Pain after MTX in tube TTC

Preparing For Your Next Pregnancy
1

Hi, I got the all clear that my HCG levels had returned to below 5 12 weeks ago after an ectopic in my right tube. I had 2 doses of mtx and they said I could try in 5 months. Well 6 months is 8 weeks away! However since then I’ve been experiencing pain on the ectopic site during my period and ovulation. My periods seemed to have settled and returned to a normal flow but the pain is bothering me as I wonder if something is there. I called the GP ans asked for a HSG but they are saying it’s too soon im probably still bruised inside.

Thing is im nearly 41 and don’t want to wait longer than I have to.

How long can I expect this pain to last for? At what point is it worth Investigating? Is this normal 3 months down the line? Should we try when it’s time if im still experiencing pain or go private for a HSG or something? The GP said wait 6 months for pain to pass!

Has anyone gone private for a HSG test to check tubes?

Any advice most welcome xx

2

Dear Nat81,

I am so sorry to hear of your ectopic pregnancy and loss,

I also experienced pains when I hadn’t prior to ectopic pregnancy, this is quite common. As you have stated the pain can commonly be felt when our bodies may be preparing to ovulate and many women experience ovulation pain when they did not before their ectopic pregnancy - including myself. You also may have a heightened perception because of the sad loss that you have had to go through.

I never found a reason for my pains but I had them right up until I next fell pregnant (which was a successful pregnancy). I was offered a hsg test to find the cause of my pain, but I fell pregnant before I could have The test completed.

Whilst I always advocate sticking to medical advice, I also wonder if there was a reason your doctors advised to wait for 6 months before trying to conceive following methotrexate. Some doctors (mistakenly) think that because they have administered a second dose of Methotrexate that that they must also double the recovery time for the body. However, even in a second dose of Methotrexate, the dosage is still much lower than for treatment of other conditions and is still metabolised by the body very quickly. We usually advise waiting until your hCG levels have fallen to below 5mIU/mL and then take a folic acid supplement for 12 weeks before you try to conceive, regardless of it one or 2 doses, so I would ask the question to your doctor.

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

3

Thanks for your reply Karen. It’s reassuring to hear that this might be common and not a cause for concern and it’s also nice to hear you were offered a HSG. Although I still find it frustrating they will not consider this for me at this stage.

I’m regards to the 6 months I think we have touched on this before and either yourself or one of the other ladies sent me the NICE guidelines. Basically EPAU said that I have to wait 6 months after 2 doses or there’s a risk any new pregnancies will have birth defects and affected by the MTX. One of the sisters on the ward was very clear about this as were the consultants. When I got the phone call from the nurse and was officially discharged with levels below 5, I did challenge this in a polite way and said to her I’d read the nice guidelines and spoken to the ectopic trust and I did get a weird response which wasn’t an outright “the medical evidence says 6 months” it seemed more of an “airing on the side of caution after 2 doses”

It’s pretty frustrating. I’ve also tried to research this and know I’m not alone in getting this advice. It puts me in a difficult situation as I’m scared to try again if something bad happens to a future pregnancy but equally I am at the right time and have taken the folic acids for 3 months nearly now too so would like to try soon.

I know the ectopic trust is partnered with kings so I do trust what you are saying but you can imagine my fear when that’s what my doctors have said!

4

Dear Nat,

I absolutely understand your worries.

Ultimately the decision has to be one that you are comfortable with, and we would support you in which ever decision you make.

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

There was some more paint his week and I passed some what looked like small amounts of tissue like blood. I called the doctor and got a nurses appointment who says she’ll send me for an ultrasound. I explained that the trans vaginal ultrasounds I had throughout my ectopic experience weren’t successful in locating the pregnancy for about 4 weeks and I really felt that a HSG was needed but there was reluctantance as I needed to be refered to gynea.

I left in tears. I really feel like the pain and now this weird bleed is related ans I just want someone to check the health of my tubes or tube. I feel really upset about it all

6

Dear Nat,

I am sorry to hear that you are still struggling.

Is it possible that this bleed was your first period following surgery? As they can certainly be heavier than we have experienced before.

Unfortunately I am not medically trained, but as I understand it, they may wish to complete an ultrasound to also look at you womb and any obvious blockages if you are still bleeding rather than the patency of your tubes, to try and check a reason for your heavy bleeding.

I have taken this information from our website about HCG testing, as I was under the understanding that they preferred not to complete testing so close to ectopic pregnancy due to the increased chance of infection.

Doctors prefer not to use a tubal patency test unless they really need to because it is not a 100% accurate test. For example, if the Fallopian tubes go into spasm during the test they can appear blocked even though this is not the case. The test can also not determine what the internal villi of the Fallopian tube look like. Furthermore, it is an invasive test and there is a small (1%) chance that it can cause infection of the Fallopian tubes hence their preference to only perform the test when it is unquestionably required.

When an ectopic pregnancy is treated, the remaining Fallopian tube is typically examined externally and the doctors would usually have told you if they had seen any problems with it at that time. If you would like peace of mind about this you could ask for a post-operative follow up appointment to ask whether they had looked at the condition of your Fallopian tubes during the operation. You can also request a copy of your medical notes for your operation.

The examination is a pretty good indicator about the condition of your remaining Fallopian tube(s) because it looks at:

*The fimbriae – The Fallopian tubes are not attached to the ovaries and, at the point of ovulation, some very delicate structures called the fimbriae begin to move gently creating a slight vacuum to suck the egg toward the end of the Fallopian tube it is nearest to (like lots of little fingers waving and drawing the egg towards it).

*Whether there are any adhesions (scar tissue)

*Whether there is any thickening of the Fallopian tube

*The shape of the Fallopian tube

If the bleeding or pain continues, I would advise speaking to your medical team again.

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

7

Thanks Karen, no it seemed to be a weird one off bleed outside of my cycle. I was treated with MTX 2 doses so I’ve had 3 periods already which have followed a default pattern albeit heavier. The last seemed to have calmed down back to normal. Today I’m a week early and started my period. This is also really unlike me as I’m so regular. Even after the exptopix I went straight back to a normal cycle so this is also worrying. I guess all I can do is wait for the ultrasound and then see what happens from there. Thank you for the information so far.

8

I also got various pains (including near ovary/tube location, mostly on ectopic side but also the other side) after my MTX treatment.

I didn’t end up having any further tests other than a regular ultrasound so not sure if anything wrong but I assume not.

The bleeding sounds more concerning, I hope you get some answers.