Expectant Management - what to expect next?

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Hi, I am extremely hopeful that I can find some answers here. Thank you for your help…

Here’s my story:

On August 26 I had a positive home pregnancy test. I visited the obgyn on Aug 28 and she didn’t find something quite right so called me for a blood test day after. I was also complaining of cramping pain in my lower left abdomen. I was about 5 weeks pregnant.

Hcg on Aug 28 - 4200

Hcg on Aug 30 - 1000 : I was told this 2 as unhealthy pregnancy and I will have a miscarriage

Hcg on Sep 1 - 500 (round figures) : I was finally sent to radiology who said it’s probably ectopic and it’s in the left side.

Bleeding

I had some spotting on Aug 30 and started bleeding on Aug 31.

Pain - no overwhelming excruciating pain. But a painful period.

Other pains

Shoulder tip and rectal pain around Sep 7th. The doctor found some internal bleeding on the subsequent ultrasound.

Pregnancy sac

My doctor said the sac is about 2cms. She monitored it every second day with ultrasound and said it is not reducing and looks persistent.

Where initially the doctors (took two opinions) said that the sac had fallen off the tube when I showed to a radiologist who did a 3 D scan, he was very confident that the sac is still in the tube. He also said it is 3.5 cms. Not that the size has increased but that he is able to see it better.

I have not been given any methotrexate and have been told that there is no eminent need of surgery. I am being managed expectantly. My hormone level has dropped from 4000 to 1 in one month. The size of the sac has not reduced…but the doctor’s say it will take time to go and it’s just a clot now.

It has been ~40 days.

I am advised against heavy work, exercise and I’m on medical leave from work. I still have mild pain and discomfort in my lower left abdomen on and off.

I have been advised to wait for the sac to go before we start trying again. We have also been told to try normally without taking any diagnostic test (eg the dye test).

How long does it take for the sac to dissolve?

With the sac still inside my tube, is there still any risk given my hormone level is negative?

Is my tube damaged? Should we just try normally now??

How soon can we try again?

How long does it take for the period to come? Will taking herbs like primrose oil and agnus castus help? I also have pcos and my periods were not very regular.

Are there any side effects of taking these herbs?

What could have been the reasons for ectopic pregnancy? I was not aware that I was pregnant and I was doing extremely heavy exercises and also did hot yoga. Could that be it??

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Hello

I am sorry no one was able to help you on here and I hope you have found your answers through time. I have just been discharged with a hormone level of 3 following expectant management treatment. I stopped bleeding about 4 days ago. Based on your experience, now that it was a few months back, when do you think I can expect another period or expect to ovulate? Can you give me a walk through of what you went through after this post if possible?

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Dear Dcmw

I know you addressed your post to someone who has had experience of expectant management, but I just wanted to flag some guidance from The EPT which may help - it is about periods starting after an ectopic pregnancy. Our advice is here:

When can I expect a period after my ectopic and will it be painful?

Your periods can take a while to re-establish and they can re-start anything between two and ten weeks after surgery, or once hCG levels have fallen below about 100mIU/mL. Most women find that their period arrives sometime around week six or seven after surgery, and at some time in the four weeks after their hCG levels have fallen to 0 if treated with Methotrexate.

The body is a very clever thing and before you can have a period you have to ovulate. It is perfectly possible to ovulate within 14 days after surgical treatment and almost as soon with Methotrexate treatment, so it is important to be aware that it is possible to become pregnant without having a proper period first if you are not using some form of contraception.

The first period may be more painful or less so than usual, heavier or lighter, last for longer or shorter than usual – there really is no set pattern. You should be able to manage the discomfort with over-the-counter pain relief and should not be soaking a pad in less than an hour. If this is not the case, you should seek medical attention.

Much love

Beth - Host x

If we have been able to help you, are you able to help us with a small donation or by volunteering?

Email us at ept@ectopic.org.uk. Our helpline is 020 7733 2653 (available Monday to Friday 10am - 4pm).

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.

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Hello - I’m in exactly he same boat and I wanted to ask what the outcome was please? How long did I think take for the sac to dissolve :frowning:

Many thanks