What is ectopic pregnancy? A look into its symptoms and treatment options.

At the beginning of a pregnancy, many women expect to experience notable symptoms like a missed period or sensitive breasts. And no matter how much ginger ale you’ve sipped, you can’t seem to ease your nausea. For many, these signs are that of a typical pregnancy, but for a very small number of women, it can overlap with the symptoms of an ectopic pregnancy.

Ectopic pregnancy is rare and accounts for only 2% of all reported pregnancies in the United States. But no matter how rare it is, it’s normal for expecting moms to worry, especially as you keep track of the ongoing changes to your body and what it means for you and your baby.

While there may be some overlap with traditional pregnancy symptoms, the signs that you’re experiencing an ectopic pregnancy will often stand out. And it helps to know what to look for.

Keep reading to learn more about ectopic pregnancies and their symptoms. We’ll also talk about the risks, when to talk to your doctor, how to get diagnosed and treatment options.

Ectopic pregnancy is a rare condition that happens when a fertilized egg grows outside of the uterus

Pregnancy begins with fertilization – usually in the fallopian tubes. The fertilized egg should travel down the fallopian tube and implant itself in the uterus, where the embryo starts growing.

At the beginning of an ectopic pregnancy, it’s likely that the fertilized egg never made it out of the fallopian tubes. The egg can get stuck, and if it doesn’t reach the uterus, it begins developing wherever it is.Because fertilized eggs can’t survive outside of the uterus, an ectopic pregnancy that implants itself in the fallopian tubes or elsewhere can’t continue.

As the pregnancy goes on, the growing tissue can lead to a rupture and potentially life-threatening bleeding. More than 90% of these pregnancies happen in the fallopian tubes, and if the tube bursts, it can cause major internal bleeding that requires immediate surgery.

Ectopic pregnancies are usually discovered at the first prenatal appointment, when you’re about 6-12 weeks pregnant. However, you may experience symptoms before then, and we’ll talk more about the symptoms shortly.

Tubal is the most common type of ectopic pregnancy, but there are others

Ectopic pregnancies are tubal – happening in one of the fallopian tubes – or non-tubal. The majority of ectopic pregnancies occur in the fallopian tubes; however, the fertilized egg can also implant itself in a:

• Abdomen
• Bowel
• Cervix
• Cesarean scar
• Ovary

Early ectopic pregnancy symptoms may feel like traditional pregnancy, but often feel more severe

The beginning of an ectopic pregnancy may include the symptoms of a typical pregnancy. Your pregnancy tests will show up as positive, and you can expect symptoms like tender breasts, morning sickness and a missed period. Even though ectopic pregnancies happen right at fertilization, the symptoms usually don’t show up until 6-8 weeks after your last menstrual period.

Symptoms specific to ectopic pregnancy may include:

• Abnormal vaginal bleeding
• Shoulder pain
• Sudden, severe pain in the pelvis or abdomen
• Weakness, dizziness or fainting

Mild cramping can be normal during pregnancy, but if you’re experiencing pelvic pain or abnormal bleeding, contact your OB-GYN. These are usually the first signs of an ectopic pregnancy. If the symptoms include sudden, severe pain or weakness and dizziness, go to the emergency room.

It’s also possible to have an ectopic pregnancy without any symptoms. It may not be detected until you’re at a routine pregnancy appointment. Be sure to stick to the prenatal appointment schedule your doctor recommends, which will depend on whether it’s a low-risk or high-risk pregnancy.

What causes ectopic pregnancy?

In a traditional pregnancy, fertilized eggs travel down the fallopian tube and implant into the uterus. Instead of having a clear path, the egg in an ectopic pregnancy was likely slowed down or blocked on its way. This could be caused by:

• Abnormal development of the fertilized egg
• Damage to the fallopian tube from inflammation
• Hormonal imbalances
• A misshapen fallopian tube

All ectopic pregnancies require treatment with medicine or surgery, even if there’s no fallopian tube rupture. Ectopic pregnancies won’t continue because fertilized eggs can’t survive outside of the uterus. That’s why it’s important to know the risk factors, monitor your symptoms and talk to your doctor to ensure quick and proper treatment.

Ectopic pregnancy risk factors

Half of all the women who have an ectopic pregnancy don’t have any of the known risk factors. For the other half, there are a few conditions that might increase their chance of having an ectopic pregnancy.

The potential risk factors for ectopic pregnancy include:

• Certain sexually transmitted infections (STIs), or a history of these infections, such as chlamydia and gonorrhea
• Cigarette smoking
• Endometriosis
• A history of infertility and infertility treatment
• Pelvic inflammatory disease (PID)
• Pregnancy after 35
• A previous C-section or pelvic/abdominal surgery
• A previous ectopic pregnancy
• A previous fallopian tube surgery

These factors may increase your risk, with previous C-sections and infertility treatment being the most common risk factors for ectopic pregnancy.

How a doctor diagnoses an ectopic pregnancy depends on what symptoms are showing

Your doctor will immediately check for symptoms of fallopian tube rupture, such as sudden, severe pain in your abdomen or pelvis, shoulder pain, or weakness and dizziness. These symptoms require immediate treatment, so they’ll refer you for emergency medical attention.

If you’re not showing any of these symptoms, they may go through a series of diagnostic tests that include a pelvic exam, ultrasound or blood test.

Ectopic pregnancies can be diagnosed very early, especially if your doctor feels it’s a high-risk pregnancy and you’d benefit from early testing. Blood tests – where they test for human chorionic gonadotropin (hCG), a pregnancy hormone – and ultrasound exams can help them identify where the pregnancy is growing.

Ectopic pregnancy requires immediate treatment

Unfortunately, once a fertilized egg implants itself outside of the uterus, it can’t move into the uterus. Ectopic pregnancy treatment depends on multiple factors, including whether or not your fallopian tube has ruptured, and your treatment options will include medication or surgery.

When medication is used to treat ectopic pregnancy

If an ectopic pregnancy hasn’t ruptured the fallopian tube, your doctor may prescribe methotrexate. It’s the most commonly used drug to treat ectopic pregnancy. However, there are some health factors your doctor will check before prescribing.

They’ll assess whether you’re able to have follow-up blood tests. This allows them to check for hCG after treatment. Additionally, they won’t prescribe methotrexate if you’re breastfeeding or have other health conditions. Methotrexate use could also be limited by other factors, including the size of the ectopic and the pregnancy hormone level.

Before administering methotrexate, your doctor will order a blood test to check your hCG levels and organ function. Then, the medication is given as a one-dose injection. Methotrexate targets the cells of your pregnancy and stops them from growing. Within 4-6 weeks, the body absorbs the pregnancy. There are side effects to using methotrexate, which may include abdominal pain, vaginal bleeding or spotting, nausea, vomiting, diarrhea and dizziness.

After initial treatment, your doctor will check your hCG levels on days four and seven. If your levels don’t decrease enough, they may recommend another dose. Your doctor will require follow-up appointments and blood tests until they find no traces of hCG in your blood, because the risk of fallopian tube rupture doesn’t go away until the end of treatment.

To keep your body as healthy as possible during methotrexate treatment, you should avoid:

• Alcohol
• Gassy foods, like beans and lentils, dairy products and bran
• Heavy exercise
• Prescription pain medication and NSAIDs
• Prolonged exposure to sunlight
• Sexual intercourse
• Vitamins and foods that contain folic acid

When surgery is used to treat ectopic pregnancy

If an ectopic pregnancy causes a fallopian tube rupture, it requires immediate surgery. Sometimes surgery may still be needed even if the tube hasn’t ruptured.

Your doctor will perform a laparoscopy, a procedure done under general anesthesia where they insert a small instrument into your pelvic cavity to look at your organs. During surgery, they’ll either remove the embryo from the tube or the entire fallopian tube with the embryo. Rarely, a larger incision is necessary to successfully complete the surgery and provide the safest treatment.

As you recover from surgery, you may experience pain, fatigue, bleeding or infection. However, your care team will give you the tools to manage your aftercare.

What to expect after treatment

After ectopic pregnancy treatment, it may take some time for you to feel like you’re back to “normal.” You can expect fatigue for a few weeks after treatment – from both medication and surgery. Some abdominal pain and discomfort are expected but should be manageable with over-the-counter medications. If not, talk to your doctor for help with your pain management.

As your hCG levels drop, you may even feel like you’re still pregnant. It can take a few days before the pregnancy hormone completely leaves your body. And it may even take a few months for your periods to return to normal.

However, losing a pregnancy doesn’t only affect your body. Beyond the physical discomfort, there’s the mental and emotional pain that is often devastating. But you don’t have to go through the healing process alone. Grieving and healing looks different for everyone, and you should take care of your mental health – in addition to your physical health – and consider seeking support after pregnancy loss.

Can I prevent an ectopic pregnancy?

Your body has no control over whether a fertilized egg implants in your uterus or elsewhere. Ectopic pregnancies can’t be prevented, but you can make adjustments to your lifestyle to help reduce your risk.

You can reduce your risk of ectopic pregnancy by:

• Maintaining a healthy weight with a balanced diet and exercise
• Not smoking cigarettes
• Practicing safe sex to avoid STIs

You can’t prevent an ectopic pregnancy, but you can catch it early. Talk to your doctor about how to reduce your risk and what signs to look for. Catching an ectopic pregnancy in its early stages can help you protect yourself and support the possibility of getting pregnant in the future.

Can I get pregnant after an ectopic pregnancy?

Yes, you can. Most women are born with two fallopian tubes. So even if you’ve had a tube removed, you can still get pregnant with the other one.

Having an ectopic pregnancy does put you at a higher risk of having another one in the future, but it’s still possible to have a healthy full-term pregnancy. Talk to your doctor about your concerns. They can recommend how long you should wait before it’s safe to try to conceive again.

If you become pregnant again, try not to immediately jump to worry. Just watch for the signs and symptoms until you can make an appointment with your doctor to confirm the placement of your pregnancy. Reach out early to your doctor or clinician so they can help guide your care.

Get the medical care you need

Ectopic pregnancy is a worry on many expecting mothers’ minds, but it helps to know that it’s very rare. While it can’t be prevented, there are ways to reduce your risk. And experiencing an ectopic pregnancy doesn’t keep you from having a healthy pregnancy in the future.

Talk to your doctor or OB-GYN. If you’re showing symptoms of an ectopic pregnancy, they can get you the care you need. And if all you need is some peace of mind, not only will they talk you through your concerns, but they’ll also give you help and advice for every part of your pregnancy.