Methotrexate for Persistent Ectopic

Your doctors have suggested that you have some further treatment following an ectopic pregnancy. If you’ve already received treatment with methotrexate, you may be concerned about needing additional treatment. While it can cause you anxiety, repeat treatment is sometimes necessary but not out of the ordinary.

Why do I Need Further Treatment?

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 laparoscopic (key-hole) treatment for ectopic pregnancy in some cases. The actual surgery carried out is the same – some patients requiring removal of the affected tube, in others the tube can be preserved and just the pregnancy is removed.

Where possible, the tube is preserved, so it is still possible to fall pregnant again via that side. One of the known complications of leaving behind the affected tube, however, is the possibility of persistent ectopic pregnancy. This is not a complete pregnancy, but a small amount of tissue which remains, and can cause discomfort and bleeding as it swells. Overall, this happens in about one in 20 cases of ectopic pregnancy treated this way. It is more common with ectopics treated laparoscopically or where the ectopic is squeezed along the tube to remove it.

The persistent tissue is known to be present because the blood tests have shown that the hormone levels are not falling as expected.

How is the Treatment Given?

By a single injection of methotrexate. Your hormone levels will then need to be checked on, as before, to ensure they fall appropriately.

How Successful is It?

Very. By far, most women require only one treatment, but very occasionally two may be necessary. Although it may seem to be taking a long time to get over the surgery with all the follow-up and blood tests, at the end of the day, it is worth the effort having avoided a much more major operation or removal of your tube.

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.

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. It is fine to use regular paracetamol (to a maximum of 2 tablets, 4 times per day)
  
• If you have severe pain or heavy vaginal bleeding, get in touch with your doctor.
  
• 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.