Ectopic Pregnancy: What You Need to Know

What is an ectopic pregnancy?

An ectopic pregnancy (sometimes called a “tubal pregnancy”) happens when a fertilized egg grows outside the uterus, most often in a fallopian tube. Because the tube cannot safely hold a growing pregnancy, this condition can be dangerous and needs prompt care.

An ectopic pregnancy is not the same as a miscarriage. A miscarriage usually happens in the uterus; an ectopic pregnancy is outside the uterus and cannot continue. It must be treated to protect your health.¹

Early Signs and Symptoms of Ectopic Pregnancies

Early symptoms can look like regular pregnancy, so it’s important to know warning signs:¹

• Light vaginal bleeding or spotting
• Lower belly or pelvic pain, often worse on one side
• Shoulder pain (blood in the abdomen can irritate a nerve that travels to the shoulder)
• Dizziness
• Fainting

Get help right away (call 911 or go to the ER) if you have sudden, severe pain, heavy bleeding, feel very weak, or develop shoulder pain with a positive pregnancy test. These may mean the tube has ruptured, which is life‑threatening.¹

Ectopic Pregnancy Risk Factors

Sometimes the cause of ectopic pregnancy is unknown. You can have an ectopic pregnancy even with no risk factors. Certain things can increase your risk:¹

• Past ectopic pregnancy or fallopian tube surgery
• Pelvic infections (including some STIs) or pelvic inflammatory disease (PID)
• Endometriosis
• Fertility treatments (like IVF) or pregnancy with an IUD in place
• Smoking
• Age over 35

About half of ectopic pregnancies happen in people without known risk factors. You can lower some risks by treating infections early and not smoking.¹

How is an ectopic pregnancy diagnosed?

When diagnosing an ectopic pregnancy, doctors use:

• Transvaginal ultrasound to see the uterus, tubes, and ovaries
• Blood tests for the pregnancy hormone hCG (often checked over several days to see how levels change)
• Pelvic exam for tenderness or a mass

If no pregnancy is seen in the uterus and hCG levels do not rise as expected, doctors may suspect an ectopic pregnancy. Early testing helps prevent complications.¹

Treatment Options for Ectopic Pregnancy

A pregnancy cannot grow normally outside the uterus. Treatment protects your health and prevents dangerous bleeding. Your care team will choose the safest option based on your symptoms, test results, and overall health. They may choose one of the following treatments:

Medication (Methotrexate) 

If ectopic pregnancy is caught early and you are clinically stable, a single methotrexate injection can stop the fertilized egg from growing so the body can absorb the tissue over time. Your doctor will check your hCG levels with blood tests to make sure your levels drop. A small number of individuals need a second dose of the medication.²

Surgery 

If there is heavy bleeding, severe pain, rupture, or if medicine is not appropriate, you'll need surgery to remove the ectopic pregnancy. Most procedures are laparoscopic (small incisions with a camera). If your fallopian tube is also damaged, your doctor may have to remove it as well.

You may need an emergency laparotomy if you are unstable or bleeding significantly.  Recovery usually takes a few weeks; your clinician will advise activity limits and when you can return to normal routines.²

Recovery and Emotional Health

Physical recovery after medicine or surgery often takes a few weeks. Follow all instructions, keep your blood test appointments, rest, and avoid heavy activity until you’re cleared. Expect vaginal bleeding and mild belly pain. You can use pads until bleeding stops. Go to the ER if bleeding is heavy, pain is severe, or you feel dizzy or faint.¹

Emotional recovery can take longer. It is normal to feel depressed, sad, worried, or exhausted. Many people find it helpful to speak with a counselor, go to therapy, or join a support group. Ask your care team for local resources.¹

Future Fertility After Ectopic Pregnancy

Many people can become pregnant again after an ectopic pregnancy. Future fertility depends on your overall health, the condition of your tubes, and the treatment you had. In your next pregnancy, your doctor will likely arrange an early ultrasound to confirm the pregnancy is in the uterus. If you received methotrexate, wait at least three months before trying to conceive.^1,2

When to Seek Help

Call your doctor or go to the ER immediately if you have sudden or severe belly pain, heavy bleeding, shoulder pain, dizziness, or fainting with a positive pregnancy test. Early treatment saves lives.¹

¹ Ectopic Pregnancy FAQs, American College of Obstetricians & Gynecologists, Last reviewed May 2024, https://www.acog.org/womens-health/faqs/ectopic-pregnancy

² Ectopic Pregnancy: What to Know, WebMD, January 8, 2024, https://www.webmd.com/baby/pregnancy-ectopic-pregnancy

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