Can You Take Methotrexate for Ectopic Pregnancy?

There are different methods of ectopic pregnancy treatment. Depending on the situation, healthcare providers may go with medical treatment with a drug called methotrexate or surgery to remove the ectopic pregnancy. Please continue reading to find out more about methotrexate treatment for ectopic pregnancy.

What is an ectopic pregnancy?

After fertilization occurs, the fertilized egg gets attached to the lining of the uterus, and the fetus grows in the uterine cavity. Ectopic pregnancy happens when the fertilized egg implants outside the uterus.

Most ectopic pregnancies occur in the fallopian tubes (these are a pair of thin tubes through which the egg passes from the ovaries into the uterus).

Risk factors for ectopic pregnancy include:

Previous ectopic pregnancy
Previous surgery on the fallopian tubes
Prior abdominal or pelvic surgeries
Medical conditions involving the reproductive organs, such as sexually transmitted infections, endometriosis, and pelvic inflammatory disease
Maternal age older than 35 years
Cigarette smoking
Conception with an IUD in place
History of infertility or infertility treatments like in vitro fertilization (IVF)

In approximately half the women with an ectopic pregnancy, there is no known risk factor.

What are the symptoms of an ectopic pregnancy?

The initial signs and symptoms of an ectopic pregnancy can be similar to a normal pregnancy, such as a missed menstrual period and breast tenderness. Other symptoms include pelvic or abdominal pain, low back pain, cramping on one side of the lower abdomen, and abnormal vaginal bleeding.

If there is a possible rupture of the fallopian tube, more severe symptoms can develop. These may include sudden severe abdominal pain or pelvic pain, shoulder pain, weakness, dizziness, and fainting. It’s important to seek immediate medical attention for these signs and symptoms. A ruptured fallopian tube is a life-threatening emergency and can lead to severe internal bleeding.

Doctors can diagnose ectopic pregnancy by performing a pelvic exam and ultrasound exam and by measuring serum hCG levels (hCG is short for human chorionic gonadotropin, also called the pregnancy hormone).

How is ectopic pregnancy treated?

It is not possible to move an ectopic pregnancy from the fallopian tube to the uterus. Therefore, an ectopic pregnancy must always be treated by ending it. There are two ways to do this:

Medical management with a drug called methotrexate.
Emergency surgery to remove the ectopic pregnancy from the fallopian tube or to remove the entire fallopian tube.

In some cases, expectant management is recommended. This involves watchful waiting while the body absorbs a small ectopic pregnancy, and hCG levels drop naturally. Expectant management is only recommended in patients in good general health who have falling hCG levels, acceptable pain levels, and no worrisome bleeding in the abdominal cavity on ultrasound examination.

How does methotrexate treat ectopic pregnancy?

Methotrexate is an antimetabolite medication that is often used in the treatment of cancer and other autoimmune diseases. Methotrexate interferes with the folic acid in the body. Therefore it inhibits the rapid growth of cells in the body. Due to this mechanism of action, methotrexate is used to stop the rapid growth of cancer cells and also cells in an embryo. In other words, methotrexate treatment ends an ectopic pregnancy by preventing the embryo’s cells from growing. There is no need to surgically remove the fallopian tube if you take this medicine and it successfully ends an ectopic pregnancy.

When is methotrexate used to treat ectopic pregnancy?

Methotrexate is used to treat ectopic pregnancy when the fallopian tube has not ruptured. If the fallopian tube has ruptured, then medical management is not an option. Emergency surgery is needed to remove the ectopic pregnancy from the tube or to remove the entire fallopian tube containing the ectopic pregnancy.

Sometimes, even when the fallopian tube has not ruptured, medical treatment with methotrexate is not an option. For example, if you are breastfeeding or have certain health conditions such as liver disease, lung disease, peptic ulcer disease, kidney problems, blood disorders, or a weak immune system.

How many shots of methotrexate do you need for ectopic pregnancy?

Most women receive methotrexate as a single injection. Following this one dose, your doctor will order serial blood tests to check hCG levels. If your hCG level is still high after the first dose of methotrexate, a second dose may be prescribed.

In addition, your doctor may give you a shot of folic acid because methotrexate can interfere with the action of this vitamin.

It is important to be closely monitored after taking methotrexate. Careful follow-up is required to check the pregnancy hormone level until no more hCG can be detected on a blood test.

It is worth noting that the risk of fallopian tube rupture continues for several weeks after taking methotrexate until the ectopic pregnancy is absorbed by your body. Be sure to get immediate medical attention if you develop signs of fallopian tube rupture (see above).

How long will I bleed after a methotrexate shot?

You will have vaginal bleeding similar to a menstrual period after your methotrexate shot. This bleeding can last for about a week. Other side effects of methotrexate include tiredness, dizziness, nausea, vomiting, and diarrhea.

What precautions should I take during methotrexate treatment?

Once you’ve received methotrexate, you should avoid heavy exercise and sexual intercourse for 2 weeks during the medical management of ectopic pregnancy. Your doctor will ask you to avoid alcohol during this time. You should also avoid multivitamins with folic acid (vitamin B-9) and penicillin until your HCG gets down to 0. Watch out for foods that cause gas since they can worsen abdominal cramps. Travel is not recommended during methotrexate treatment.

Check with your doctor before taking pain medicine because some medications, such as ibuprofen, can affect how methotrexate works. You can take acetaminophen (Tylenol) for symptoms like cramping or headache unless your doctor tells you otherwise.

Lastly, avoid unnecessary sun exposure while taking methotrexate because this medicine can increase your skin’s sensitivity to sunlight.

How quickly does methotrexate work for ectopic pregnancy?

The average time taken for the pregnancy hormone level to return to baseline is around 3 weeks.

What is the success rate of methotrexate for ectopic pregnancy?

Success rates of methotrexate for ectopic pregnancy are good. Meta-analyses have shown the single-dose protocol is successful in ending 88% of ectopic pregnancies, and the multi-dose protocol has a success rate of over 92%.

How soon can you get pregnant again after an ectopic pregnancy?

It can take a few cycles for your menstrual periods to return to normal. It is difficult to predict how long it might take you to get pregnant again after an ectopic pregnancy. However, it is recommended that you wait at least 3 months to try to be fully recovered.

The advantages of methotrexate treatment over surgical treatment for ectopic pregnancy are that methotrexate allows the fallopian tube to be preserved, improving the chances of future pregnancies. Also, methotrexate treatment is less invasive, less expensive, and can be completed in an outpatient setting. It is important not to miss any follow-up appointments with your doctor to make sure your recovery is going well.

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