Ectopic pregnancy: What it is and what you can do about it

Imagine this: You’ve just seen those two pink lines, and your heart is already picturing nursery colors and baby names. But then something feels off, cramps that don’t feel like the usual kind, light bleeding that raises questions, or pain that won’t go away.

This is how many women first discover they’re having an ectopic pregnancy, a condition that accounts for approximately 1% to 2% of pregnancies in the United States.  While it can feel scary, understanding the signs, causes, and treatments of ectopic pregnancy can help you act quickly and take care of yourself, both physically and emotionally.

To help us break this down, we spoke with Dr. Rachel Miller, a board-certified OB/GYN and hospitalist at Atrium Health in Charlotte, NC, who’s cared for hundreds of patients navigating this difficult diagnosis.

What is an ectopic pregnancy?

According to The American College of Obstetricians and Gynecologists (ACOG), an ectopic pregnancy happens when a fertilized egg implants somewhere other than the uterus. Most often, this occurs in a fallopian tube (sometimes called a “tubal pregnancy”), but it can also happen in the ovary, abdominal cavity, or cervix.

“I typically explain to patients that an ectopic pregnancy occurs anytime when the pregnancy (or more correctly, the embryo) has implanted anywhere it’s not supposed to be,” says Dr. Miller. “Most commonly, that’s in the fallopian tube (96% of the time).”

Since only the uterus can safely support a pregnancy, an ectopic pregnancy can’t continue, and it can become dangerous if untreated, sometimes causing internal bleeding.

Early signs and symptoms of ectopic pregnancy

Spotting the signs of ectopic pregnancy early can save lives. According to the American Academy of Family Physicians (AAFP), here’s what to watch for:

• Light vaginal bleeding that’s different from a period
• Pelvic or abdominal pain, often on one side, starting mild and growing sharper
• Shoulder pain or rectal pressure (a red flag for internal bleeding)
• Dizziness, fainting, or weakness

When does ectopic pregnancy pain start?

Dr. Miller states, “Most often, the clinical signs occur in the first 6 to 8 weeks after the last normal menstrual period. Bleeding can be anywhere from scant brown to heavy bleeding. It’s typically intermittent, but can occur as a one-time episode or even continuously. The type of pain can vary widely. It can be ‘all over’ the pelvis or localized to one side. It might be consistent or it might come and go.” 

If you have sudden, severe pain, heavy bleeding, or fainting, seek emergency care right away.

What causes ectopic pregnancy?

Sometimes, there’s no clear cause. “The highest risk factor for having an ectopic pregnancy is having a history of an ectopic pregnancy,” Dr. Miller explains. “Other risk factors are a history of pelvic infection (pelvic inflammatory disease), having an IVF pregnancy, and having a history of tubal reconstruction surgery.”

Other possible risk factors include:

• Smoking
• Prior pelvic or fallopian tube surgery
• Structural issues with the reproductive system

How an ectopic pregnancy is diagnosed

If your doctor suspects an ectopic pregnancy, they’ll typically:

• Order an ultrasound to see where the pregnancy is located
• Check hCG hormone levels in your blood to see if they’re rising as expected

Because early symptoms can mimic a miscarriage or even a normal early pregnancy, timely testing is critical.

Treatment options for ectopic pregnancy

Treatment depends on how early the ectopic pregnancy is detected and your overall health:

1. Medication (methotrexate)

If caught early, doctors may use methotrexate to stop the pregnancy’s growth and allow your body to absorb it naturally.

Dr. Miller explains, “We, gynecologists, typically prefer methotrexate when specific criteria are met. A patient has to be stable, and we need to be sure that the ectopic pregnancy has not ruptured. There are HCG (pregnancy hormone) limits; the patient has to be willing and able to follow up in recommended time frames.”

Methotrexate isn’t right for everyone. “If these defined criteria are not met, the patient has an increased chance of a complication from the ectopic pregnancy, including rupture,” she adds. “The methotrexate can have potential side effects, so we want to make sure that they don’t have any allergies or any abnormalities of their kidneys or liver, as the medication can cause complications in these organs.”

• Pros: Avoids surgery, shorter recovery time
• Cons: Requires follow-up blood tests to ensure hormone levels return to zero

NOTE: Never self-medicate with methotrexate. This drug should only be taken under a doctor’s supervision and with proper follow-up care.

2. Surgery

If the pregnancy is more advanced or if there’s internal bleeding, surgery is often needed.

• Laparoscopic surgery is minimally invasive, allowing for quicker recovery
• In some cases, removal of the affected fallopian tube is necessary

What recovery looks like

Healing from an ectopic pregnancy is more than just physical.

“Take it easy; don’t rush recovery,” Dr. Miller explains. “Follow your doctor’s recommendation. Take time off from work if you need to. Don’t risk your health for a work deadline.”

Dr. Miller adds, “Sometimes, as career-minded women, we sacrifice our own needs for the requests of our employers. This is one thing that doesn’t need to take a back seat to our career. Complications occur, and following up can make sure we catch those potential complications sooner.”

Caring for your mental health

An ectopic pregnancy can bring a flood of emotions: anger, sadness, guilt, and even fear about the future. You’re not alone; many have been through this. Dr. Miller reminds patients, “The more you are willing to talk about it and be open about your feelings, the more others may share their experiences.”

And don’t forget your partner. “It’s also important to address the partner’s feelings, as they can potentially be going through a tough time. Often, we forget to address them throughout this,” she adds. 

Joining support groups or talking to a counselor can help you and your partner process your experience.

Future pregnancies after an ectopic pregnancy

Many people go on to have healthy pregnancies after an ectopic one. Your doctor may recommend waiting at least three months before trying again, especially if methotrexate was used, to ensure your body is fully healed.

“After having one ectopic pregnancy, the risk of ectopic pregnancy increases with subsequent pregnancies,” says Dr. Miller. “Be sure to reach out to your gynecologist as soon as you get a positive pregnancy test, because we often will monitor you more closely.”

When to call your doctor

Reach out to your provider right away if you notice:

• Sharp or worsening abdominal pain
• Heavy bleeding or clotting
• Dizziness, fainting, or shoulder pain

Emergency tip: If you can’t reach your doctor quickly, head straight to the ER.

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Sources

• Comprehensive overview of ectopic pregnancy. NCBI Bookshelf. 2024. “Ectopic Pregnancy.”
• Patient FAQs on ectopic pregnancy. American College of Obstetricians and Gynecologists (ACOG). 2024. “Ectopic Pregnancy.”
• Clinical review of diagnosis and management. American Academy of Family Physicians (AAFP). 2014. “Ectopic Pregnancy: Diagnosis and Management.”
• Practice bulletin on tubal ectopic pregnancy. Obstetrics & Gynecology (ACOG Practice Bulletin No. 191). 2018. “Tubal Ectopic Pregnancy.”
• Guidelines for clinical management of tubal ectopic pregnancies. American College of Obstetricians and Gynecologists (ACOG). 2018. “Tubal Ectopic Pregnancy.”
• Mental health support for parents. Postpartum Support International. “Support for Families.”
• Guidance on recovery and trying to conceive again. The Ectopic Pregnancy Trust. “Physical Recovery and TTC After Ectopic Pregnancy.”