Methotrexate for
Ectopic Pregnancy
Your physician has prescribed
methotrexate as a treatment
for ectopic pregnancy. This
pamphlet will describe the
treatment as well as the risks,
benefits, and alternatives to
treatment. You have been
diagnosed with an ectopic
pregnancy. What this means is
that the pregnancy is
developing in the wrong place
– usually in your fallopian tube.
If left untreated, the growing
pregnancy will eventually
rupture the tube and lead to
an emergency surgery and
sometimes even death of the
patient.
Reproductive Health Specialists
419 Rodi Road
Pittsburgh, PA 15235
(412) 731-8000
Reproductive Health
Specialists
Methotrexate for Ectopic
Pregnancy
- Penicillin
- Nonsteroidal anti-inflammatory drugs
(NSAIDS), such as ibuprofen, can also affect
the level of methotrexate and cause serious side
effects. Speak to your doctor before using
NSAIDs.
● TREATMENT
Methotrexate stops the growth of rapidly dividing
cells. It is therefore useful in stopping the growth of
pregnancy cells which are growing in the wrong
place, such as your fallopian tube. It is given by
injection into either your arm or hip muscle.
During the week you receive injections, your
pregnancy levels (human chorionic gonadotropin or
hCG) are tested several times. Your doctor looks
for a drop in hCG levels, indicating the pregnancy is
ending.
- If your hCG levels dropped enough after 1
week, you are then tested on a weekly basis
until they are low enough to suggest that the
pregnancy has safely ended. Typically, this
takes a month, but can take more than 3
months.
- If your hCG levels aren’t dropping enough
after 1 week, you may be given another dose of
methotrexate.
- If your hCG levels continue at higher levels, or
your doctor becomes concerned about tubal
rupture, surgery will be needed to remove the
ectopic pregnancy.
Methotrexate treatment can be given as a single shot
or as several injections. If an ectopic pregnancy
continues after 2 or 3 doses of methotrexate,
surgical treatment is needed to remove the ectopic
pregnancy.
● SIDE EFFECTS
Several side effects from methotrexate treatment are
usually related to longer term use. Using alcohol or
certain medicines during treatment can also lead to
severe side effects. You will be advised to
completely avoid the following, until treatment is
finished:
- Vitamins containing folic acid (including
prenatal vitamins)
- Alcohol
● COMMON SIDE EFFECTS:
- Abdominal pain (cramping) and it usually
-
occurs during the first 2 to 3 days of treatment.
Report any abdominal pain to your doctor,
because it is also a sign of a ruptured ectopic
pregnancy.
Vaginal bleeding or spotting
Nausea, vomiting, and indigestion
Fatigue, lightheadedness, or dizziness
● RARE SIDE EFFECTS:
- Skin sensitivity to sunlight.
- Inflammation of the membrane covering the
eye.
- Sore mouth and throat
- Temporary hair loss.
- Severe low blood counts (bone marrow
-
suppression)
Inflammation of the lung (pneumonitis)
Because of the risk of side effects, methotrexate
treatment requires close medical supervision by a
doctor who is experienced with this medication.
During methotrexate treatment, keep your doctor
informed of any symptoms you may have.
● METHOTREXATE VERSUS SURGERY
If your ectopic pregnancy is not too far
advanced and has not ruptured, methotrexate
may be a treatment option for you. This
treatment avoids the risks of surgery and may be
less likely to damage the fallopian tube than
surgery. And it may offer a better chance of
preserving your fertility after treatment.
If you are not concerned with preserving
fertility, surgery for an ectopic is faster than
methotrexate treatment and causes less bleeding.
Some women who receive a methotrexate series
for ectopic pregnancy report more side effects
and less overall comfort than women who have
laparoscopy. On the other hand, women who
have laparoscopy may experience side effects
related to general anesthesia and surgery, such as
fatigue, abdominal bloating, shoulder pain, and
injury to internal organs.
● METHOTREXATE INSTEAD OF SURGERY
Methotrexate can be used instead of surgery in
the following cases:
- Pregnancy hormones (hCG) levels are low.
Methotrexate treatment is not likely to be
successful when hCG levels are high.
- No fetal heart movement is noted on
ultrasound (methotrexate treatment is not as
likely to be successful when the embryo is
more developed and growing and has heart
activity).
- The ectopic pregnancy is smaller than 4cm.
- There is no bleeding into the abdomen.
- The fallopian tube has not ruptured
● WHEN NOT TO USE METHOTREXATE
Methotrexate cannot be used if you:
- Are breast feeding
- Have liver or kidney disease
- Have a low red blood count (anemia)
- Have an impaired immune system
- Have a ruptured fallopian tube
● THINGS TO AVOID
-
If you are treated with methotrexate, you may
be advised to avoid:
Gas producing foods, such as beans and
cabbage, because abdominal discomfort is
common with methotrexate.
Exposure to the sun, because methotrexate can
cause skin sensitivity to sunlight.
Use of alcohol and other medicines.