I had heavy bleeding prior to the methotrexate but on the day of the injection and after it became spotting and stopped completely. I’m getting some pain. I’m only on day 3 but I am worried it isn’t working.
Is there anyone who hasn’t had it work or has and had a similar experience?
Am i bring to impatient?
My hcg levels are low and were dropping but sub optimally.
Dear Nillob7445,
I am so sorry to hear of your ectopic pregnancy and loss.
Unfortunately I am not medically trained so cannot give you specific advice on your symptoms and it is also difficult as we all react differently to the methotraxate injection. Some women bleed or spot continuously others do not.
Generally 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.
Personally I had two very heavy bleeds prior to my methotraxate injection and then stopped and didn’t start bleeding again until around 2 or 3 weeks after the injection.
You should be having regular blood tests and 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, but your medical team will inform you if this is the case.
As you are day 3, I thought I would also remind you 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.
If you have any concerns please do not hesitate to discuss this with your medical team too.
Sending much love,
Karen x
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First off, sorry to hear about your ectopic.
I’d say yes, you’re probably being too impatient. Things didn’t happen so quickly for me either, and my levels didn’t drop fast enough either at first. I had lots of bleeding before the methotrexate too, which was why I was sent for an early scan, at which the ectopic was diagnosed.
I started at levels of 1672. On day 4, they were 1632 (they do typically go up on Day 4). On day 7, they were 1477 (not low enough). On day 9, they dropped to 983 - and have been dropping very well ever since. I got the all clear last week on day 41, when they finally reached 3.
The first week, the reaction to the methotrexate was incredibly painful - it’s a nasty drug. I didn’t have much bleeding. The second week, I physically miscarried what was left inside - like a bad period. Since, I’ve had on and off spotting and bleeding that still seems to be going on even now, but less and less.
I struggled to find credible advice on what to do, so I cannot give you my advice and say ‘this is the right thing to do’, only that what I did seemed to work for me and some other women on other forums that suggested the ideas - but also, unfortunately this doesn’t happen overnight and will take time for your body to deal with, so you will have to be as patient as you can, even though I know how hard it is when you want it all to be over.
On the weeks I applied these strategies, my levels plummeted the most:
Firstly, I cut out my pregnancy supplement on day 0, as was advised. But when my levels didn’t go down much, I took a keen look at my diet - annoyingly, most foods contain, or are enriched with folate. I cut everything out. It’s definitely not good for your body, but I basically had a junk food diet (not as yummy as it sounds!) for a couple weeks, to ensure that as little folate as possible entered my body and counteracted the methotrexate. Even eating a diet beforehand that wasn’t particularly folate rich (i.e. I cut out the things recommended when you’re pregnant like brocoli and eggs), I was getting several times my daily recommended allowance through i.e. cereals and orange juice. Eating too much folate stops the methotrexate working. So that’s definitely an idea to examine, though how far you take it is up to you. I took it to the extreme, to the point I made myself ill denying myself a balanced diet, because I was so desperate for it all to be over… I wouldn’t recommend that. Just be sensible, and cut out things that are folate rich you may not have realised you were eating…
Secondly, my next biggest % drop happened when I started drinking green tea. It’s full of good things, but you’re not recommended it when pregnant, because, as I discovered, it lowers folate absorption which is bad for the baby. Well, that was perfect for me then. I drank a cup or two a day and my levels dropped hugely again.
Who knows if it’s coincidence, or something more - I hope the latter. I looked at the medical evidence that was there, examined my lifestyle, and found changes to make - they worked for me.
I really hope this helps. 
I am in week 9 right now after the injection and my latest HCG was 84. I have had a consistent drop of 50% each week.
During week 5 I had heavy bleeding with severe cramps. I had spotting that ranged from light to heavy for the next 4 weeks.
I keep reading that everyone is different so there is really no “normal” but I believe that mine seems to be taking longer than others.