Bleeding: 8 Weeks after MTX

Hi all,

Here’s some quick background: I had my second methotrexate shot on April 19. I did bleed for four days after that. In May I had my first normal period that lasted for seven days. I had my second normal. June 8 through June 11. It was short, shorter than normal. Six days later 6/17, my partner and I have sex. Within an hour or two after, I started experiencing cervical cramping — the type that feels like a miscarriage. Different than period cramping. I hope you know what I mean. And I started bleeding bright red blood.

Is this normal? My hCG level was down to 17 as of last Wednesday 6/14. I’m worried we jumped the gun and had sex too soon. What do you all think? I’m supposed to be ovulating this week and although I’m not at zero, I wanted to try again. Some resources say after two periods, you can safely try to conceive again. Seems like I might be having to wait another month but I really don’t want to. Should I wait another month? What are you all think?

Thank you,

Dear Rachael,

I am so sorry to hear of your ectopic pregnancy loss,

As we are a charity, we cannot provide individualised medical advice but can provide general information.

Following methotrexate injections, we would advise not doing any activities that increase the chance of infra-abdominal pressure and this would include penetrative sexual intercourse until.your hCG levels are below pre pregnancy levels.

It is also very important to avoid trying to concieve and to use additional contraception for a period of time following Methotrexate injection.

We and many health care professionals strongly advise to wait until your hCG levels have reached pre-pregnancy levels (your doctor will tell you when this is) then take folic acid supplements for 12 weeks. This is because the Methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The Methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as hare lip, cleft palate, or even spina bifida or other NT defects. This is why the “wait” and then taking folic acid for 12 weeks before trying to conceive is so important.

This also gives chance for your body to recover from the ordeal of an ectopic pregnancy, it gives your periods to return to a more normal cycle. This can be key when dating possible future scan dates.

We have more information.in methotrexate treatment on our website which I have added here

https://ectopic.org.uk/treating-an-ecto … thotrexate

And trying to conceive again here.

https://ectopic.org.uk/physical-recover … eive-again

If you are experiencing worsening bleeding or pain or feel dizzy and unwell, we would always advise to seek urgent medical advice.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

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Thank you for your reply, Karen. We did get my folic acid tested recently and I’m at a healthy level— 10.1ng/mL. I contacted my healthcare provider and will be expecting a zero hCG result in the coming week.

Thank you for sharing the recourses and compassion.

-Rachael