Remaining questions after ectopic (expectant management)

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I’ve used this forum once before and thought it immensely helpful and enlightening, so I’m using it again with the hope of gaining some knowledge about the state of the reproductive system after ectopic pregnancy (through expectant management). I didn’t have the chance to ask these questions when receiving my diagnosis as my head was too clouded to think this far into the future. I am also aware of the incomparable value of receiving advice from a doctor as opposed to advice from online. I will be seeking medical support but in the meantime I’m just seeking ballpark knowledge of the questions I will be posing. I went the expectant management route and was able to keep my left tube (the location of the pregnancy) and I’ve since had a negative pregnancy test. The doctor did not mention that the ectopic pregnancy was caused by an existing blockage; if anything she put it more down to bad luck. I also do not smoke and have had no (known) history of pelvic infections or issues with inflammation.

  1. Upon receiving my diagnosis, the doctor said the tube is understandably damaged. Is this damage permanent or can the tube heal on its own and return to a relatively normal state? Can this ectopic pregnancy have caused blockages and how will I know if it has? If there are blockages/damages, does this render the tube useless in terms of conceiving with it?

  2. I had the negative test about a month ago, yet still experience the occasional twinge on my lower left side. Could this be due to healing/scarring or infection? Or could it simply be in my head since I became so used to living with the pressure and mild pain during the recovery process.

I’ve found a dearth of information on the state of the reproductive system after ectopic pregnancy without having had surgery or methotrexate, so I hope someone is able to shed some light on these issues. Again, I do not undermine the value of speaking to a doctor about this and how it ties to my specific situation. Thank you in advance

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Just a small add-on, I also started taking the pill (Rigevidon) about a week ago after my first period finished. Yet since taking it I’ve been experiencing significant mood swings, with many of my dips in mood resembling how I felt when I was still enduring the pregnancy. I never had issues before my tubal pregnancy when it came to taking the pill - is this a common experience with contraception after ectopic pregnancy?

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Hi Millie_457,

I am sorry you have to go through this. I actually experienced something very similar to you. I was diagnosed with an ectopic pregnancy in my left tube in March and was managed expectantly. Apart from being over 35 years old, I have none of the other risk factors and my doctor also said that my case was probably just bad luck. I can try and give you an idea of what I experienced to give you some answers to your questions. As I am not a doctor, what I will say is only based on my own experience and what I’ve read with the idea in mind that all women will experience this differently.

To answer your first question, my understanding is that because the tube is not designed to have anything implanted in it, having a fertilised egg implanting in it will cause some damage. If the tube is not removed, the dead tissues should be reabsorbed by the body. However, even if everything is reabsorbed and the tube is clear, there is still a possibility that the cilla (little hairs that helps move the egg down the tube to the uterus) are damaged and no longer able to do its job which increased your risk of another ectopic. But it is already known that once you’ve had an ectopic, the risk increases from 1% to 10%. Some people believe that by keeping the ‘damaged’ tube, you increase your risk of another ectopic. But there is no evidence to support that. Your risk of another ectopic remains 10% regardless of the treatment you received, whether you remove that damaged tube or not. In other words, your chance of a healthy pregnancy is 90% regardless of your treatment.

I have read some informal accounts from women whose mass was never fully reabsorbed despite several months after reaching HCG 0 so they still had to remove the tube as it would increase further the risk of a repeat ectopic.

Some women get their tube checked to make sure there is no blockage. There are different procedures that consist of sending a liquid up your uterus and if the liquid flows through your tube, you know it’s not blocked. I was tempted to do it but it’s not something offered by the NHS (I’m from the UK) and I actually read that it can lead to complications such as pelvis inflammatory disease or can make your tube appear blocked if your uterus contract too much or something like that. So instead of paying over £1000 for that test, I decided to just leave it and hope for the best next time. Moreover, I had a 6 weeks follow up with a scan and my doctor said that the mass has completely gone so technically, my tube is clear.

If the tube is blocked, it probably means that you won’t be able to conceive with it as the fertilised egg wouldn’t be able to meet the sperm and move to the uterus. But then, I’m not a doctor so I can’t say for sure.

I hope all of this makes sense.

And to answer your second question, since the ectopic, I still experience twinges on my left side and sometimes my right side. I read on this website that it may be ovulation pain or just me being so aware of any twinge or pinching in my pelvis that I have become almost over sensitive and can feel absolutely everything which is completely normal. I did tell my doctor and she didn’t seem that concerned. I don’t think it’s in your head and it’s hard to say if it’s normal or not. So if in doubt, I’d definitely say go to your doctor.

I am not currently on the pill and I find that my moods are very fluctuating still. It has been a couple of months now since my ectopic resolved but I still have a lot of mood swings. I broke down in tears in front of my boss the other day and it was very unexpected… and embarrassing. I am still recovering from the trauma so I need to give myself a break. I hope you’re also taking good care of yourself.

I hope this gives you some answers and prepares you for when you meet your doctor. Good luck x