Journey after methotrexate - worried!

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1

Hello all,

I was hoping to get some advice from others who have also had a dose of methotrexate and are monitoring the decline of hcg, or anyone who has already experienced this previously!

In March I was diagnosed with an ectopic in my right tube, at that time the hcg level was 4500 and the methotrexate seemed to be the best option so I could avoid the surgery. Luckily I only needed one dose and my hormone level has been falling since, from week to week it falls by at least 100. Worryingly over the last couple of weeks I seem to be stuck at 55 with no change since my last blood test.

I don’t know why the hormone level isn’t continuing to drop, I am experiencing some light bleeding and a feeling of ‘tightness’ on my right side. The hospital are unclear as to why, and I’m not sure what the solution is if it fails to get to 15 (at which point they will discharge me). Is this normal? Hoping someone can help!

Thanks

J xx

2

Dear J,

I am so sorry to hear of your ectopic pregnancy and loss and of the worrying time you are going through.

hCG levels can often stall and seem to take a while to reduce to pre pregnancy levels the closer we get to the end.

I am afraid it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. What I can say is that it can take a number of weeks and, while it can take some time, it is not as invasive a procedure as surgery but I appreciate that it can be a drawn out process. Also, in terms of chances of future successful pregnancies, studies do not show a significant difference between treatment routes, whether surgical, medical using methotrexate or expectant management (allowing time for the body to resolve the pregnancy itself).

It is difficult to comment on what steps your medical team will take as it depends upon their local protocol but I presume you will have another blood test soon and they will review you on the results of these.

In the meantime please take care of yourself, do not do any strenuous exercise or heavy lifting.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

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

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

The latest EPT newsletter is out now! You can take a look at the Winter edition and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

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 for your response Karen, I have had 2 blood tests since posting and my level has come down from 50 to 26! Compared to the earlier tests this seems to be creeping down very slowly. I’m now on week 10 of blood tests and it just seems to be taking very long. Would there be a scan done in any scenario?

I’m also worried of a blockage or the long term impact, I can definitely feel some pressure in my right side and have pain all down my side and back when ever I do anything remotely active. I’m hoping this will resolve itself in time but it’s very difficult to hear such a small decrease every week.

Thanks

J.

4

Dear J,

I’m glad to hear your levels are reducing again,

With methotrexate treatment, when the pregnancy is ended, the whole pregnancy sac including any cells that might have eventually grown into a baby is usually reabsorbed by the mother. This happens because it is our own DNA and cellular material. In some cases, the Fallopian tube may remain blocked which can take some time to shrink and occasionally it may not shrink and may leave a blockage as a small cyst. However the use of methotrexate does not reduce the chances of a successful pregnancy and it is not usual practice to rescan in the UK. It may offer some comfort to know that around 65 per cent of women are healthily pregnant within 18 months of an ectopic pregnancy and some studies show that around 85 per cent of women are pregnant within two years. I would discuss your current pain with your medical team. If they discharge you and the pain persists however I suggest keeping a pain diary noting when the pain appears, the intensity on a scale of 0-10 and anything that helps the pain eg resting, hot water bottle, paracetamol etc. Visiting your doctors with this information helps them to assess how best to manage your symptoms.

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

During the coronavirus outbreak, The EPT team is still working hard to provide crucial information and support to women and families experiencing ectopic pregnancy as quickly and efficiently as we can.

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

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

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

Thank you for this, that information is reassuring. Just wondering, I was told I can’t try to conceive for 3 months- does this mean 3 months from the methotrexate injection or 3 months from when my hcg reaches zero? (Which it thankfully did a couple of weeks ago!)

J xx

6

Dear J,

When you hCG reaches below 5, you should then start taking folic acid supplements for 12 weeks (3 months) before TTC.

I hope this helps,

Sending much love,

Karen x

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

Ectopic pregnancy patient information suite: Highly Commended in the 2019 BMA Patient Information Awards

During the coronavirus outbreak, The EPT team is still working hard to provide crucial information and support to women and families experiencing ectopic pregnancy as quickly and efficiently as we can.

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

Further information is available at ectopic.org.uk

Email us: ept@ectopic.org.uk

We provide a call-back helpline service: 020 7733 2653

Take a look at our newsletters and subscribe to our mailing list here: https://mailchi.mp/986bdd6091ee/ectopic-matters

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