Do you have a period with ectopic pregnancy

Ectopic pregnancy - Symptoms - NHS

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th weeks of pregnancy.

Some women don't have any symptoms at first. They may not find out they have an ectopic pregnancy until an early scan shows the problem or they develop more serious symptoms later on.

Main symptoms

You may have an ectopic pregnancy if you miss a period, have a positive pregnancy test, and have other signs of pregnancy.

Contact your GP or call NHS 111 if you have a combination of any of these symptoms and you think you might be pregnant – even if you haven't had a positive pregnancy test.

Vaginal bleeding

Vaginal bleeding tends to be a bit different to your regular period. It often starts and stops, and may be watery and dark brown in colour.

Some women mistake this bleeding for a regular period and don't realise they're pregnant.

Vaginal bleeding during pregnancy is relatively common and isn't necessarily a sign of a serious problem, but you should seek medical advice if you experience it.

Tummy pain

You may experience tummy pain, typically low down on one side. It can develop suddenly or gradually, and may be persistent or come and go.

Tummy pain can have lots of causes, including stomach bugs and trapped wind, so it doesn't necessarily mean you have an ectopic pregnancy.

But you should get medical advice if you have it and think you might be pregnant.

Shoulder tip pain

Shoulder tip pain is an unusual pain felt where your shoulder ends and your arm begins.

It's not known exactly why it occurs, but it can be a sign of an ectopic pregnancy causing some internal bleeding, so you should get medical advice right away if you experience it.

Discomfort when going to the toilet

You may experience pain when going for a pee or poo. You may also have diarrhoea.

Some changes to your normal bladder and bowel patterns are normal during pregnancy, and these symptoms can be caused by urinary tract infections and stomach bugs.

But it's still a good idea to seek medical advice if you experience these symptoms and think you might be pregnant.

Symptoms of a rupture

In a few cases, an ectopic pregnancy can grow large enough to split open the fallopian tube. This is known as a rupture.

Ruptures are very serious, and surgery to repair the fallopian tube needs to be carried out as soon as possible.

Signs of a rupture include a combination of:

• a sharp, sudden and intense pain in your tummy
• feeling very dizzy or fainting
• feeling sick

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience these symptoms.

Page last reviewed: 23 August 2022
Next review due: 23 August 2025

Bleeding And Periods - The Ectopic Pregnancy Trust

Bleeding and periods after ectopic pregnancy

Your body is likely to go through a demanding process of recovery following an ectopic pregnancy. You may also find that having periods restart is a reminder of your previous ectopic pregnancy and emergency surgery which can be emotionally difficult. It is important that you are gentle with yourself and give yourself time to heal. You may have questions regarding vaginal bleeding and first periods after an ectopic pregnancy. We hope the following information helps to answer them. If you still have questions after reading through please feel free to contact us or our support groups or leave feedback in the green box at the bottom of the page. Please remember that online medical advice is no substitute for expert medical care from your own healthcare team.

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If you or someone you know needs support with an ectopic pregnancy, please feel free to contact us.

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Commonly asked questions

Is the bleeding after treatment/monitoring of my ectopic pregnancy my period?

The vaginal bleeding you have after surgery, after treatment with methotrexate, or if you are managed expectantly, is not actually classed as your first period after the ectopic pregnancy. This is your body expelling the thickened lining of the uterus (pregnancy tissue) because you are, sadly, no longer pregnant.

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 early 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 menstrual period bleeds.

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How long will the bleeding last?

The length of time anyone bleeds varies greatly, as the vaginal 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 on and off for up to six weeks.

Provided you are not soaking a pad in less than an hour or the abdominal pain is so severe you can’t manage it with over-the-counter pain relief, such as paracetamol, you should try not to worry. If the amount of bleeding worries you or you have any concerns, you should seek medical advice and a reassessment.

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Should my bleeding have all these clots in it?

The bleeding that follows an ectopic pregnancy, particularly when treated with methotrexate, can be very heavy and clotty and result in the passing of what we call a decidual cast. This decidual cast can cause confusion and worry and it can often be mistaken for the tissue of their baby.

The lining of the uterus when we are pregnant, other than that which is taken up by the placenta, is called the decidua. The appearance of the normal lining of the uterus by the presence and action of progesterone (hormone that prepares the uterus for a fertilised egg) becomes decidualised. When an area of the decidua is shed we call it a decidual cast. It is thought to occur as a result of the lack of stability of the integrity of the lining and this lack of stability is because the hormones aren’t functioning properly in an ectopic pregnancy.

The sudden drop in hormones can cause the pregnancy tissue inside the uterus to be shed in layers and the material that is passed can be grey, pink or white as well as appear like a clot or dark or frank red blood.

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I haven't bled following my treatment with methotrexate.

It is common to begin bleeding a few days following injection with methotrexate and this bleeding may persist anywhere between a few days to up to six weeks.

Not experiencing vaginal bleeding after being treated with methotrexate is not something you have to be too worried about. Some will not experience bleeding as a side effect with this medical treatment option.

To check that the treatment is working, it is important to attend regular appointments with your healthcare professionals to have your hCG levels monitored.

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When can I expect the first period after my ectopic pregnancy and will it be painful?

Your menstrual periods after an ectopic pregnancy can take a while to re-establish. They can restart any time between four and ten weeks after medical treatment. Most find that their first period arrives sometime around week six or seven after surgery, or, if treated without surgery, at some time in the four weeks after their hCG levels have fallen to below 100 mIU/mL.

Before you can have a period, ovulation needs to occur. It is perfectly possible to ovulate 14 days after surgical treatment and almost as soon with methotrexate treatment. It is important to be aware that it is possible to become pregnant even without having the first period if you are not using some form of contraception when having sexual intercourse.

The first period may be more painful or less so than usual, heavier or lighter, and last for longer or shorter than usual – there really is no set pattern. You should be able to manage the discomfort with over-the-counter (OTC) pain relief medications and should not be soaking a pad in less than an hour. If this is not the case, you should seek medical advice.

One of the symptoms of endometriosis is heavy bleeding and so if you have this condition it is worth remaining extra vigilant.

Contraception

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Will my period cycle return to normal after my ectopic pregnancy?

Before, they were 25/26 days but this time it has been 30 days. I have taken a pregnancy test and am not pregnant. Is my changed menstrual cycle length ok?

The first period can occur up to ten weeks after the ectopic pregnancy although it may not be like your normal menstrual period. It might be heavier or lighter and it may be more painful than expected. The period after that is usually more like your usual pattern. However, although there is no medical reason for it, women do very often report some irregularity in their cycle for several months after an ectopic pregnancy.

Broadly speaking, doctors consider menstrual period cycles of between 23 to 42 days to be within normal parameters. If the first day of your last period was more than 42 days ago, make an appointment with your doctor to discuss the possible reasons for this. Your doctors may also discuss periods returning at a follow-up appointment.

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Will I still have a period every month after removal of one/both of my Fallopian tubes?

You will continue to have normal periods every month after the removal of one or both Fallopian tubes (salpingectomy), following tubal pregnancy. The menstrual cycle is controlled by hormones produced in different sites in the body, predominantly in the ovaries, and a period is the shedding of the lining of the womb. The Fallopian tubes play no part in controlling your period cycle. Periods usually continue normally even in the very rare cases when one of the ovaries is removed as part of the surgical process, whether by laparoscopy or laparotomy.

Additionally, during surgical treatment for ectopic pregnancy in a Fallopian tube, the ovaries are typically not removed and remain intact. This means it is possible to have a regular menstrual cycle with ovulation and periods making it possible to conceive again in most cases.

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Is it normal to have pain during ovulation after my ectopic pregnancy?

After surgery for an ectopic pregnancy, you may have some adhesions in the abdominal cavity which might cause some pelvic pain, abdominal pain during sexual intercourse and pain at ovulation, but this usually settles with time. Some women do report that they can feel themselves ovulate, often because there is more awareness of sensations within our bodies after suffering an ectopic pregnancy. However, this is not usually cause for worry, as in most cases, these feelings can reduce or stop after a few cycles.

Sometimes, pain around the pelvic area can be due to an underlying condition including one called pelvic inflammatory disease or PID. If you have symptoms and are worried, you can visit your doctors and they can discuss tests and investigations. You can read more about symptoms of PID and diagnosis and treatment here:

https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/

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Can an ectopic pregnancy affect my menopause?

There is no evidence that an ectopic pregnancy affects or changes the timing of menopause. However, if it was necessary to undertake surgery on the ovary or remove one of the ovaries, this can result in menopause developing slightly earlier although the impact does not appear to be significant. If the ectopic pregnancy is treated with surgery where one of the ovaries is removed, soon after the surgery the remaining ovary overtakes the function for producing hormones that control the menstrual cycle, so it is unlikely that menopause will start earlier.

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My ovary was removed at the time of surgery does this mean my periods will change?

It is unlikely that your periods will change following the removal of your ovary, whether by keyhole surgery or open surgery. Typically, the remaining ovary compensates and produces sufficient hormones to control the menstrual cycle so your periods are likely to settle into a regular cycle over the next few months even though one of your ovaries has been removed.

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“So then I had my next period, which weirdly lasted two days which is totally out of the norm for me – it’s usually a good six or seven days. That really concerned me and I made the mistake of Googling it and of course it mentioned it was one of the risk factors of an ectopic pregnancy….”

Get in touch

If you or someone you know needs support with an ectopic pregnancy, please feel free to contact us.

Other pages you might find helpful

Returning to "normal"

Are you ready to return to everyday activities? Click here to get answers to your questions

Following up with the hospital

Do you have questions on following up with the hospital? Click here to find the answers

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Ectopic pregnancy: what to do? Obstetrician-gynecologist consultation

Ectopic pregnancy: what to do?

In cases where pregnancy is diagnosed and confirmed by laboratory tests (blood for hCG), but the growth dynamics of these indicators is insufficient, and the fetal egg is not visualized in the uterus, the obstetrician-gynecologist conducts additional diagnostics to exclude the development of an ectopic pregnancy. If an ectopic pregnancy is diagnosed - a condition when the fetal egg is attached to the ovary, remains in the fallopian tube, that is, it has not reached the uterine cavity - surgical treatment is performed, the task of which, first of all, is to prevent further development of the pathological and inflammatory process. nine0005

Ovarian resection

The operation is performed in cases where an ectopic pregnancy on the ovary is diagnosed. In this case, the removal of its part along with the fertilized egg is shown.

Fallopian tube removal

Trubectomy is an operation to remove one fallopian tube. It is indicated in the case of the development of an ectopic pregnancy in its cavity or in the case when the functionality of the organ cannot be restored by treatment (for example, when the adhesive process is running). In this case, its removal is a necessary measure that protects a woman from the risk of developing an ectopic pregnancy in the future, as well as other complications caused by the inflammatory process in the altered organ. nine0005

How is the operation

In cases where an ectopic pregnancy is diagnosed, doctors recommend making a decision about the operation and acting immediately, since delay in this case can lead to serious complications.

However, any surgical treatment is preceded by a detailed diagnosis, on the basis of which the doctor concludes that surgical intervention is necessary, after which the operation is planned and preparations are made for it. nine0005

Preparation for the operation consists in a number of laboratory tests that will indicate the general condition of the body, as well as help anesthesiologists to select the necessary allowance for anesthesia and adjust therapy in the postoperative period. Also, in the case of latent inflammatory processes or infectious diseases in the acute phase, the tests will indicate that it is currently safer to postpone the operation to a later date, prescribing the necessary therapy.

Medgard surgeons-gynecologists have everything they need for professional and gentle care. In most cases, operations are performed laparoscopically, that is, without large incisions, but through three punctures in the anterior abdominal wall from 0.5 to 1.5 cm in length. This not only provides a good cosmetic effect, but also contributes to better healing and recovery of the body. nine0005

The operation is performed in the morning hours. After it, the patient is transferred to the intensive care unit, where he is looked after by doctors and nurses of the department. When the patient's condition stabilizes, he is transferred to the ward of the day hospital, from where by the evening of the current day it is already possible to go home.
Postoperative appointment with the attending physician is scheduled for the next morning. In this case, the patient remains in touch with the doctor.

One day surgery or one day surgery is one of the young directions in medicine, which, by its methodology, does not involve a long stay in a hospital, allows you to solve the patient's health problems in a short time, without "turning off" a person from social life. nine0025 Currently, up to 70% of patients in developed countries receive surgical treatment in the framework of the "one day" hospital.

Ectopic pregnancy - early signs, first manifestations

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Signs of an ectopic pregnancy. How not to miss the pathology

August 06, 2019

Ectopic or ectopic pregnancy is an atypical course of pregnancy in which implantation and development of the fetal egg occur outside the uterus, for example, in the abdominal cavity, ovary, cervix, fallopian tube. nine0045

According to the latest statistics, ectopic pregnancy accounts for approximately 2% of all pregnancies. At the same time, tubal ectopic pregnancy is most often diagnosed.

Ectopic pregnancy threatens with serious complications - rupture of the fetal egg and peritonitis, recurrence of ectopic pregnancy, infertility. Often it is a threat to a woman's life and, as statistics show, in 3% of all cases it ends in death. Therefore, it is very important to be able to recognize the first signs of an ectopic pregnancy in time. nine0005

Further in the article, we will analyze in detail at what time an ectopic pregnancy can manifest itself, its signs in early and late terms, as well as on ultrasound.

How an ectopic pregnancy manifests itself: the first signs

Given all of the above, it is very important to know how an ectopic pregnancy manifests itself. Timely diagnosis of this pathology will help to avoid complications, and in some cases even save the life of a woman.

In the early stages, women can often ignore unusual symptoms and believe that this is how a normal pregnancy should proceed. nine0005

Indeed, as the ovum develops, even with an ectopic pregnancy, a woman may show signs of a normal pregnancy, namely:



• Absence of menses
• Increase in basal body temperature
• Breast engorgement
• Nausea, vomiting

However, along with these symptoms, the first signs of an ectopic pregnancy appear, which should alert. So how does an ectopic pregnancy manifest itself? nine0005

The following symptoms may indicate an atypical pregnancy:



• Unpleasant sensations in the lower abdomen, aching, pulling pains in the location of the fetal egg, or in the lower abdomen, mainly on one side - the very first signs of an ectopic pregnancy. Pain may increase during urination or defecation.
• Scanty bloody, spotting discharge that usually lasts a long time. In rare cases, uterine bleeding, or profuse spotting, resembling menstruation, is observed. nine0066
• With severe blood loss in the early stages, signs of shock may occur, namely, pale skin, tachycardia, drop in blood pressure, loss of consciousness.

How long can an ectopic pregnancy appear

The timing when the first signs of an ectopic pregnancy appear is individual in each case. In some women, an ectopic pregnancy can be asymptomatic right up to the development of complications, while in others, adverse symptoms can be noticed already from the first weeks of pregnancy. nine0005

Usually, the first signs appear with an increase in the size of the fetal egg. Therefore, at what time an ectopic pregnancy appears can be established using ultrasound. Usually, a fetal egg is visualized at a period of 4.5-5 weeks of pregnancy.

The average time for an ectopic pregnancy to appear is 3 to 8 weeks. It is during this period that the highest risk of adverse symptoms!

What are the signs of an ectopic pregnancy at a later date

If you ignore the first signs of an ectopic pregnancy, the risk of complications increases significantly. An ectopic pregnancy can have two outcomes - abortion, or rupture of the fallopian tube, or another organ in which the fetal egg has attached.

In the first case, with an ectopic pregnancy, the signs include intense pain, pain in the posterior vaginal fornix, and bleeding. With intense bleeding, symptoms of shock may appear - a decrease in blood pressure, tachycardia, a weak rapid pulse, shallow breathing, weakness, loss of consciousness.

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