Dear Nikki,
I am so sorry to hear of your ectopic pregnancy and loss.
When we experience ectopic pregnancy we are suddenly faced with a life threatening emergency and it’s treatment, reduction in fertility, concerns about the future and the loss of our babies. Experiencing any one of these is an ordeal, putting them together is immense and your feelings are completely normal.
I too bled heavily following my methotraxate injection. I found it got lighter and then for some reason, just a my hCG levels were getting towards 5, I experienced another heavy bleed and like you was told this was normal.
The bleeding occur as once the beta hCG levels (pregnancy hormones) in your body have dropped, the chemical signals to retain the thickened uterine lining that has built up in preparation for pregnancy, are no longer being produced and so the lining of the uterus is shed. The process involves vaginal bleeding and the material may be clotty, heavy, dark in appearance or appear just like one of your normal period bleeds.
The length of time anyone bleeds varies from woman to woman greatly, as the bleeding is from the lining of the womb and is hormonally controlled. It will probably last a week or two, changing in colour from red to brown and diminishing. Some women report bleeding and spotting for up to six weeks.
Providing you aren’t soaking a pad in less than an hour or the pain is so severe you can’t manage it with over the counter pain relief, such as paracetamol, you should not worry. If you have any concerns, you should seek reassessment.
As a gentle reminder regarding trying to conceive following methotrexate injections, regardless if you have had one or two doses of methotraxate, you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement for 12 weeks before you try to conceive. This is because the Methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The Methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as hare lip, cleft palate, or even spina bifida or other NT defects. This is why the “wait” and then taking folic acid for 12 weeks before trying to conceive is so important.
I completely understand how you feel about trying again. We experience a mix of emotions from wanting to try again to being petrified of what may lie ahead. Generally the chances of a further ectopic after a first in UK is 10%. So thats 90% chance of the embryo being in right place next time.
Importantly early scans avail. As soon as you know you are pregnant, contact your local EPU to inform them and book in for an early scan at around six weeks. Remind them of your previous ectopic pregnancy. This self refer route is the best route in our view. Hopefully you will have some comfort to know you are under the radar of medical professionals right away.
As a side note, I was also treated with methotraxate and went on to have two successful pregnancies, don’t give up hope.
Sending much love,
Karen x
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