Hi everyone. I am currently dealing with an ectopic pregnancy which occurred whilst I was on holiday. Not only I had to be hospitalised and treated in a hospital abroad (which is my home country anyway), but I feel I am stuck here until the levels haven’t gone down significantly. During the last check up I felt a bit brushed off by the docs and I was told I can fly back after friday if the levels keep dropping (currently my hcg is 1450). I was also told I can go back to work and there is no contraindications to this. I am bleeding heavily so I guess this is a sign that the pharmacological treatment with methotrexate is working? I had only one dose on 28/04 and the starting hcg level was 1289..on day 4 it had gone up to 1782 and now it’s slowly descending. How long are people bleeding for (on average) after the injection? I’m not sure how I feel, I just would like this over and be back to normal life however, I have read it takes an average of 6/8 weeks to clear up. I guess I’m looking for a bit of empathy and possibly some encouragement words.
Dear Valentina,
I am so sorry to hear of your ectopic pregnancy loss. Experiencing this whilst away from friends and family is difficult and we will be here for you as you need.
Bleeding after methotrexate is common, it can be anything from heavy with clots to slight spotting. It will probably last a week or two, changing in colour from red to brown and diminishing. Some women report bleeding and spotting on and off for up to six weeks.
Although I do not wish to alarm you, heavy bleeding or worsening pain can also be a sign of rupture so provided you are not soaking a pad in less than an hour or the abdominal pain is so severe you can’t manage it with over-the-counter pain relief, such as paracetamol, you should try not to worry. If the amount of bleeding worries you or you have any concerns, you should seek medical advice and a reassessment.
This usually takes a few weeks for hCG levels to return to normal. According to a study, for women with ectopic pregnancies in a Fallopian tube who are treated with methotrexate (with hCG of 1000–5000 IU/L before treatment), it takes an average of 28 days for the ectopic pregnancy to resolve.
We have more information on medical management with methotrexate on our website here-
https://ectopic.org.uk/treating-an-ectopic-pregnancy/medical-management-with-methotrexate
Whilst you can go back to work, please don’t think or feel you have too. Depending on your job, we advise that you avoid any heavy lifting or strenuous exercise whilst your hCG levels are declining as there sadly remains a risk of rupture still. People can also be very surprised at the level of fatigue that comes with methotrexate and you are also having to process being diagnosed with an ectopic pregnancy and losing your baby. If you feel you need more time for the physical and/or emotional recovery, please take it.
Best wishes,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.
Further information is available on our website.
Email us: ept@ectopic.org.uk
We provide a call-back helpline service: 020 7733 2653
Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team
Dear Karen,
Thank you so much for your answer, I really appreciate it.
I am going to repeat the HCG levels today as advised by the doctor here and I was hoping to fly back if these are descending. I have read that flying is not advised until the levels are down to 0 but my husband needs to go back to work and I don’t want to be left here whilst the levels are still going down. I have consulted different gynae consultants here and they all have different opinions about flying but I’m desperate to get back home. What’s your view on this?
This would be a 2.5 hours flight however, I could break the journey in 2 flights of 1 hour each if necessary.
I’m hoping that the check up today shows that the levels are still going down.
Dear Valentina,
I am so sorry you are stuck in this situation. We would not advise flying until your hCG levels are at pre pregnancy levels and you have been discharged by your medical tea. There does remain a risk of rupture with declining or low levels and this would result in a medical emergency with you needing surgery. This would obviously not be able to happen if you were in the air. If you have insurance, they would also be unlikely to cover you whilst still undergoing monitoring (although you could obviously check with them)
I know this is not what you want to hear, but it would be the safest option in our opinion.
Best wishes,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811
Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards
If the information provided here or through the EPT website has helped you, you can donate towards our support services, volunteer, or fundraise to raise awareness.
Further information is available on our website.
Email us: ept@ectopic.org.uk
We provide a call-back helpline service: 020 7733 2653
Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team