According to Dr. Celestine, one of the common first signs of pregnancy is the classic one: a missed period. “That’s usually around what we call four weeks pregnant,” she explains. “Even though it might seem like less than that, we count it from the first day of your last period.” Don’t forget using a period tracker such as Flo can help you determine whether you’ve missed a period or not.

Nausea and vomiting

Two other common (and admittedly less pleasant) early signs of pregnancy are nausea and vomiting. One study found that 87.8% of women experienced these symptoms, so if you find yourself feeling queasy and physically sick, take comfort in knowing you’re not alone. You might have both symptoms at the same time, or only experience one. “Some people only feel nauseous, and some people vomit constantly,” says Dr. Celestine. 

These signs of early pregnancy are most likely to appear after a missed period. “Nausea and vomiting are most commonly experienced at around seven to eight weeks,” she adds.

Food aversion and cravings 

Do you find yourself horrified at the thought of eating your usual lunchtime sandwich while also feeling a sudden and inexplicable craving for something you’ve never liked to eat before? Or perhaps it’s a strange new combination of foods that’s suddenly weirdly appealing. These are also common early signs of pregnancy to look out for. In the early days of pregnancy, around three weeks after conception, 54% of women experience food aversions, meaning you might have a more sensitive sense of smell or experience an aversion to certain food and drink. 

You could also crave new foods that you wouldn’t usually eat — something that happens to 61% of women. Wondering if anyone else has experienced your immense and insatiable pregnancy craving for pickles? You can find out about the nine most common pregnancy food cravings here.

Breast tenderness

You might also be able to spot the very early signs of pregnancy through how your breasts feel. According to one study, 76.2% of women experienced breast pain or tenderness in the first trimester. Breast tenderness can occur from a few days to one to two weeks after conception and is caused by the change in hormones in your body that occur during a pregnancy. 

This might be an early sign of pregnancy before a missed period, as you can experience it as early on in your pregnancy as one or two weeks after conception. “It’s different for everyone, and some people don’t get it all,” says Dr. Celestine. “It’s caused by an increase in both estrogen and progesterone in pregnancy.”

Spotting

The term “spotting” usually refers to light bleeding that happens outside of your normal period. While this might be an alarming symptom to experience, it’s not necessarily a cause for concern. Spotting in early pregnancy can be due to implantation bleeding, which is perfectly normal and can occur when the embryo implants itself into the wall of the uterus, usually around 10 to 14 days after conception.

Spotting is also common in the first trimester of a pregnancy, with around 25% of pregnant women experiencing bleeding in the first 12 weeks of their pregnancy. 

Dr. Celestine advises anyone experiencing this kind of “abnormal period” to take a pregnancy test. If it’s positive, she says it’s a good idea to monitor the bleeding. Implantation bleeding typically lasts for one to two days and is very light; it’s usually not enough to need any more protection than a panty liner. Unfortunately, bleeding any more than this can sometimes be a sign of a miscarriage or an ectopic pregnancy. As scary as this sounds, try not to panic; one study found that one in four pregnant people reported bleeding, but only around 1 in 10 women (12%) who experienced bleeding had a miscarriage. 

So rest assured, “A lot of times, pink, brown, or red spotting can still be a normal pregnancy,” explains Dr. Celestine.

Cramps

Just as you might have cramps during your period, you might also have some cramping in the early stages of pregnancy, around six to 10 days after conception. This can happen during implantation, with some women experiencing implantation cramping, although there is currently little scientific evidence around this phenomenon.

“If you experience mild cramping, just like if you experience mild spotting, then keep an eye on it,” advises Dr. Celestine. “But if it’s severe pain and heavy bleeding, then we need to look into it as soon as possible because it could be a miscarriage,” Dr. Celestine says. Unfortunately, this could also be a sign of an ectopic pregnancy. It’s important to consider how intense the cramping is, as mild cramping is not necessarily a cause for concern, so try not to jump to conclusions and cause yourself unnecessary worry.  

Vaginal discharge

During pregnancy, some women will experience more vaginal discharge than before pregnancy. But the discharge you have might change, too. “Sometimes your vaginal discharge might change because of the new hormones with the pregnancy,” says Dr. Celestine. She explains that “increased estrogen causes a white milky discharge.” 

What about expecting a change in urine color during pregnancy? “No, definitely not,” she says. “It’s not related. Urine color has to do with what [and how much] you eat and drink in all people, whether pregnant or not.”

Mood change

Obviously, a bad mood could be caused by many things, but mood swings are one of the early signs of pregnancy, experienced as early as three weeks after conception. “Some people feel more irritable,” says Dr. Celestine. If you’re feeling anxious or depressed, you’re not alone. These are the most common mental health concerns during pregnancy — around 12% of women experience depression, while 13% experience anxiety. These can be understandably difficult feelings to navigate, so if you need support, don’t hesitate to reach out to loved ones or your doctor.

Fatigue

Hands up if you feel absolutely exhausted! Dr. Celestine says that while fatigue isn’t usually the first sign of pregnancy, people do tend to experience fatigue in the first trimester. In some people, that could be as early as one week after conception. For others? “A little after the nausea and vomiting, so after seven or eight weeks, people usually start to feel more tired,” she explains. That makes sense, considering your body is creating an entirely new human from scratch.

Increased urination

Feel like you need to pee a lot? If you’re visiting the bathroom more often than usual, including during the night, that could be an early sign of pregnancy. This is because you have increased blood levels during pregnancy. Your blood is filtered by your kidneys, which remove the extra waste fluid, which then leaves your body as urine. Basically, the more blood you have in your body, the more you will need to pee. This can happen as early as three weeks after conception, although Dr. Celestine explains that this symptom tends to be more noticeable in the third trimester because of “pressure on the bladder from the uterus, due to having a larger uterus and baby. ”

Bloating

Bloating is another early sign of pregnancy, thought to be caused by a rise in progesterone. You’ll likely experience this around a week after ovulation, although remember that bloating can be caused by a wide range of things, including eating a large meal too quickly (we’ve all been there).

Constipation

It might not be the most pleasant early sign of pregnancy, but you could find yourself becoming constipated as early as three weeks after conception. In fact, one study found that between 11% to 38% of pregnant people experienced constipation at some point in their pregnancy, usually around the third trimester. Again, you can likely thank a rise in progesterone for this one.

Less common early signs of pregnancy

While many of the very early signs of pregnancy are well known, there are some less obvious indications, too. Read on to find out more about unusual signs of early pregnancy.

Headaches

A headache might not be the most obvious sign of pregnancy, but it can be an early symptom. “Sometimes I’ve seen people have headaches early on. It can happen with hormone changes,” explains Dr. Celestine. The most common headaches associated with pregnancy are migraines and tension headaches. Research shows that tension headaches account for 26% of all headaches experienced during pregnancy, while up to 10% of pregnant women will experience a migraine without aura (a migraine with aura is where you also experience sensory symptoms such as flashes of light or blind spots). 

A range of things can cause headaches during early pregnancy, including changing hormones, nasal congestion (more on that below), hunger, and low blood sugar levels. If you’re (understandably) struggling with pregnancy headaches, experts recommend trying some physical exercise, drinking lots of water, getting enough sleep, eating regularly, and practicing some relaxation techniques.  

Nasal congestion

If you have a stuffy or runny nose, that could be because of a rise in hormone levels and blood production. This happens in pregnancy and can cause the mucous membranes in your nose to swell. Known as ‘rhinitis,’ around 39% of women experience it, and the main symptoms are sneezing, nasal congestion, and a runny nose. It can start at any point but should stop after you give birth. Keep that in mind when you’re buying your 150th multipack of pocket tissues at the grocery store.

When is the right time to take a pregnancy test?

We know the wait between ovulation and taking a pregnancy test can feel long, and it can be tempting to take one straight away. If you’re worried about the idea of a possible pregnancy, waiting can undoubtedly be hard to do. However, a very early pregnancy can be difficult to detect with a home pregnancy test, and experts recommend you wait until the day after a missed period to make sure it’s more accurate.

Once you realize that you’ve missed your period, Dr. Celestine recommends taking a pregnancy test. She advises doing it first thing in the morning. “The urine pregnancy test needs a certain amount of the pregnancy hormone in order to register as positive,” she explains. The pregnancy hormone is called human chorionic gonadotropin (hCG), and it only develops in a woman’s body during pregnancy. Around 10 days after the egg is fertilized, this hormone starts to build up in the body. 

“It comes out in your urine, so the first pee in the morning usually has the highest concentration of that pregnancy hormone because it builds up in your system all night,” explains Dr. Celestine. She explains that during the day, as you eat, drink, and urinate, your urine may be diluted. “So the morning is the best time to do it, especially if you’re testing early on in the pregnancy,” she says.

Is it possible to have early pregnancy symptoms and not be pregnant?

If you have symptoms that seem like the early signs of pregnancy, it doesn’t necessarily mean you are pregnant. Dr. Celestine says that there’s a lot of overlap with your period, for example. “A lot of times, PMS has similar symptoms – bloating, nausea, breast tenderness,” she explains.

Cramping or spotting could be symptoms of many things. “If you’re looking at cramping or spotting, it can even be an STI, an ovarian cyst, polyps [an overgrowth of tissue that’s usually benign] in the uterus, or fibroids on the uterus. Any other type of vaginal infection can also lead to spotting sometimes,” explains Dr. Celestine. “There are so many other things it could be. So if you’re ever concerned that it’s a pregnancy or you miss your period, I would take a pregnancy test and see a doctor.”

When is the right time to see the doctor about your early pregnancy?

If you take a pregnancy test at home and it’s positive, give your doctor a call (or find a doctor if you don’t have one) and book an appointment to discuss prenatal care. Your first visit will usually be between six to 12 weeks pregnant, although the exact timing will depend on both your health needs and history, as well as your doctor’s care plan.  

And what can you expect during this first visit? One of the most important things is to confirm that your growing baby has a healthy heartbeat, which will be done by either an ultrasound or by listening with a handheld doppler. But keep in mind that even an ultrasound can’t visualize a baby until around six to eight weeks, so don’t panic if this doesn’t happen before then.

If, however, you have a missed period, but a pregnancy test is negative, Dr. Celestine recommends waiting a week and doing another one. After that, if you haven’t had your period and a pregnancy test is still negative, she advises seeing a doctor to find out what’s going on. “That’s as long as you’re feeling fine,” she says, adding that you should see a doctor if you’re in severe pain or have concerns.

If you’d been hoping for a positive pregnancy test, try not to be too disheartened. It’s totally natural to feel disappointed, but remember that around 85% of people will conceive within the first year of trying, so try to focus on your next cycle. If you feel like you’ve had a lucky escape with a negative pregnancy test, it might be a sign it’s worth rethinking your contraceptive method.

Early pregnancy signs: The takeaway

As we’ve seen, there are lots of different early pregnancy signs and symptoms, and of course, it can vary a lot between different people. That said, a missed period is often the first sign, followed by symptoms such as vomiting, nausea, and breast tenderness. 

If you’re concerned about a missed period or any other symptoms that could potentially be an early sign of pregnancy, it’s a good idea to take a pregnancy test and speak to a health care professional.

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History of updates

Current version
(15 December 2022)

Medically reviewed by Dr. Jennifer Boyle, Obstetrician and gynecologist, Massachusetts General Hospital, Massachusetts, US

Written by Isabelle Aron

09 November 2018

Symptoms and feelings in early weeks

In the first few weeks of pregnancy, various physical symptoms and new emotions arise. Although many women felt some anxiety during these early weeks, and some found it hard to believe it was really happening to them, there was also joy and excitement. (See also ‘Discovering you are pregnant and telling other people’).

Unpleasant physical symptoms affected people’s feelings in the early weeks of pregnancy. Nausea and sometimes vomiting is well known as ‘morning sickness’, but these symptoms can happen all day, and can occasionally be very severe. Because this is so common, it has a separate section on the website (see ‘Sickness and hyperemesis’).

Another common symptom is feeling tired or run down. Some people are surprised to feel so exhausted. Others include getting a strange taste in your mouth, having tender breasts, feeling dizzy or faint, and abdominal cramps or twinges. To some people it felt a bit like premenstrual tension at first. But some women we talked to felt physically fine during the first few weeks, or noticed only minor changes.

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Physically I didn’t feel that much different in terms of how I looked, or, or feel that I looked any different. I felt exhausted and the first three months, or the first – it was more like the third month was I think the most exhausting month of my life, I’ve never been so tired. I couldn’t get out of bed some days because I’d just wake up, eat some food, sleep all day, eat some food and go back to sleep again. And that was difficult, and I found that no-one understood that at all because – I don’t know whether it was, it was because I was slightly stressed about the situation, maybe, and that the best way I dealt with it was by sleeping through everything – but I really, I was just exhausted all the time. Yeah, but my appearance I didn’t worry about too much at the time.

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Actually, going back to the symptoms that I had – symptoms, it’s not an illness – but, you know, the feelings that I had when I first was thinking, ‘I wonder if I am pregnant?’ As I said, I felt really, really pre-menstrual. I mean, my breasts were really sore, I had cramps, crampy sort of pains that, you know, really I would get at the start of my period, which actually worried me slightly. And in none of the information do you actually get that that is – and I actually found on one of the BBC-i pages that as an indication of pregnancy. But nobody had actually said that to me. And I actually said, ‘You know, I really do feel like my period could start.’ And I think that went on for probably about three weeks to a month, you know, after me knowing. And I did keep thinking, you know, go to the toilet and think, ‘Is there going to be blood there?’ And my sort of rational mind was saying, ‘Well, you know, no, there won’t be. ‘ But still thinking, ‘God, you know, there might be.’ And then that all just stopped. But for somebody who maybe isn’t as well informed, I think that could be quite a frightening thing to have.

She noticed changes in her breasts in early pregnancy, and things began to taste strange. At…

She noticed changes in her breasts in early pregnancy, and things began to taste strange. At…

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I kept on wondering if my boobs had gotten bigger. I sort of felt like a little bit, like I looked in the mirror and just thought, “My tits have gotten bigger. Have they’ve gotten bigger?” I was just feeling a bit like that. And I was asking, asking my partner at the time, “Is my -?” – you know, I asked him, “Are they? Do you reckon? Do you think they are?” I was feeling a little bit like that, really. And also because I usually do get PMT as well so – and I had sort of PMT symptoms which had disappeared. So that was another thing as well. I didn’t actually, you know what I mean? I was feeling very stressed out, but I wasn’t feeling as stressed as I had been a couple of weeks earlier, so I thought maybe that was something. I wasn’t feeling particularly stressed. Things were tasting funny when I was eating. I didn’t like, I mean I didn’t associate it to be, associate it at the time and think I was pregnant, but if I had a drink I just sort of didn’t feel like drinking it any more, it tasted a bit funny. And because I smoked at the time as well, cigarettes tasted a bit funny as well. And it was just the boob thing and the fact that I realised I’d had no period since quite a few weeks that I thought I’d better go and check this. You just felt that there’s something going on here. So [laughs].

Many women get some minor abdominal cramping in early pregnancy, but as one noted (Interview 44 above), there is little information about it. In some cases it is a sign that something is wrong (such as a miscarriage starting, or an ectopic pregnancy, when the embryo implants and develops in the fallopian tube rather than the womb). If you are at all worried you should contact your GP.

One woman experienced bloating, sharp pains and sickness in the early weeks as a side effect of IVF. She had developed ovarian hyper-stimulation syndrome, where the fertility drugs used have over-stimulated the ovaries. In rare cases this can be serious, but she recovered well after a stay in hospital.

She developed bloating, sharp pain and sickness in early pregnancy. This was caused by ovarian…

She developed bloating, sharp pain and sickness in early pregnancy. This was caused by ovarian…

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We did three cycles of IVF and on the third cycle we were, we were successful.

And then what happened? [laughs]

Right. Well I then, they told me that I would know within, in sort of, ten days whether I was, whether or not I was pregnant and they told me the symptoms to, to look out for and I was suspicious that I might be pregnant because I suddenly started to feel very sick and started vomiting and in fact I was actually working a weekend shift and I was actually at a patient’s house visiting them and they had vomiting and diarrhoea and I had to rush to the bathroom and be sick myself which they thought was rather amusing, I think. 

But then I actually started to feel more and more unwell and my stomach got more and more bloated, so I contacted the hospital and they asked me to come up, and they, they examined me and took a pregnancy test which was positive but they took some blood tests and they were concerned that I might have this ovarian hyper stimulation syndrome. Because my hormone levels had been very high on that IVF attempt they were aware that it might be a complication, so they told me to go home and just rest. But things got worse over the next few days and I was getting more and more bloated. I had lots and lots of fluid in my stomach and that was irritating the bottom of my lungs which was giving me what we call pleuritic type pain which is a sharp pain going up to your shoulders which is very uncomfortable. And I just couldn’t keep any fluids down. So after a few days I was admitted to the hospital and they put up a drip and I was in hospital for several days and then, then the fluid started to go down again, so I was, I was allowed home then. And I felt sick probably for about the first six weeks of the pregnancy and then that eventually just settled down to just to normal morning sickness. And the rest of the pregnancy was straightforward after that. 

Is that complication potentially serious?

It is. I think you can get it in mild, moderate and severe forms and if you have – I had moderate, apparently – but if you have it in the severe form you, you can, you know, you can be very ill and in intensive care and- but that’s very rare, it’s, you know, it’s a rare complication.

Several women we talked to had some vaginal bleeding in early pregnancy. This may be a sign that the pregnancy is going to miscarry, but not always. One woman described quite strong pains with blood loss, which suggested that the pregnancy might be ectopic. It was very frightening at the time, but in the end the baby was fine and the pain and bleeding stopped.

At nine weeks, she experienced bleeding and severe pain, and an ectopic pregnancy was suspected….

At nine weeks, she experienced bleeding and severe pain, and an ectopic pregnancy was suspected….

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Once I discovered I was pregnant, in the fourth week from my last period, so it was week four, I then made a doctor’s appointment with my local GP and she then referred me to the hospital of my choice within the area; I had a choice of four hospitals. And she confirmed that yes, I was pregnant, and then from there the ball started rolling. I was due for my first scan at twelve weeks, then in fact I went on holiday, weeks seven and eight, to Spain and during those weeks I was absolutely fine. I had no sickness, I felt in brilliant health and there were no problems at all. A little bit of nauseous but other than that I was fine. And I’d been in Spain walking up mountains one week and then came back to England with excruciating pains week 9 of my pregnancy. And they lasted for nearly 24 hours by which time I was at the GP’s surgery. And I was sent to A&E to my next hospital, local hospital, where it was discovered after a lot of trauma that they suspected I had an ectopic pregnancy at that time due to the fact that I was in excruciating agony. And I was spotting, so I was losing blood, not a great deal, but enough for concern. And at that stage it was four o’clock in the afternoon and by midnight I was still in A&E awaiting to be seen by a consultant. And a gynaecologist did actually see to me that night and basically, I mean it was a very upsetting time but I had the choice, I was on a drip and ready for theatre, and I had to make a choice whether they wanted to investigate or I could hang on a little bit and see if the pain subsided. By which time I decided to hang on and stick it out, and then it got better and better and better, and by seven o’clock the next morning I was having an internal scan within the hospital. I wasn’t allowed to walk, I was taken by wheelchair, I wasn’t allowed to get out of bed, I wasn’t allowed to eat, I wasn’t allowed to drink, all the usual scenario ready for surgery in the case of an emergency. And they then confirmed that there was a heartbeat and that it was all in the right place. So that was a huge relief.

So, did they do any investigations to determine whether or not it was ectopic?

Yes, they can tell by an internal scan. Using an internal scan they can tell very quickly whether it’s ectopic or not. If the cells are embedded correctly therefore it is not ectopic. But due to the fact that I had excruciating pain which, to this day, no-one knows why, it’s one of those things, and it can be quite common apparently. If you have symptoms that I had, such as spotting and pain, it is usually the case of an ectopic pregnancy but in my case it wasn’t. So that was wonderful.

Early miscarriage is unfortunately quite common, and women’s experiences of it are explored in more detail in ‘Bleeding and miscarriage’.

The possibility of losing the baby was not the only source of anxiety early in pregnancy. People described various other worries in the first few weeks of pregnancy. Some women who had not intended to become pregnant continued to feel uncertain about whether to go ahead with the pregnancy. One mother described how seeing her baby at the first scan made her feel differently. Another single mother had no doubts about keeping the baby, but still worried about how she would manage financially. For some people, pregnancy led to a break-up in their relationship. This mother briefly considered adoption, but changed her mind.

For the first few weeks she felt she did not want the baby, but seeing the baby at the first scan…

For the first few weeks she felt she did not want the baby, but seeing the baby at the first scan…

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I think it was about two, three weeks before I went for my scan so it was about, I was about, I think it was about three, four weeks I was going on ‘Oh, I don’t want her, I don’t want her, I don’t want the baby’. But they were all saying to me, ‘Just, just wait, just wait, just, just wait. You’ll see how, you’ll see how you feel in the next few weeks’. But when I went in for my first scan and I seen it, that was it, I knew that I wanted this baby and I’d love this baby, do you know what I mean? 

But that, that, I think that was the turning point for me then, when I went and actually had my first scan. That was my turning point for me, that this baby was mine and it was growing inside me and I wouldn’t have it any other way. I wouldn’t have dreamt of hurting it then, do you know what I mean? But I wasn’t, I wasn’t that keen on it at first, I was saying, ‘No, I don’t want it’. I think most girls do in places, don’t they? But, no, I wouldn’t change her now, wouldn’t do.

Early on, her main worry was how she would manage financially. (Read by an actor.)

Early on, her main worry was how she would manage financially. (Read by an actor.)

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What sort of hopes and fears did you have in the early weeks, the early part of the pregnancy?

My biggest concern I remember was that I wouldn’t be able to support, to bring up the baby because I didn’t have any money. I’d just graduated and I didn’t have a job and I had thousands of pounds of debts and I felt a bit lost because, because it had been a surprise and because my parents weren’t quite sure how to react and my partner wasn’t quite sure how to react. And, and so I was determined to go through with the pregnancy but I did feel quite stressed because I knew that emotionally I could give him all the, all that he needed but financially and, and I didn’t know how my circumstances were going to, I mean I, I didn’t know what was ahead of me. And so that worried me, so I worried about money a lot at the beginning. But I knew that, well I felt like I knew that I could give him all the love that he needed and the support and the, and so I wasn’t too worried about that. It’s just all the practical things.

How did those things get resolved? I mean did you, were, was it quite, reasonably easy to kind of figure out how you were going to manage and so on?

No, I just it wasn’t easy to figure out how I was going to manage. I had to take each step, each day as it came and it was difficult, it was really difficult but I just had to, to know that the next day would be another day and that things would change and I just had to trust in, that, that the whole situation would evolve. And it did and I got through it but it was difficult.

Who supported you through that difficult period? Where did you go for support?

I went to my friends for support initially. Not so much my family because they were getting round the idea as well, and to my partner who, despite being stressed and confused about the situation, was supportive and, yeah. I went to him quite a lot, and my friends.

Getting pregnant when she was very young led her to break off the relationship with her boyfriend…

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How did you feel when you discovered you were pregnant, what happened?

I was upset. And I dumped my boyfriend because of it.

You dumped him?

Yes.

When you told him that you were pregnant how did he react?

Well, I didn’t tell him. My mum told him.

Your mum told him? How come?

Because I didn’t want to tell him, because I wasn’t speaking to him. So my mum told him. And he didn’t speak to us all the way through my pregnancy.

Did you not want his support at all?

No, because he didn’t really talk to me while I was going out with him really.

And how did you feel?

I felt weird at first because I didn’t really want a baby. But I didn’t want to get an abortion because I don’t like the sound of it. So I got asked off my auntie if she could have him, because my auntie can’t have children. And she didn’t know whether I was going to keep him or not, so she asked if she could have him. But I wanted to keep him.

When did you decide that you wanted to keep him rather than give him to your auntie?

When I was about three or four month.

Right. So, at the beginning though, if you can think about how you felt right at the beginning, what kind of thoughts were going through your head then?

I wanted to get him adopted because I was, I felt that, I felt as though I was too young and that I wouldn’t be able to cope, and that I’d get called all sorts of names off people. But it all changed once I had him.

Can you remember what changed your mind, what, what it was that made you change your mind?

I think it was feeling him kicking for the first time. I think that’s what changed my mind as well. And just feeling him moving around all the time. It’s weird.

See also ‘Discovering you are pregnant and telling other people’ and ‘Emotions during pregnancy’.

Last reviewed May 2017.

Pregnancy and emotions | Nutriclub

The joy of the impending appearance of a new person and the energy that is in full swing during pregnancy can be replaced by fears, insecurity, sadness and anxiety for the future. Sometimes these changes happen at breakneck speed. Nutriclub will try to understand how the emotional state changes during pregnancy and what it is connected with.

How the emotional state changes depending on the trimester

• First trimester

In the first trimester, the level of the hormone progesterone increases significantly, which is responsible for attaching a fertilized egg to the uterine wall, preparing the body for pregnancy and childbirth, and for the state of the woman’s nervous system. Due to the rise in progesterone levels during this time, you may tire more quickly than usual. A constant desire to go to bed can also become your companion during this period. Don’t fight biology, lie down and rest whenever you can.

In the first trimester, you may experience elation, anxiety, excitement and exhaustion (sometimes all at the same time!). Even if you are very excited about the upcoming changes in your life, your new state can cause stress. Another common companion of this period of pregnancy is sudden mood swings. Know that what you are experiencing is normal and due to a hormonal rush. But if mood swings cause you significant discomfort, be sure to discuss them with your doctor.

• Second trimester

Many consider this time to be the most pleasant during pregnancy: toxicosis is already receding, it is not difficult to carry the stomach yet, and the baby inside begins to move noticeably (and this still looks like dancing butterflies in the stomach). Often in the second trimester there is a surge of energy. The emotional state at this time is usually the most stable: this is a great time to choose a maternity hospital, furnish a nursery and look for courses for future parents.

• Third trimester

The day of childbirth is approaching, and with it the fear of childbirth may become more acute (especially if you are expecting your first child). You may be tormented by questions such as: “How much does it hurt?”, “How long will this last?”, “How will I deal with this?”. Courses for pregnant women will help to dampen this kind of anxiety, where they will tell you in detail about all the stages of childbirth and prepare you for various possible scenarios. When possible, experts recommend communicating with women who are happy with their birth experience and keeping a diary of their emotions. Planning ahead can also help deal with fears: for example, if you are going to breastfeed, you may need suitable underwear and clothes for this. And, of course, it doesn’t hurt to talk to women in your community who have had successful lactation experiences.

Fears during pregnancy: what they are and what to do about them

You may be worried about your health or the health of your child: pregnancy is not a disease, but it can have complications. Therefore, it is important to eat right, do not forget about physical activity and be in touch with your doctor in order to receive answers to emerging questions in a timely manner.

Another common fear is related to the financial situation or the housing problem. To minimize expenses, you can take care of buying used things in advance (or arrange with friends who will give you things for the baby for free – children grow up very quickly and do not have time to take down a bunch of clothes).

The fear of childbirth, which we have already mentioned above, occurs in most women, even if they are not giving birth for the first time. It helps a lot to cope with the fact that millions of women have already gone through this, some more than once – which means you can too.

Some women worry about their careers and see having children as a threat to their professional growth. Yes, maternity leave can really become a career brake – but it is up to you to plan everything so that your work is almost not affected. At the same time, many women, having given birth to a child, understand that a career is not so important now and make a choice in favor of spending his infancy with the baby. You can choose any option that suits you.

Pregnancy depression

It is absolutely normal to feel sad, longing, worrying and worrying about the future during pregnancy. But it is important to distinguish these conditions from a dangerous disease: pregnancy depression. The statistics* are as follows: from 14 to 23% of women experience depression during pregnancy.

How can you tell the usual mood swings in pregnancy from depression? It is difficult to do this without the help of a specialist, but there are a number of signs that may indicate that it is worth seeking help from professionals:

• exhausting anxiety for the child
• low self-esteem
• inability to enjoy activities that normally bring joy
• insufficient medical care during pregnancy
• smoking, drug and alcohol use
• insufficient weight gain due to poor diet
• thoughts of suicide

When using any materials from the site nutriclub.ru, a link to the site is required.

© Nutriclub, 2020

Psycho-emotional disorders during pregnancy. The need for their correction | Tyutyunnik V.

L., Mikhailova O.I., Chukhareva N.A.

Currently, more and more attention is paid to the influence of a woman’s psycho-emotional state on reproductive function, pregnancy and perinatal outcomes [2,4,14]. In recent years, in developed countries, there has been an increase in the frequency of various mental disorders in women of reproductive age, the proportion of patients taking psychotropic drugs has increased, including among women who are planning a pregnancy and pregnant women [3,6,9].

Almost all pregnant women are subject to sharp emotional swings, since the expectation of a child is associated with changes – both physical and emotional. Hormonal changes during pregnancy lead to the fact that the mood of a pregnant woman changes dramatically almost every hour.
A future mother can get rid of such emotional swings and feel calm during pregnancy by observing the rules of emotional health. Emotional balance and physical fitness are equally important for a pregnant woman, they equally help her prepare for motherhood. Due to the lack of maternal experience, a pregnant woman may experience sudden emotional outbursts. The first pregnancy is a new experience that is quite difficult to comprehend. Ignoring the fact that the emotions of a woman who is expecting a child is much more complex and sharper than usual, can lead to a number of problems, including in relations with her spouse. Acceptance of this fact is the basis of emotional health during pregnancy [1,5,11].
Also, if a woman is pregnant for the first time, she experiences many fears, which include fear of childbirth and untimely termination of pregnancy, concern about the health of the unborn child and her own health, fear of labor pains and inevitable pain, fear of partner / spouse disappointment due to changes occurring with body. Modern women have to worry about careers, financial problems, and many additional costs associated with the appearance and upbringing of a new family member.
All these fears can lead to many negative emotions, such as anxiety, depression, irritation, anxiety, stress, anger, feelings of loneliness, confusion. Most often, changes in the psycho-emotional background during pregnancy lead to the development of depressive and anxiety disorders. Until the end, the pathogenesis of these changes is unclear, several theories are discussed, it is believed that changes in the hormonal background during pregnancy, including a significant increase in estrogens, and especially progesterone, in the blood serum can exacerbate existing emotional disorders [5,7,15]. As a rule, minor manifestations in the form of irritability, tearfulness, resentment accompany manifestations of early toxicosis in the first trimester of pregnancy – nausea, vomiting, etc. [6,10]. After the disappearance of these symptoms, the neuropsychic state of pregnant women usually improves. At the same time, an important role in the development of anxiety states is played by certain physical discomfort and psychological factors, which include forced changes in lifestyle, communication in the family and with work colleagues, concern for the health of the unborn child, financial difficulties – all this contributes to the appearance or exacerbation of psycho-emotional disorders during pregnancy. For some women, the onset of pregnancy is unexpected and not always desirable, however, due to the circumstances, a decision is made to prolong this pregnancy, which can lead to a further increase in stress and anxiety [5,8,12]. It should be noted that additional psychotraumatic factors may appear during pregnancy, such as the occurrence of pregnancy complications requiring hospitalization, or the detection of congenital malformations in the fetus, which can cause negative images and feelings [1,10,12].
The state of psycho-emotional stress with the presence of anxiety of various levels is observed in 40% of women with a normal pregnancy [2,7,11]. Borderline neuropsychiatric disorders can be presented in the form of hypochondriacal and hysterical syndromes. However, there are other forms of gestational borderline neuropsychiatric disorders, their features are the invariable inclusion in the clinical picture of certain psychopathological phenomena directly related to pregnancy: various fears for the successful course of pregnancy, obsessive fears for the fate of the fetus, expectation of childbirth, conditioned reflex fears associated with unfavorable past pregnancies and childbirth [5,6,8]. A study of pregnant women who do not have signs of borderline neuropsychiatric disorders showed that character accentuation was established only in a quarter of women. The first trimester of pregnancy is usually characterized to some extent by the sharpening of existing character traits. Soft, vulnerable, insecure women become even more impressionable, sometimes excessively tearful, and anxious (those women who have had miscarriages in the past or this pregnancy are not going well, in this case, the fear of another abortion can become simply obsessive) ). Powerful women with a sharp character can become even more aggressive, irritable and demanding. In the third trimester of pregnancy, emotional swings may begin again in connection with the expectation of childbirth, and with them fear – especially women who have to experience this event for the first time are susceptible to it [5,6,11].
Anxiety disorders may first appear during pregnancy, there may be a change in the course of already existing disorders. In one retrospective study in women with panic attacks, 20% of cases showed a decrease in symptoms during pregnancy, 54% remained unchanged, and 26% worsened the course of the disease [12]. The detection of depression in pregnant women is difficult. Many symptoms, such as emotional lability, increased fatigue, changes in appetite and cognitive decline, are often found in physiologically normal pregnancy. Under stress, the hormones of the adrenal glands of the mother release catecholamines (stress hormones) into the blood, and during the experience of positive emotions (joy, calm, etc.), the hypothalamic structures produce endorphins, which, penetrating through the placental barrier, directly affect the fetus. Consequently, mother and child are a single neurohumoral organism, and each of them equally suffers from the adverse influence of the outside world, which is recorded in long-term memory, affecting the entire subsequent life of the child. Positive maternal emotions cause an increase in the growth of the fetus and an increase in the level of its sensory perception.
According to the literature [2,5,11,15], a significant effect of anxiety disorders on the course of pregnancy and perinatal outcomes has been noted: the frequency of placental insufficiency, fetal growth retardation, premature birth, the birth of children with low body weight, which subsequently affects negatively on long-term forecast for them.
Thus, emotional swings are dangerous not only for the woman herself, but also for her unborn child. When a pregnant woman experiences stress, her body produces more of the hormone cortisol, the main “stress hormone”. Cortisol increases blood pressure and blood sugar levels, negatively affects the strength of the immune system – which, of course, adversely affects the health of the child.
Stress during pregnancy is dangerous for a variety of reasons. Chronic stress experienced for several weeks can slow down the development of the cells of the body of the embryo, the growth of the fetus. This increases the risk of miscarriage or spontaneous abortion or premature birth. Elevated levels of stress hormones can damage the brain of an unborn baby and lead to parenting problems later on.
Psychological stress in the perinatal period brings with it a whole range of problems that require serious attention to the psychological sphere of a pregnant woman in order to avoid obstetric and other complications. However, diagnostic criteria for the transition of the stress syndrome from the link of adaptation to the link of pathogenesis of various diseases have not yet been found [2,4,15].
Emotional control is necessary to maintain normal emotional balance during pregnancy. A pregnant woman who successfully manages her emotions is aware of the changing emotional balance and is ready to accept what is happening to her.
There are several basic rules that will help to cope with emotional imbalance:
• You must come to terms with the fact that physical and emotional changes are an inevitable part of the pregnancy period. You need to understand that this is a temporary stage that will last only a few months and end a maximum of 1-2 months after the birth of the child.
• Each trimester of pregnancy brings new changes, both in the body and in the emotional state. The main source of information about pregnancy is special literature and the experience of women who have recently given birth, who can share their feelings and experiences.
• A pregnant woman is responsible for the emergence of a new life. Taking care of yourself means taking care of your child. Proper nutrition, rest and self-indulgence are essential.
• A pregnant woman should be open to dialogue and not be afraid to discuss her problems with a gynecologist, partner or friends – anyone who can provide emotional support. You should not keep fears and worries in yourself – this will only aggravate internal tension.
• Changes associated with pregnancy can lead to low energy and, as a result, rapid fatigue. You need to slow down, re-prioritize your work, and give yourself a break.
• Emotional tension and negative emotions can be overcome by being distracted by pleasant activities or hobbies. When emotions overwhelm you, try to analyze what is bothering you, and then find an adequate solution.
• Engaging in certain physical activities designed specifically for expectant mothers will help improve both physical and emotional health.
• The main components of emotional health during pregnancy are rest and comfort.
However, unfortunately, during pregnancy, a woman cannot always cope with nervous tension, irritability, anxiety, excitement and other symptoms of stress on her own. Therefore, in some situations, she needs medical help.
The relative risk of using drugs during pregnancy makes it difficult to choose therapy, therefore, for the correction of psycho-emotional disorders that occur during pregnancy, herbal drugs that have practically no side effects can be considered as highly safe therapy.
The basis of anti-anxiety complex herbal remedies is valerian. It has been used in traditional medicine for many years for its hypnotic and sedative effects and remains a highly sought after remedy to this day. The mild hypnotic effect of valerian makes it possible to use it for the relief of shallow insomnia caused by anxiety. In addition, the vegetotropic effect of valerian is well known, its ability to have a uniform effect on both mental and somatic (vegetative) symptoms of anxiety. Valerian preparations also have anxiolytic and neuroprotective effects. The spectrum of side effects of valerian is very narrow and practically limited only to allergic reactions. Although valerian extract is metabolized by the cytochrome P450 system, it has virtually no effect on the metabolism of other drugs, and thus unwanted drug interactions are excluded.
Among the phytopreparations used by clinicians for the treatment of psycho-emotional disorders, Persen, a modern combined sedative preparation of plant origin, is widely used to relieve stress symptoms (anxiety, irritability and emotional stress) without causing drowsiness. Along with valerian, the composition of the drug includes dry extracts of medicinal plants with pronounced anxiolytic activity – peppermint and lemon balm (Table 1). The additional antispasmodic effect of peppermint makes it possible to successfully use the drug in patients with a pronounced somatic component of the anxiety syndrome. In addition, lemon balm has a nootropic (increased concentration and speed of problem solving), antioxidant effect. Persen is administered orally to adults and adolescents over 12 years old, 2-3 coated tablets, 2-3 times / day, Persen forte – inside to adults and adolescents over 12 years old, 1-2 capsules 2-3 times / day.
The advantages of Persen over other sedatives are:
• the preparation contains only natural ingredients;
• the effectiveness and safety of herbal ingredients Persena are well studied;
• does not contain alcohol and bromine;
• can be combined with any psychotropic drugs, including antidepressants;
• effective as a fast-acting symptomatic remedy when it is necessary to stop the symptoms of anxiety, agitation, and during a course of treatment for stress conditions, anxiety and phobic disorders.
Due to the natural components of plant origin that are part of Persen, this drug can be used during pregnancy. In each case, the doctor must evaluate the benefits and risks of taking Persen and other drugs, depending on the severity of the symptoms of the disease.
Thus, to prevent possible development, as well as to treat psycho-emotional disorders in pregnant women, it is advisable to use sedatives, the effect of which softens the damaging effects of psychogenic factors.

Literature
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2. Avedisova A.S. Anxiety disorders // Alexandrovsky Yu.A. “Mental disorders in general medical practice and their treatment”. M: GEOTAR-MED. 2004, pp. 66–73.
3. Voznesenskaya T.G., Fedotova A.V., Fokina N.M. Persen-forte in the treatment of anxiety disorders in patients with psychovegetative syndrome // Treatment of nervous diseases. 2002. No. 3 (8). pp. 38–41.
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