Nosebleeds during pregnancy

Nosebleeds, sometimes called 'epistaxis', occur when the tiny blood vessels inside your nose burst.

Nosebleeds during pregnancy are a common problem. You may experience nosebleeds more often if you're pregnant, even if you haven't had them often in the past.

Although nosebleeds can be alarming, in most cases there's no need to worry. You should be able to manage them yourself at home.

Symptoms of nosebleeds in pregnancy are not usually different from a regular nosebleed. You may have sudden bleeding from one or both nostrils. Blood flow can be light or heavy. Sometimes you may taste or feel blood running down your throat.

Nosebleeds may last from a few seconds to more than 10 minutes.

Nosebleeds sometimes happen while you're sleeping. You may wake up feeling the blood going down the back of your throat. When you sit up, the blood will then come out of your nose.

There are several reasons why nosebleeds are more common during pregnancy. These are related to the changes in your hormones during pregnancy.

How can hormonal changes lead to nosebleeds?

Increased oestrogen levels during pregnancy cause the delicate blood vessels in your nose to dilate (widen), become more congested and likely to rupture (burst).

Progesterone also increases the amount of blood circulating in your body (your blood volume). This can increase the pressure in the tiny blood vessels in your nose, causing them to burst, resulting in a nosebleed.

Other hormones that are increased in your body during pregnancy can cause your blood vessels to relax and widen. This causes more blood to flow around your body putting extra pressure on the delicate blood vessels in your nose.

Other causes of nosebleeds

It is good to remember that even in pregnancy, a nosebleed may be caused by an issue unrelated to pregnancy.

Nosebleeds can occur due to damage caused by:

• picking your nose
• blowing your nose too hard
• dry air (such as from heaters or cold weather)
• a foreign object in your nose

Nosebleeds can also be due to accidents and medical conditions such as:

• an injury or broken nose
• hypertension (high blood pressure)
• conditions that affect your blood vessels or how your blood clots
• certain medicines

Your doctor will ask questions about your symptoms and recent health. Let your doctor know if you are taking any medicines. Your doctor may ask about:

• how often you get a nosebleed
• if it is always from the same nostril
• how long your nosebleeds usually last
• how much blood you lose during a nosebleed

Your doctor will examine your nose and may perform a general physical examination.

In some cases, your doctor may recommend a blood test to check for a medical issue that is causing your nosebleeds.

If you're getting severe nosebleeds, your doctor may refer you to an ear, nose and throat (ENT) specialist.

Nosebleeds usually can be easily managed with first aid. To take care of a nosebleed:

1. Sit up and lean forward slightly.
2. Firmly pinch your nose below the bridge (the bony part of your nose).
3. Breathe through your mouth.
4. Keep pinching for 10 minutes.
5. If any blood enters your mouth, spit it out.
6. You can put an ice pack on your forehead and the back of your neck.
7. After the 10 minutes is up, let go and see if the bleeding has stopped.

If bleeding starts again, get medical advice. If bleeding doesn't stop after 20 minutes, seek medical help.

In the past, other ways of dealing with nosebleeds were often used, but these aren't considered effective. Follow the advice above, and don't:

• tilt your head backwards — the blood may flow down your throat and make you sick
• lie down
• put tissues or cotton wool up your nose

Cases of more severe nosebleeds that won't stop can be treated in hospital. Treatment may include:

• packing your nose with special gauze or balloons
• medicines to constrict the blood vessels in your nose
• medicines to encourage blood clotting

In the 24 hours after a nosebleed, you should try to avoid:

• blowing your nose
• picking your nose
• bending down
• vigorous exercise
• drinking hot drinks or taking a hot shower or bath
• drinking alcohol
• taking NSAIDs (non-steroidal anti-inflammatory drugs)

Nosebleeds can be upsetting, but generally there's nothing to worry about.

As long as you don't lose a lot of blood, you can treat your nosebleed at home. In most cases, a nosebleed won't harm you or your baby.

Nosebleeds in pregnancy can't always be prevented, but there are things you can do to reduce the chance of them happening.

Avoid rubbing or picking the inside of your nose.

You may find that you get more nosebleeds in winter when the air is drier. Try using a humidifier in your home to help moisten the air. Saline spray and saline nasal gel may also help.

If there is an underlying cause of your nosebleeds, managing it can prevent future nosebleeds.

Your nosebleeds may become less frequent as your hormone levels return to normal after birth.

Talk to your midwife or doctor if you're worried about your nosebleeds.

For more information, or to discuss any concerns you might have about nosebleeds, call Pregnancy, Birth and Baby on 1800 882 436.