Methotrexate follow up - help

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I’m (hopefully) coming to the end of treating an ectopic with Methotrexate. Two doses. It’s been horrible. The headaches are still bad, the tiredness is awful and I feel meh most the time.
If I knew then, what I know now, I feel like I might have chosen surgery. But who knows…with that came IVF only as we lost the other tube to an ectopic already. I have felt at my lowest points and emotionally it’s been hard. I feel like I am getting my sanity back now, but I’d really like to get on with life and sort my mental health out. This will be by exercising and by going away (hopefully) on a holiday that was booked before all this and is on the 18th may (which I won’t go on if there’s risk…cause it’s an island in middle of nowhere and if something happens… game over I imagine…who knows…).

So my big question…what advise have you all been given about what happens when levels go below 25 and you are considered non-pregnant?

Can you exercise straight off the bat?

Does it no longer matter about being close to a hospital?
(For context…I live 50 mins drive from a hospital and ambulances do not get here quicker than 30 mins, usually an hour EVEN for major blue light situations. For this reason, I was admitted for five days to have the first dose and again when that didn’t work on Day 7 for three nights. So we really have understood the dangers of being away from hospital.

But what we can’t make sense of is these statements, that have all been made to us by consultants / GPs etc…but seem to contradict each other…

  1. When HCG is zero, go about your life. Exercise, have sex, go running, rowing etc…live as you did before

  2. Right now. Don’t exercise, even lightly, short walks is ok, but nothing else until your levels are below 5. Because there remains a risk of rupture even if levels are falling. This is the same even if the ectopic is small and not growing as the mass is still there.

  3. We don’t routinely scan at the end when levels are less than five because you can be “non pregnant” and the ectopic still be there…

So …how is possible that one day the risk of rupture is there, and then suddenly it’s not even if the ectopic is still there???
If my ectopic hasn’t grown since the beginning and hasn’t ruptured in a month, but is still a risk now with 48HCG, how is it suddenly not if <25hcg but still there the same size as the day before at say 27hcg???

I’m SO over the ridiculous anxiety and being terrified all the time ..every change in pain…bloods etc… today again, it is hitting me when I move, step forwards etc…and bright red blood back …but the bleeding has gone from period, to brown discharge, to nothing, to bright red, to nothing, to streaky…so it’s always changing and the pain changes a lot. Sometimes nothing, then a tweak. Sometimes more…
I feel like I don’t trust my body any more and I just want out. But like I’m so close…

How does the risk change at <25 HCG? Why does it? And is it gone even if your ectopic stays there?

Thanks so much and so sorry to everyone on this journey.

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Dear Esterr,
I am so sorry to hear of your ectopic pregnancy losses. To experience one loss is difficult, dealing with multiple losses is heartbreaking and i completely understand your worry about everything.
The problem is that doctors can’t say there is no risk of rupture until your hCG is at pre pregnancy levels. We class this as below 5. There does remain a risk even at declining and low levels, but I have never known anyone rupture under 25 and i’m guessing your medical team hasn’t either. They just can’t say that for definite and so, are exercising caution.
It is not common to re-scan. The thought is that once hCG levels are below 5, you need to take folic acid supplements of 12 weeks before trying to conceive and this 12week time frame gives time for any masses to be reabsorbed.
I would start with gentle exercise and build up, you’ll be surprised at your fatigue and reduced conditioning in this time.if you are used to heavy exercise. Again, we at the, trust advise this when levels are below 5. You can now however enjoy gentle walks and anything that does not increase your intra-abdominal pressure.
I hope this helps, we will be here for you for as long as you need,
Best wishes,
Karen x

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