Hi, i had the injection to halt my pregnancy 24 hours ago after 10 hrs waiting around in hospital! I was given very minimum information about what to expect but have been reading up while i was waiting round yesterday and feel very anxious. I have, in the last half an hour, started getting a cramping like pain on my right hand side, is this the start of it? Any info is appreciated
Dear Kazshuker89,
I am so sorry to hear of your ectopic pregnancy and loss. I am very sorry to hear that you have not been given alot of information, please do not be afraid to ask any questions at your next appointment.
The most common side effects of Methotrexate are:
cramping abdominal (tummy) pain is the most common side effect, and it usually occurs during the first 2 to 3 days of treatment. Because abdominal pain is also a sign of a ruptured ectopic pregnancy, report any abdominal pain to your health professional;
fatigue – Many people feel very tired and are shocked by the sheer exhaustion that they encounter during treatment;
vaginal bleeding or spotting;
nausea, vomiting, and indigestion;
light-headedness or dizziness – Again, because this is also a sign of a ruptured ectopic pregnancy, please report it to your health professional;
A numb or sore bottom from the injection.
Other rarer side effects from Methotrexate treatment for ectopic pregnancy, include:
Skin sensitivity to sunlight.
Inflammation of the membrane covering the eye.
Sore mouth and throat.
Temporary hair loss.
Severe low blood counts (bone marrow suppression).
Inflammation of the lung (pneumonitis).
Methotrexate treatment does require careful monitoring and follow-up. This means that you will have to attend the hospital regularly for blood tests to monitor your hCG levels until the tests are negative. This can take several weeks. Your hospital will make arrangements for you to have the hormone level checked. Your doctors will usually test your hCG levels on the day the medicine is given, again on day four, and on day seven after the injections.
The hCG level often rises on the day four blood test because the action of Methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of Methotrexate or surgery.
A few days after the injection, it is usual to begin to bleed and this bleeding can last between a few days and up to 6 weeks.
Every 3-7 days, beta hCG levels will continue to be monitored to ensure that they are falling appropriately. Most women only need one injection but in up to a quarter of cases a further injection may be required if serum hCG levels are not decreasing.
Methotrexate is at least as good as surgery in terms of subsequent successful pregnancies. This may be due to the fact that medical treatment is non-invasive, whereas surgery may cause some scarring around the tube.
Whilst I do not wish to alarm you, there are risks being treated with methotrexate. Occasionally 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 and 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.
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 should 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.
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 until your hCG levels are falling consistently and are in the low 100s.
As a gentle reminder regarding trying to conceive following methotrexate injection, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the Methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The Methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as hare lip, cleft palate, or even spina bifida or other NT defects. This is why the “wait” and then taking folic acid for 12 weeks before trying to conceive is so important.
Do not hesitate to contact us with any questions you may have, we are here for you for as long as you need,
Sending much love,
Karen x
If we have been able to help you, are you able to help us with a small donation or by volunteering?
Further information is available at www.ectopic.org.uk
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.
Thanks Karen
I have only had some light spotting but should i expect this to get heavier?
My partner and i had just booked our first holiday together the week before this (due to fly the 13th) so have been advised to cancel it. Just feeling very teary and sorry for myself at the mo. Back to have my hcg levels tested monday morning but expecting them to have increased from what other people have written
Dear Kazshuker89,
Personally my bleeding got heavier but some women only report spotting, we are all different, so just take each day as it comes.
Experiencing an ectopic pregnancy is an emotional rollercoaster and you are in the early stages of recovery. Your emotions at this moment are completely normal, be kind to yourself and allow time to grieve, to heal both physically and emotionally.
It is correct that the hCG level often rises on the day four blood test because the action of Methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of Methotrexate or surgery.
Sending much love and warm hugs,
Karen x
If we have been able to help you, are you able to help us with a small donation or by volunteering?
Further information is available at www.ectopic.org.uk
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.
Well i have had a rough few days as I ended up in A and E on Saturday due to the amount of pain I was in and terrified i was rupturing even though the doctor hasn’t told me which area my ectopic pregnancy is developing in! I was admitted and monitored for 24hrs and released Sunday afternoon but I just feel like a ticking tome bomb now and wish i’d opted for surgery as then at least it would be out of me! My hcg before i had tbe drug on thurs was 1234 and when they did it on Saturday it was around 1024. I had bloods done Monday morning but havent had the results so im assuming all ok and its Thursday (day 7) thats the biggy! The pain has subsided in my stomach apart from the odd twinge, im still bleeding but i dee that as a good sign. The thing thats worrying me is my right arm is painful/achey (not my shoulder tip) so im getting paranoid it could be DVT although i know its more than likely due to having so many needles in there … anyone else had similar ??