Ectopic Pregnancy: Symptoms, Causes, Diagnosis and Treatment
It may be a difficult subject to approach, especially if you have been hoping to become pregnant for a long time, but you must be able to recognise ectopic pregnancy symptoms and signs when they present themselves. Below, we have provided a guide on everything you will need to know about ectopic pregnancies, their symptoms and signs, why they can happen, and how you might be diagnosed and treated.
Read on to learn more, or speak with one of our friendly team members to book a consultation with a fertility specialist today.
What is an Ectopic Pregnancy?
An ectopic pregnancy is a pregnancy that takes place outside of a patient’s uterus. This means that the fertilised egg does not reach the womb and instead implants itself in part of the reproductive system that cannot support its growth. Usually, this will be one of the patient’s fallopian tubes, in which case it can also be called a “tubal pregnancy”. In rare cases, it is even possible for an ectopic pregnancy to occur in an ovary or the abdominal cavity.
Unfortunately, ectopic pregnancies are not viable and they are not possible to save. Instead, they are considered a miscarriage and should be treated as soon as they are diagnosed. This is because they can be life-threatening if the egg is allowed to develop.
What are the Symptoms of an Ectopic Pregnancy?
Ectopic pregnancy symptoms are not always obvious, and not every ectopic pregnancy will have symptoms. If you do experience symptoms, they will most usually be a combination of:
- Abdominal pain, particularly low down and on one side of your body
- Diarrhoea or frequent bowel movements
- Discomfort when using the toilet (either urinating or bowel movements)
- Dizziness or weakness
- Missed periods, or other signs of pregnancy
- Vaginal bleeding (this will often look different to normal blood; it will often be brown and watery and may stop and start)
It is also important to note that having one of these symptoms doesn’t necessarily make it a sign of an ectopic pregnancy. For many people, they will be caused by something such as a stomach bug or virus.
If you have a ruptured fallopian tube as a result of an ectopic pregnancy, you may also experience the following further signs:
- A very pale complexion
- Hypotension (low blood pressure)
- Nausea or feeling sick
- Shoulder pain (particularly in the tip of your shoulder; this is a sign of internal bleeding)
- Rectal pressure
At the point the fallopian tube becomes ruptured (the moment it bursts), you may also feel a sharp pain in your lower abdomen. This is also when the condition becomes an immediate medical emergency, so you must contact your doctor or healthcare provider or seek immediate assistance at your nearest hospital.
When do Ectopic Pregnancy Symptoms Start?
If an ectopic pregnancy produces symptoms, these are likely to develop in early pregnancy, between the 4th and the 12th-week. However, it is strongly recommended that you do not rely on symptoms presenting themselves, as many patients will not get them until an early scan shows that there is a problem, or even later on when the effects become more serious.
When to Seek Medical Advice
You must contact your GP or ask for advice from NHS 111 if you have a combination of any of the symptoms we have described and believe that you may be pregnant. Even if you haven’t had a positive pregnancy test, this does not mean that you are not experiencing an ectopic pregnancy.
Your doctor should ask you about your symptoms and will normally require you to take a pregnancy test to determine if you are having an ectopic pregnancy or not. Depending on the results, they may then refer you to a specialist early pregnancy clinic for further assessment. At this time, an ultrasound scan and blood tests may also be carried out to confirm a diagnosis.
What are the Causes of Ectopic Pregnancy?
For many patients, the cause of their ectopic pregnancy will not be clear, but the most common causes are usually related to the fallopian tubes being narrow or blocked. As a result of either of these, an egg cell can become trapped and be prevented from reaching the womb.
An imbalance in a patient’s hormone levels or abnormal development in the fertilised egg may also be causes of ectopic pregnancies, although they are not as common as issues with the fallopian tubes.
What are the Risk Factors Involved in Ectopic Pregnancy?
Several factors could increase the risk of developing an ectopic pregnancy:
- Being between the ages of 35 and 40
- Having a history of infertility
- Having a history of pelvic inflammatory disease (PID)
- Having a history of smoking
- Having an intrauterine device (IUD) or intrauterine system (IUS) in place at the time of conception
- Having endometriosis
- Having had a previous ectopic pregnancy
- Having had surgery on your fallopian tubes (including having a tubal ligation, which is also known as having your tubes tied)
- Having sexually transmitted infections or diseases (STIs or STDs)
- Having treatment for infertility using in vitro fertilisation (IVF; this risk is very rare)
Preventing an Ectopic Pregnancy
Unfortunately, it isn’t possible to prevent ectopic pregnancies from happening. It is, however, possible to reduce the risk of one developing. Ways that you can help to prevent an ectopic pregnancy include:
- Maintaining a healthy lifestyle and diet (including balanced meals and regular exercise)
- Stopping smoking
- Using a condom to prevent STIs and STDs
Diagnosing an Ectopic Pregnancy
It can be difficult to diagnose an ectopic pregnancy, but if you talk to your doctor and they carry out an examination and offer you a pregnancy test, you may then be referred to a specialist early pregnancy clinic. These clinics will then carry out further testing, usually in the form of:
A transvaginal ultrasound scan will often show whether or not a fertilised egg has become implanted in a patient’s fallopian tubes, though it may occasionally be difficult to spot this. The procedure works by inserting a probe into the patient’s vagina. Once inserted, the probe will emit sound waves that bounce back to create an image of the patient’s reproductive system.
The probe is so small that it will not require an anaesthetic.
Blood tests that measure the hormone human chorionic gonadotropin (hCG) may also be used to help diagnose an ectopic pregnancy, especially one that wasn’t found during an ultrasound scan. HCG levels tend to be lower and rise more slowly during an ectopic pregnancy than they would during a normal pregnancy, meaning that two hCG tests taken 48 hours apart can often determine if the levels are changing as they should over time.
The results of these blood tests can also help to determine the best method of treatment for a patient’s ectopic pregnancy.
In the unlikely event that it still isn’t possible to determine whether or not a patient has an ectopic pregnancy, or if the location of the pregnancy is still unknown, a specialist may decide that a laparoscopy (keyhole surgery) should be carried out. This procedure is performed with the patient under general anaesthetic and involves making a small incision (or cut) in the abdomen to insert a viewing tube known as a laparoscope. The doctor will then use this laparoscope to directly view the patient’s womb and fallopian tubes.
If an ectopic pregnancy is found during this procedure, the doctor may decide to use another set of medical instruments to remove it then and there. This may help to prevent the need for a second operation later on.
Treating an Ectopic Pregnancy
Treatment will always be needed to remove an ectopic pregnancy before it can develop too much and become too large. There are a few main treatment options that most doctors will suggest, and they are most likely to suggest the one that they believe will work best in your circumstances.
Factors that help to determine what treatment method will be used include:
- The levels of pregnancy hormone (hCG) present in your blood
- The size of the foetus
- The symptoms you are experiencing
The main treatment options themselves are:
If a patient has no symptoms or only mild symptoms, and the pregnancy is very small or cannot be found by other means there is a chance it may dissolve by itself. In these cases, patients may only need to be closely monitored in a treatment method known as expectant management.
In this treatment, regular blood tests will be taken to monitor hCG levels. These tests will continue until the hormone is no longer present in your blood. You may require further treatment later on if the hormone level doesn’t go down or if it increases, or if the fallopian tube becomes ruptured anyway (though there is only a very small risk of this happening).
A patient may experience abdominal pain and vaginal bleeding at this time, though these can be managed with paracetamol and sanitary pads. They will also be advised further by a doctor on what to do if their symptoms become more severe.
There are no known side effects as a result of this treatment being carried out.
If an ectopic pregnancy is diagnosed early but monitoring is not a suitable option, doctors will normally recommend a medication called methotrexate. This prevents the pregnancy from growing and is given as a single injection into a patient’s buttocks.
Patients do not need to stay in the hospital after treatment, but they will have to undergo regular blood tests to ensure that the treatment is working. Second doses are often needed, and surgery may be offered as a last resort if they don’t work.
A patient will need to use reliable contraception for at least 3 months after treatment, as methotrexate can be harmful to the development of a baby if a person falls pregnant during that time frame. It is also very important to avoid alcohol until told otherwise, as drinking soon after receiving your dosage can damage your liver.
Side effects that a patient may experience when taking methotrexate include:
- Abdominal pain (which should pass within a couple of days)
- Diarrhoea or frequent bowel movements
- Feeling or being sick
It is still possible, although the chance is very small, for a patient's fallopian tube to become ruptured after this treatment. A doctor will advise on what signs to look out for and what a patient should do if they think this has happened in their case.
If necessary, another laparoscopy may be carried out to complete the treatment. The first steps in this procedure will be the same as those used during the surgery to make the diagnosis.
After this, a doctor will decide whether the whole fallopian tube should be removed or if the pregnancy can be removed without having to remove it all. Usually, how healthy a patient’s unaffected fallopian tube looks will play a part in determining the course of action, as having only one not-completely healthy fallopian tube may be detrimental to conceiving in the future.
A doctor will always ask a patient if they consent to having their fallopian tube removed before this surgery is carried out. Most patients will be allowed to leave the hospital after a few days, though it may take between 4 and 6 weeks for them to fully recover.
If a patient’s fallopian tube has already ruptured, they will require emergency surgery. This will mean making a larger incision, known as a laparotomy, to stop the bleeding and repair the fallopian tube where possible.
After laparotomies and laparoscopies, a treatment known as anti-D rhesus prophylaxis will be given if the patient’s blood type is RhD negative. This involves an injection of medication that helps to prevent rhesus disease in future pregnancies.
Help and Support after an Ectopic Pregnancy
An ectopic pregnancy is a miscarriage, and it’s only natural that you may feel overwhelmed and devastated by experiencing one. It’s also not uncommon for these feelings of grief and loss to last several months, though they tend to improve over time. You should never be pressured into moving on before you’re ready, however; both you and your partner if you have one should take the time necessary to grieve.
If you feel that you are struggling to come to terms with the loss of your pregnancy, you may decide to look for support through counselling or support groups for those who have experienced miscarriage or loss of pregnancy. Your doctor should be able to help you search for counselling services, and the NHS offers a list of support groups that may be beneficial:
- Cruse Bereavement Care
- The Ectopic Pregnancy Foundation
- The Ectopic Pregnancy Trust
- The Miscarriage Association
Trying to Conceive After an Ectopic Pregnancy
Experiencing an ectopic pregnancy does not mean that you will never be able to get pregnant, even if things currently seem like they will never get better. In most cases, patients who have had an ectopic pregnancy will be able to get pregnant again ‒ even if one of their fallopian tubes has been removed as part of their treatment.
Your doctor may advise you to wait until two menstrual cycles have passed before trying again, to give yourself time to recover. As we have previously mentioned this waiting period becomes at least 3 months if you are treated with methotrexate, as the medication can affect a future pregnancy.
According to the NHS, around 65% of patients overall will achieve a successful pregnancy within 18 months of having an ectopic pregnancy. Occasionally, this may mean using a fertility treatment such as IVF.
If you do become pregnant again, it is strongly recommended that you speak to your doctor and inform them right away. This ensures that early scans can be booked in as soon as possible and carried out to make sure that your pregnancy is as healthy as it can be.
Book a Specialist Consultation
If you and your partner (if you have one) feel that you are ready to try for a baby again but also think you may need some help getting there, please do not hesitate to contact us. GENNET City Fertility will be ready to welcome you in for a free, 30-minute mini consultation with a discreet and understanding specialist as soon as you get in touch.
After an initial assessment and a tour of our facilities, our team will be able to take you through your available options for treatment. Everything you decide on will then go on to form a bespoke treatment plan that keeps you comfortable and suits your needs, no matter what you would like to do to expand your family.