First bleed after ectopic

Hi there, I found out a few weeks ago that I had a ectopic pregnancy but the doctors went wIth expectant management approach. I just started my period but wondered if it’s now safe to start using tampons and if it’s safe to start having intercourse (with protection).

I feel a huge relief but Also sad the pregnancy has ended.

Dear Star12345,

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

Please note that the first bleed after an ectopic pregnancy (which sounds like the one you have just had) is not classed as a period - it is the body’s response to falling hormone levels as you are sadly no longer pregnant and shedding of the uterine lining that had build up which involves bleeding.

We would recommend using tampons with your next bleed.

Regarding your query

If you are being treated with a drug called methotrexate or being “expectantly managed” (ie allowing time for your body to resolve the pregnancy by itself without immediate treatment), please do not undertake any strenuous exercise or lifting or housework while your hCG levels are dropping. While I do not want to alarm you, there remains the risk of rupture even with low or declining hCG levels. You should not resume exercise or sexual intercourse until your hCG levels are falling consistently and are in the low 100s.

As a gentle reminder, we and many medical professionals advise waiting at least two menstrual cycles before trying to conceive again - and this is the same with expectant management treatment, too (ie allowing time for the body to resolve the pregnancy without medical or surgical treatment).

This “wait” is to allow your cycles to resume and have a last menstrual period date from which to date a new pregnancy - important information for checking for ectopic pregnancy in the future. It also allows time for your emotions to surface and be worked through after your ordeal.

Sending much love,

Karen x


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Thank you Karen.