Rockingham Assessment Unit
Methotrexate treatment for ectopic pregnancy
Patient information
We are extremely sorry that you are having an ectopic pregnancy (pregnancy developing
outside the womb).In this leaflet we will give you some information regarding ectopic pregnancy
and the treatment we offer based on best available evidence. We know that this is a sad and
distressing time for you. If you have any questions please don't hesitate to speak to a member
of the team.
What is an ectopic pregnancy?
A pregnancy that develops outside the womb is called ectopic pregnancy. One in 80
pregnancies can be ectopic (NICE 2012) and it can be life threatening. It can develop in the
fallopian tube (tube that carries the egg from the ovaries to the uterus) and rarely in the cervix,
ovary or the abdominal cavity. It presents with pain and bleeding. If not treated early enough it
ruptures from the area where it is growing and causes severe bleeding and pain.
How can an ectopic pregnancy be treated?
Ectopic pregnancy can be treated conservatively with medicine or surgery depending on the
individual circumstances.
Medical treatment will be offered to you:
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If you are in good health and your condition is stable with no severe pain or bleeding into
your tummy
Your pregnancy hormone (β HCG) is low
The size of your ectopic is less than 3.5cm with no fetal heart beat inside it
If you need this information in another format or language 01536 492510
Further information about the Trust is available on the following websites:
KGH - www.kgh.nhs.uk | NHS Choices - www.nhs.uk
Ref: PI 993 April 2016
Review: January 2018
What is methotrexate?
Methotrexate is a drug that temporarily interferes with the growth of cells. In particular rapid
growing/dividing cells such as those found in a developing embryo and placenta. The drug
works by affecting the way in which the cells use a vitamin called folate, which is essential to the
growth of new cells. The drug greatly reduces the need for an operation to treat an ectopic
pregnancy, although 1 in 15 women may still need surgery following treatment with
Methotrexate.
What are the advantages of methotrexate treatment over surgery?
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It avoids the risk of surgery and preserves the fallopian tube
It avoids the risk of general anaesthetic especially if you have a medical problem where
general anaesthetic can be extra risky
If you have adhesions (scar tissue) from a previous surgery or infection
If the ectopic pregnancy is situated in the neck of the womb or as the tube enters the
womb
Treatment of ectopic pregnancy with methotrexate is not appropriate if you suffer from any of
the following conditions:
 An ongoing infection
 Severe anemia or shortage of other blood cells
 Kidney problems
 Liver problems
 Active infection
 HIV/AIDS
 Peptic ulcer or ulcerative colitis
How is the treatment given?
Methotrexate is given as an injection deep into the muscle. The dose depends on your body
weight and height. Before the injection, your kidney and liver functions will be checked and a
blood analysis will be carried out to find out that you are not anaemic.
What happens after treatment?
After the injection you need careful monitoring and follow up. You need to attend the hospital
regularly for blood test until the test is negative. This can take several weeks. You need an HCG
test on the day of the injection and then on day 4 and again on day 7. The HCG levels usually
rise on day 4 and then we will expect a fall of 15% between day 4 and day 7.It is usual to bleed
after the injection and the bleeding can last between a few days and 6 weeks. It is also usual to
feel slight discomfort after the injection. As long as it is not severe and you are feeling well there
is nothing to worry about.
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You will need to go to hospital immediately:
 If the pain persists for more than 10 days
 It is severe
 Not helped by taking paracetamol
 You feel faint
What can I do to help the treatment work?
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Avoid pregnancy for the next 3 months by using a barrier method of contraception( eg,
condoms)
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Whilst having treatment do not drink any alcohol or take any recreational drugs
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Avoid folic acid supplements
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If you feel unwell, or have a swollen abdomen, vaginal bleeding, shoulder tip pain or
shortness of breath you should return to hospital immediately. This may be an indication
of a ruptured ectopic pregnancy.
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Avoid aspirin or drugs like ibuprofen (NSAIDs) for 1 week. Paracetamol is safe to take.
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Do not lift heavy weights and avoid sexual intercourse until the pregnancy hormone is
less than 100 IU/L
What are the side effects or possible complications?
Some women may experience an increase in abdominal pain following the injection
usually on day 3 to 4. This usually settles after a couple of days. However, if the pain persists
and is getting worse rather than improving, and you are feeling generally unwell with dizziness
and sickness, please contact the hospital for advice, by calling the number at the end of this
information leaflet. Other side effects include:
 Tiredness
 Abdominal symptoms like nausea, indigestion, diarrhoea
 Sore mouth
 Rarely, change in blood count, kidney and liver function but usually this is temporary
 Some reversible hair thinning
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How successful is the treatment?
Success rates do vary depending on the circumstances in which methotrexate is given. Studies
report success rates of 65-95%. Success rates tend to be higher with lower serum HCG levels.
Methotrexate is at least as good as surgery in terms of subsequent successful pregnancies.
This may be due to the fact that medical treatment is non-invasive, whereas surgery may cause
some scarring around the tube.
Who can I contact for further information?
Rockingham Assessment Unit
Monday to Saturday
8:30am – 4pm
Telephone:  01536 492236
Maple ward
Out of hours
Telephone:  01536 492911/493555
Ectopic Pregnancy Trust
weekdays
10am - 4pm
email: www.ectopic.org.uk
Helpline:  0207 7332653
Reference
National Institute for Clinical Excellence (NICE) (2012)
Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of
ectopic pregnancy and miscarriage (CG145). NHS England
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