Ectopic Pregnancy Treatments: A Complete Guide

An ectopic pregnancy is when a fertilized egg starts growing outside of the uterus—and about 90% of ectopic pregnancies involve a fertilized egg growing inside a fallopian tube^[1]Ectopic Pregnancy. American College of Obstetricians and Gynecology. Accessed 6/27/2022. . If the embryo is left to grow, it can cause the fallopian tube to rupture (burst), which can cause internal bleeding and can become a medical emergency.

“An ectopic pregnancy is a life-threatening condition which, if untreated, can lead to hemorrhage and death,” explains Anna Whelan M.D., an OB-GYN specializing in high-risk pregnancy care in Rhode Island and a fellow with Physicians for Reproductive Health. There is never a chance that an ectopic pregnancy will become viable (i.e result in a birth), Dr. Whelan continues.

It is impossible to move a fertilized egg back to the uterus once it has started erroneously growing in a fallopian tube, cervix, ovary, abdomen or cesarean scar, according to the American College of Obstetricians and Gynecology (ACOG). There are only two ways to treat it, according to ACOG: Medication and surgery.

While only 1% to 2% of all pregnancies become ectopic, they are the leading cause of first-trimester maternal death, and account for 10% of maternal pregnancy-related deaths^[2]Stremick JK, Couperus K, Ashworth SW. Ruptured Tubal Ectopic Pregnancy at Fifteen Weeks Gestational Age. Clin Pract Cases Emerg Med. 2019;3(1):62-64. . However, when this condition is caught early enough, it can be treated quickly, and typically in a minimally invasive manner.

Risk Factors

It’s not always clear why a person may develop an ectopic pregnancy, but there are some risk factors, including:

• Previous fallopian tube surgery
• Taking medication to stimulate ovulation (during some fertility treatments like IVF)
• The rare occurance of becoming pregnant while using an intrauterine device (IUD)
• Living with pelvic inflammatory disease (PID)
• Smoking
• Becoming pregnant after the age of 35
• Having a previous ectopic pregnancy

Initially, an ectopic pregnancy can cause the same symptoms that a regular pregnancy may cause—a missed period, tender breasts and upset stomach, according to the ACOG.

Early signs that you may be dealing with an ectopic pregnancy include:

• Abnormal vaginal spotting or bleeding
• Lower back pain
• Cramping or pain on one side of the abdomen or pelvis

It can sometimes be difficult to tell at this stage if you’re dealing with an ectopic pregnancy or a regular pregnancy, notes ACOG. Any time you experience abnormal vaginal bleeding and pelvic pain, you should talk with your doctor as quickly as possible.

If an ectopic pregnancy is left to grow, its later symptoms are much more obvious:

• Severe and sudden pain in the pelvic region and abdomen
• Shoulder pain
• Weakness, dizziness, fainting

These symptoms can be a sign of a ruptured fallopian tube, which is an emergency. Anyone experiencing these symptoms should call 911 or go to an emergency room as quickly as possible.

Ectopic pregnancy treatment typically includes either medication or surgery. A very small percentage of ectopic pregnancies—particularly if diagnosed earlier and if there are no signs of rupture—may resolve on their own, explains Dr. Whelan. However, this is not the recommended treatment option due to the risk of internal bleeding, she continues.

Medication

Methotrexate is the medication most commonly used to treat an ectopic pregnancy, notes Natasha Schimmoeller, M.D., who leads Cedars-Sinai’s Family Planning Clinic in Los Angeles. The drug works by stopping cells from growing, which effectively ends the pregnancy. The body then typically reabsorbs the cells over a four to six week period.

The earlier an individual’s ectopic pregnancy is diagnosed, the better chance methotrexate has of working, but because “every ectopic pregnancy is different,” this method of treatment is not always a guarantee, explains Dr. Schimmoeller. A few days after an individual has taken the medication, they’ll need to visit their doctor to make sure the treatment has worked. If it hasn’t worked, surgery is the next option, continues Dr. Schimmoeller.

Surgery

If an ectopic pregnancy has already caused a fallopian tube to rupture, emergency surgery is needed. Surgery may also be recommended in cases where the tube has not yet ruptured. Many times, surgery can be performed via laparoscopy, which is a minimally invasive procedure that involves small incisions in the abdomen and the insertion of a tiny camera. Depending on how far along the ectopic pregnancy is, one of two things will happen:

• Just the ectopic pregnancy is removed from the fallopian tube
• The entire fallopian tube is removed

With both medication and surgery, it may take the body a few weeks to recover. Fatigue and abdominal pain are common.

It’s also common to feel the need to find support or therapy to work through complicated emotions.

“The laws regarding abortion do not apply to ectopic pregnancies,” emphasizes Dr. Whelan, but she goes on to say that because Roe v. Wade is so politicized, many people may feel confused by the amount of information currently circulating and the language used to create many state laws.

“Treatment of ectopic pregnancy, medical or surgical, is not an abortion but a lifesaving intervention,” reaffirms Vineeta Gupta M.D. J.D., a maternal and child health physician, human rights lawyer and director of ACTION Global Health Advocacy Partnership. Even though the two procedures are fundamentally different, it may be challenging for individuals to interpret their state laws with certainty—especially when they’re in the middle of a medical emergency like an ectopic pregnancy diagnosis, she adds.

Ectopic pregnancy treatments should not currently be affected by the reversal of Roe v. Wade, but if you do happen to find yourself in a situation where you believe you are not receiving the care you need, both Dr. Whalen and Dr. Schimmoeller stress the importance of self-advocacy.

If you feel your provider is not providing you the proper treatment, explains Dr. Whalen, “you always have the right to ask for a second opinion.”