Hello. I was diagnosed with 3 weeks ectopic pregnancy. My Beta HCG level was 1083 before I took methotrexate. After 48hours, my HCG levels came down to 393. I started having spotting and little cramps after 2hours of the shot. I started having little more bleeding from the day 5. And on day 5 I saw some greyish red substance (I thought that as the fetus/ tissue) in my sanitary pad. I got little scared. On day 7 my bleeding reduced and I am having very little pain in the abdomen. I am scared if this is a good sign and if the injection is working or not. I will be taking a blood test tomorrow. Hope I get some positive results. I wanted to ask others if they faced something similar. 
Also, I am having a weird pain sometimes which pretty mild and I am scared if my tube is ruptured or not.
Dear Meg08,
I am so sorry to hear of your ectopic pregnancy and loss,
the first bleed that occurs after treatment for ectopic pregnancy is not classed as a period. It is the body’s response to falling hormone levels because you are sadly no longer pregnant. The body expels the lining of the uterus that had built up in preparation for the pregnancy because it is no longer needed. This process involves vaginal bleeding - it can be clotty or like one of your usual periods and some women have bleeding/spotting for up to six weeks.
The bleeding that follows an ectopic pregnancy can be very heavy and clotty and result in the passing of what we call a decidual cast. This decidual cast is the lining of the uterus when we are pregnant. The sudden drop in hormones can cause the material inside the uterus to be shed in layers and the material that is passed can be grey, pink or white as well as appear like a clot or dark or frank red blood. Women can often mistake it for the tissue of their baby which can cause worry but it is important to remember that it is a normal process for the uterus lining to be shed.
Abdominal pain is common following treatment for ectopic pregnancy, you should be able to manage this with over the counter medications such as paracetamol. If this is not the case or if your pain is worsening or you are concerned, I would always advise you to talk to your GP or EPU. Whilst I do not wish to alarm you, there is a small risk of rupture with reducing or low hCG numbers, so please do take things easy, do not do any heavy lifting or exercise and again seek urgent medical advice with any concerns.
Sending much love,
Karen x
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