Methotrexate symptoms

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1

Hi all,

I was diagnosed with a cervical ectopic pregnancy (which I hear is extremely rare). The doctors administered a methotrexate injection last Monday.

I had no symptoms on the Monday but some nausea and sickness on days 2 and 3. I had no bleeding, just a bit of spotting. My blood tests on day 4 (Friday) showed some increased hcg levels and then on Sunday I started bleeding bright red blood. I had my day 7 bloods yesterday and was told my levels hadn’t decreased as much as they would like (they are down to 3762) and so I would need a second dose.

I’ve woken up this morning and the blood on my pad is very red and there’s quite a bit of it. Is this normal? I’m on day 8 after my first dose but my hcg levels still seem quite high so I’m not sure whether this is my lining coming away at this stage. I have no pain.

Would love to hear if anyone else has had a similar experience or going through a similar experience.

Thanks in advance.

2

Dear Anon,

I am so sorry to hear of your ectopic pregnancy loss, you are right in that cervical ectopic pregnancies are rare which sadly means there is little evidence surrounding them.

Bleeding following methotrexate is normal and it can be bright red like a period. Unfortunately we are not able to provide personalised medical advice so If you are concerned about the bleeding, do not hesitate to speak to your EPU or medical team.

If you are needing to change sanitary wear every half an our or less, we would class this as heavy bleeding and would advise seeking urgent medical advice. Similarly seek advice with any worsening tummy pain or you develop shoulder tip pain or feel dizzy and unwell.

We have more information on methotrexate treatment on our website which I have added here which you may find helpful

https://ectopic.org.uk/treating-an-ectopic-pregnancy

I hope your levels start to fall, please continue to lean on us for as long as you need,

Sending much love,

Karen x

The Ectopic Pregnancy Trust

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3

Hi, I had practically no symptoms or bleeding until very late on.

My levels went up on day 4 and down by only 3% on day 7. By day 10 they dropped 30%. After this I bled and had cramping until I reached 7 and was discharged.

Did you have the second dose?

4

Hi,

Many thanks for your response. Yes I had to have a second dose of the methotrexate, which was administered on the Tuesday. I was bleeding at the time, but not enough to soak through a pad an hour or anything like that, it was just a lot more red and heavy than what I had previously been used to. Felt like a period, but I know it can’t be that. The bleeding has pretty much stopped now - I am down to brown spotting, which is where I was at before the bright red bleeding randomly started. The symptoms have also passed now - I had really bad nausea and sickness for a couple of days after the second dose, but was fine by Friday.

Went in for my bloods on Saturday and am due in again on Tuesday for my day 7 bloods following the second dose. Really praying the levels have come down a lot more as I don’t fancy a third dose of the methotrexate. The doctors don’t seem too keen on surgery for myself due to the location of the pregnancy and the risk of bleeding, but I didn’t realise you could be given three doses of the methotrexate injection as everything I’ve read is more two doses as a maximum.

But I do appreciate my case is rare and there is no set procedure like with the tubal ectopics.

May I ask for more details on your experience if possible please? Did you need a second dose of the injection and how has your experience been?

5

Hi,

Many thanks for your response. Yes I had to have a second dose of the methotrexate, which was administered on the Tuesday. I was bleeding at the time, but not enough to soak through a pad an hour or anything like that, it was just a lot more red and heavy than what I had previously been used to. Felt like a period, but I know it can’t be that. The bleeding has pretty much stopped now - I am down to brown spotting, which is where I was at before the bright red bleeding randomly started. The symptoms have also passed now - I had really bad nausea and sickness for a couple of days after the second dose, but was fine by Friday.

Went in for my bloods on Saturday and am due in again on Tuesday for my day 7 bloods following the second dose. Really praying the levels have come down a lot more as I don’t fancy a third dose of the methotrexate. The doctors don’t seem too keen on surgery for myself due to the location of the pregnancy and the risk of bleeding, but I didn’t realise you could be given three doses of the methotrexate injection as everything I’ve read is more two doses as a maximum.

But I do appreciate my case is rare and there is no set procedure like with the tubal ectopics.

May I ask for more details on your experience if possible please? Did you need a second dose of the injection and how has your experience been?

Headspace2020:
Hi, I had practically no symptoms or bleeding until very late on.

My levels went up on day 4 and down by only 3% on day 7. By day 10 they dropped 30%. After this I bled and had cramping until I reached 7 and was discharged.

Did you have the second dose?

6

Hi, how did your bloods go today?

I didn’t have the second shot as I went home to think about that or surgery and when I returned for the second shot (day 9 I think it was) my hormone had dropped 30% so I didn’t need the second one.

I really had hardly any symptoms right until the end when my hormone dropped so low I was then able to bleed (like a period but not apparently - cramping etc).

I had some tiredness but not much else tbh.

I hope you’re doing ok and your hormone finally coming down x

7

May also be important to say I had what appeared to be a miscarriage at week 6 (hence having scans at EPAU) so I’m confident that I had already passed a lot of the lining before the MTX shot which coincides with me not bleeding at all after the MTX.

I’ve seen a lot of people say the same re the lack of bleeding I don’t think it matters too much as when your hormone drops right down you’ll have a period like bleed then and that should pass everything x

8

Hi, my last two blood results were a lot better thank you! Had a massive drop to 1498 following the second injection and then the day 7 results showed levels of 980. I’ve been in again today for another test, but won’t get those results until at least tomorrow so hoping the levels have come down even further again. I’m not sure how long it’s supposed to take for the levels to go completely down but it seems to be quite a slow process?

I also had the same thing as you where I had a couple of days at about week 7 or 8 where I had a lot of pain and passed some tissue and I believed this to be a miscarriage but my test results confirmed this wasn’t the case as my levels were so high and when the doctor checked my cervix she said it was closed and it wasn’t likely that any further tissue would be passed, hence the need for the injections.

My bleeding seems to have completely stopped now so I feel like I am just waiting for my next period now? Everything just seems so strange with my body and I just want it to go back to normal now. Do you know if you get scanned again to check what’s happening, or whether it’s just blood tests? I feel like I would quite like to know what’s going in my cervix visually but I don’t know if this is normal procedure x