Methotrexate for Ectopic Pregnancy

Methotrexate is a medical treatment for ectopic pregnancy, providing an alternative to surgery. This article discusses how it is given and the follow up that will be needed afterwards.

Why use Methotrexate?

Until fairly recently, the only treatment that was widely available for ectopic pregnancy was an open operation. This meant a long stay in hospital and recovery time afterwards. Now we are able to offer another option – medical treatment.

If the ectopic pregnancy is small and the hormone levels aren't high, there is a 90% to 95% chance that using the medical treatment will be all that you need. Although this is a relatively new treatment (it has been used for about 7-8 years), it is one which has been found to be quite safe. It has the obvious advantage of not needing an open operation or even key-hole surgery, and hospital stay is usually a day or two at most.

Studies that look at how successful subsequent pregnancy is following this treatment have found that it is at least as good as following surgery and sometimes better. Surgery can cause scarring around the tube, and it may be that avoiding this is one reason why future pregnancies may be more likely to be successful after medical treatment.

How is the Treatment Given?

By a single injection. Your health care provider will then need to keep a check on the hormone levels, as before, to ensure they fall appropriately.

How Successful is It?

As mentioned above, on average only one in 15 women will need surgery after treatment with methotrexate. By far most women require only one treatment, but very occasionally two may be necessary.The treatment works by interfering with an essential vitamin (folate), which is needed for the rapidly growing tissue of ectopic pregnancy.

Are There Any Side Effects?

Sometimes you may notice some mild abdominal pain after the treatment, though this should not be severe. Other occasional side effects (affecting up to 15% of people) include nausea, vomiting, indigestion or feelings of fatigue. Very rarely, it can affect the liver or blood counts, but this really is unusual, mild if it does occur and only transient. The follow-up blood tests will check for this.

How Long Will it Take to Resolve?

The hormone levels frequently rise in the first week and it will take between two and four weeks for them to fall to normal. Your healthcare provider will make arrangements to see you in the Gynaecology clinic after the hormone test has fallen completely. It may be useful to arrange an X-ray examination to check that your tubes are open (a hysterosalpingogram or HSG).

Is There Anything Else I Need to Know?

The following points are important:

  • Avoid alcohol and vitamin preparations containing folic acid until the hormone level is back to zero.
  • Avoid aspirin or drugs such as Ibuprofen for one week after treatment. Regular paracetamol is safe to use (up to two tablets, four times per day).
  • If you have severe pain or heavy vaginal bleeding, get in touch with the Early Pregnancy Assessment Unit at the hospital.
  • It is important that you use adequate contraception for 3 months after a single injection or six months after more than one treatment.
  • Be sure that all of your questions have been answered.

Take down the hosptial telephone number and don't hesitate to phone for advice if you have any worries.

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