​Period or Pregnant? 5 Things About Ectopic Pregnancy Women Trying to Conceive Should Know by Dr. Alan Lindemann

By the time many women end up in the hospital with abdominal pain, they have no idea that they’re as pregnant as they are because they mistake ectopic pregnancy bleeding for menstruation. Here are five important tips to help women discover ectopic pregnancy before it becomes an emergency:

• What is an ectopic pregnancy? Ectopic pregnancy is when a fertilized egg grows outside the uterus, usually in the fallopian tube.

• What kind of pain is associated with ectopic pregnancy? The pain from ectopic pregnancies usually starts on either the right or left lower quadrant. Initially, the pain is from stretching of the fallopian tube, but eventually the pain may become excruciating from bleeding. Most ectopics are tubal, but the fertilized egg can implant on the ovaries or any other intraperitoneal organ. They can also implant in the cervix or wall of the uterus, especially as the fallopian tube passes through it.
  

• What kind of abnormal bleeding can be associated with ectopic pregnancy? Often the bleeding with implantation of the embryo is considered to be a period, but it is usually lighter and sooner than a normal period would be expected. Women with ectopic pregnancies usually present to the physician with the second episode of bleeding. With ectopic pregnancies, abnormal bleeding may start around seven weeks after the last normal menstrual period. When presented with a patient with a possible ectopic pregnancy, physicians need to ask when the last NORMAL period occurred.

• How dangerous are ectopic pregnancies? Survival from ectopic pregnancies is much better today. Advances in the quality of ultrasound have improved outcomes. The advances in measuring the level of human chorionic gonadotropin (hCG) have also increased the ability to diagnose ectopic pregnancies accurately.

• What is the treatment for ectopic pregnancies? In the United States, surgery is the standard treatment for ectopic pregnancies. There are some countries in which the standard of care for treatment of ectopic pregnancies is treating the patient with methotrexate rather than surgery. Surgical treatment resolves the ectopic pregnancy immediately. Methotrexate works over time, and that time may vary from patient to patient. Whether methotrexate can be used to treat an ectopic pregnancy depends upon the patient’s level of hCG and amount of bleeding, so sometimes surgery is the only option.
  

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