Medical Treatments for an Ectopic Pregnancy
Dr. Gleaton lays out the cause, symptoms, and other factors that contribute to ectopic pregnancies, as well as what treatments are available.
By OBGYN and fertility expert Dr. Kenosha Gleaton
Ectopic pregnancies are rare, occurring in about 1-2% of pregnancies in the US, but they can happen to anybody. While recent national data is lacking, we still know some common symptoms and risk factors of ectopic pregnancies, as well as how to treat them.
What’s an ectopic pregnancy?
An ectopic pregnancy refers to a fertilized egg implanting itself outside of the womb, most often in one of the fallopian tubes (in about 90% of ectopic pregnancies). If you need a refresher, the fallopian tubes connect the ovaries to the uterus and provide a passageway for eggs to travel. Sometimes an egg will get stuck in the fallopian tube and implant itself, causing an ectopic pregnancy. When this occurs, it’s impossible for the fetus to grow without rupturing the fallopian tube, causing major bleeding and resulting in a life-threatening emergency. When an ectopic pregnancy is found, it must be removed using surgery or medication.
Symptoms of an ectopic pregnancy
In order to diagnose an ectopic pregnancy, an ultrasound will be done to determine where the pregnancy is developing. At first, an ectopic pregnancy is likely to feel like a typical pregnancy with some common symptoms such as a missed menstrual period, tender breasts, or nausea. Symptoms specific to ectopic pregnancy typically develop around four to 12 weeks. Other symptoms may include:
- Abnormal vaginal bleeding
- Low back pain
- Abdomen or pelvic pain, including cramping on one side
More symptoms may develop as an ectopic pregnancy grows, including a ruptured fallopian tube. Symptoms may include:
- Severe and sudden pain in the abdomen or pelvis
- Shoulder pain
- Weakness, dizziness, or fainting
Symptoms of a ruptured fallopian tube can indicate a life-threatening emergency and anyone showing these symptoms should go to the emergency room immediately.
Medical treatment for ectopic pregnancy
Treating an ectopic pregnancy is done using medication or surgery. Whatever method is used will still require several weeks of recovery and follow up with your doctor.
- Medication: The most common drug used to treat ectopic pregnancy is methotrexate. This drug ends the pregnancy by stopping the cells from growing any further. The body then absorbs the pregnancy over the following four to six weeks. With successful use of methotrexate, there is no need for surgery of any kind. A woman is only able to use methotrexate if the fallopian tube has not been ruptured, has the ability to follow up regularly with blood tests, and isn’t currently breastfeeding or living with certain health problems.
- Surgery: Surgery may be necessary for treating an ectopic pregnancy in some circumstances, or if a fallopian tube has ruptured due to the pregnancy. In these cases, the ectopic pregnancy can be removed from the tube, or the entire tube with the pregnancy can be removed. This surgery is performed laparoscopically, meaning a small camera and tools are inserted into the abdomen while the patient is under anesthesia.
There are some risks to be aware of when treating an ectopic pregnancy.
When taking oral medications, it’s normal to experience:
- Abdominal cramping and pain
- Vaginal bleeding or spotting
- Upset stomach
As with all surgery, there are some risks, including:
- Pain or swelling
- Loss of fallopian tube(s)
If taking methotrexate, the following should be avoided:
- Sexual intercourse
- Intense exercise
- Vitamins or foods containing folic acid
- Certain medications such as NSAIDs and prescription pain medications
- Prolonged sun exposure
Risks of ectopic pregnancy
An ectopic pregnancy can happen to anyone, but there are some risk factors to be aware of, such as:
- A previous ectopic pregnancy
- Certain sexually transmitted infections (STIs)
- Pelvic inflammatory disease (PID)
- History of fallopian tube surgery, pelvic, or abdominal surgery
- Cigarette smoking
- Age older than 35 years
- History of infertility
- Use of assisted reproductive technology, such as in vitro fertilization (IVF)
About one half of all women who have an ectopic pregnancy do not have known risk factors. Sexually active women should be alert to changes in their bodies, especially if they experience symptoms of an ectopic pregnancy.
Trends in occurrence of ectopic pregnancy
In the United States, ectopic pregnancies occur in about 1% to 2% of pregnancies and a ruptured ectopic pregnancy makes up 2.7% of pregnancy-related deaths.
When observing trends early on during the COVID-19 pandemic, one health center found that the rate of ruptured tubal ectopic pregnancies in their emergency department increased significantly. Another retrospective study found that the number of ruptured ectopic pregnancies was significantly higher during the lockdown period of the pandemic, and a large number of patients had to undergo emergency surgery. Researchers state this increase is also related to an increased use of emergency contraceptives, medical abortion pills, failed abortions, and poor healthcare accessibility. These findings highlight the importance of accessible reproductive healthcare and regular checkups when TTC or pregnant.
How laws affect access to ectopic pregnancy treatments
With the current political climate and recent discussion of the Supreme Court’s draft opinion, many are questioning how laws may affect the management of ectopic pregnancies. As established, ectopic pregnancies can not be reimplanted into the uterus or saved, and must be treated immediately with surgery or medication. The truth is that the language in these laws tends to be rather vague, causing confusion and fear for patients and providers when determining a course of action.
Many abortion restriction bills have some provisions that would allow medical intervention in order to save the life of the mother, in which case, an ectopic pregnancy would fit this criteria. A specific example can be seen in Texas’ anti-abortion legislation, in which there are exceptions for ectopic pregnancies.
Unfortunately, providers and patients can still run into an issue when attempting to treat an ectopic pregnancy or miscarriage if using medication such as methotrexate or misoprostol. As discussed previously, medications are helpful for stopping the growth of cells and ensuring all tissue is expelled or absorbed by the body. These medications are also prescribed for abortions, including elective abortions.
An NPR report discussed the confusion around who is able to pick up this medication, as pharmacy staff may be reluctant to hand it out to patients in fear of fines or retaliation.
Anti-abortion laws have the ability to magnify health equity issues and create more barriers to healthcare with vague language. Natalist stands by the American College of Obstetricians and Gynecologists (ACOG) and American Society for Reproductive Medicine (ASRM) on this issue and firmly believe all medical care decisions should be based on conversations between a patient and medical provider
Support resources after ectopic pregnancy
If you or someone you know has experienced an ectopic pregnancy, counseling may be helpful. Pregnancy loss, including ectopic pregnancies, can be very traumatic and may feel very isolating. It’s important to connect with the appropriate resources, such as counseling, online forums, and spending time with family and friends.
- Ectopic pregnancies are rare and occur in about 1-2% of pregnancies.
- An ectopic pregnancy refers to a fertilized egg implanting itself outside of the womb, most often in one of the fallopian tube.
- Ectopic pregnancies can not be reimplanted into the uterus or saved, and must be treated immediately with surgery or medication.
- Symptoms mirror that of a normal pregnancy, but a ruptured fallopian tube may result in dizziness, severe abdominal pain, and vaginal bleeding.
- Some ectopic pregnancies are treated with medication that stops the cells from growing, allowing the body to absorb the pregnancy.
- In some cases, surgery may be necessary to remove all pregnancy tissue or remove or repair a fallopian tube.
- Risks include previous ectopic pregnancies, PID, endometriosis, and more.
- Access to reproductive health care is extremely important and necessary. Delayed care for an ectopic pregnancy can be life threatening. \