No period after methotrexate

Hi there

I had an ectopic pregnancy in mid October 2024. I was given one dose of methotrexate to resolve the pregnancy. After a bumpy ride and ending up on A&E, I was discharged from the EPU mid November when my hCG was under 15. I bled throughout the ectopic and until a few days after my hCG was 0.

It’s now been over three months since I had the methotrexate and 10 weeks since I was discharged but I still haven’t had my period. Did anyone else experience this and their period taking so long to return to normal? Is it something I should be worried about?

Just looking for reassurance that my period will return as we’re desperate to start trying again but are following guidance on waiting three months for the methotrexate to leave my body and two period. Trying to be patient with my body!

Hi Julie,

Your menstrual periods after an ectopic pregnancy can take a while to re-establish.

They can restart any time between four and ten weeks after treatment. Most find that their first period arrives sometime around week six or seven after surgery, or, if treated without surgery, at some time in the four weeks after their hCG levels have fallen to below 100 mIU/mL. According to a study for women who had methotrexate treatment for an ectopic pregnancy in a Fallopian tube, periods generally return to normal after an average of 24 days (range of 24–38 days) from the pregnancy ending.

Before you can have a period, ovulation needs to occur. It is perfectly possible to ovulate 14 days after surgical treatment and almost as soon with methotrexate treatment. It is important to be aware that it is possible to become pregnant even without having the first period if you are not using some form of contraception when having sexual intercourse.

If the first day of your last period was more than 42 days ago, make an appointment with your doctor to discuss the possible reasons for this. Your doctors may also discuss periods returning at a follow-up appointment.

The first period may be more painful or less so than usual, heavier or lighter, and last for longer or shorter than usual – there really is no set pattern. You should be able to manage the discomfort with over-the-counter (OTC) pain relief medications and should not be soaking a pad in less than an hour. If this is not the case, you should seek medical advice.

With good wishes,

Michele

The Ectopic Pregnancy Trust

Registered Charity Number: 1071811

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


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