Ectopic - Methotrexate

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1

Hello All,

I’m 31, trying for first baby . Had missed miscarriage last year at 6 weeks, now its ectopic but caught very early at 5 weeks

HCG Levels

July 29th - 3614

July 30th - Took 1st Methotrexate

July 31st - Folinic Acid Injection

August 1st - 777

August 8th - 1265 ( Took 2nd shot)

I’m confused about what’s happening. Why does my HCG look elevated after 1 week of methotrexate ? I started bleeding like normal period on August 8th. Bleeding is still there and cramps due to injection which I took yesterday. Is the bleeding normal and means injection is working? How long the cramping pain will be there? This feels so different than the missed miscarriage. Traumatic, always in anxiety and don’t know which symptom is normal and which is abnormal

Looking for positive stories who had a spike in HCG and got decreased after second shot.

2

Dear Sunshine,

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

I have copied this from our website which gives a little more information on methotrexate.

The risk associated with treating being treated medically is that the medicine may not work as the cells of the ectopic pregnancy may continue to divide, which could result in there still being a need for surgery. Success rates do vary depending on the circumstances in which methotrexate is given. Studies report success rates of 65-95%. Success rates tend to be higher with lower serum hCG levels. Your doctor should be able to tell you the success rate of methotrexate in their unit. Doctors can tell if the specialised cells of a pregnancy that produce the hCG hormone are still dividing because the hCG level will continue to rise and not fall. This will be monitored through blood tests.

Women with ectopic pregnancies in a Fallopian tube who are treated with methotrexate:

require a second dose of methotrexate in 14% of cases (14 out of 100 women); and

require surgery in 29% of cases (29 out of 100 women), despite treatment with methotrexate.

We do hear from many women and people whose levels decrease nicely after a second injection.

Occasionally, an ectopic pregnancy can rupture despite low hCG levels. Your hospital should have given you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the Accident and Emergency (A&E) department. If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or the NHS 111 Service by dialling 111.

I hope you don’t mind me asking, but are you in the UK? I am intrigued by you having a Folinic Acid injection as we usually advise not having folic acid supplements with the methotrexate as it works as an antagonist with methotrexate and can reduce the effectiveness of the drug (i.e. How well it works). If you have been told to continue taking folic acid supplements, I would question this with your medical team.

Here is the link to our advice about not having folic acid supplements with methotrexate

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

I hope your bloods over the next few days/weeks show a reduction,

We will be here for you for as long as you need,

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information

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 support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.

Take a look at our newsletters and subscribe to our mailing list.

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

3

Thank you Karen! I am from India. Got to know this page via FB and found it very useful. I had my HCG test today. It has reduced to 906

August 8th - 1265

August 13th - 906

4

Dear Sunshine,

Thank you for letting me know where you are from. I have been looking into the use of folinic acid injections since your post and although it is not common practice to use it in the UK, It is used in some countries.

I am glad your hCG levels are starting to decline and I am glad you have found our forums. We also have a website which has lots of information and also more on methotrexate treatment https://ectopic.org.uk/

These forums are a safe place to ask question, write whatever is on your mind or vent.

You have friends here who have been through similar experiences, so please continue to lean on us for as long as you need.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information

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 support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.

Take a look at our newsletters and subscribe to our mailing list.

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

5

Thanks for being there Karen! I struggled to find pages related to ectopic - this is something not many ppl undergo and few in my circle don’t have any idea about what is ectopic.

This forum is super helpful! Grateful to have found this.

Any idea how long would it take for HCG levels to come down to 0? Do people resume to work and travel once it starts decreasing or do they stay at home until the leaves reach 0

6

Dear Sunshine,

The length of time it takes methotrexate to work varies as it all depends upon how high the hCG levels were and our unique physiology. On average it usually takes a few weeks. 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 (when medical treatment is successful).

Returning to work is different for everyone depending upon the role, physical nature and hours of work. Please also don’t forget that some people need further time off to deal with the emotional impact of an ectopic pregnancy and baby loss. Please speak to your GP about additional time off and if you don 't feel ready to return after the note has ended, you can ask for longer.

We have more information on our website about the workplace and returning to work which you may find helpful.

https://ectopic.org.uk/the-workplace

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

The EPT is awarded the PIF TICK as a Trusted Information Creator, the UK-wide quality mark for healthcare information

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 support line: 020 7733 2653. We are able to provide support in multiple languages including British Sign Language.

Take a look at our newsletters and subscribe to our mailing list.

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