Reproductive Health Specialists

Reproductive Health Specialists

419 Rodi Road

Pittsburgh, PA 15235

(412) 731-8000

Methotrexate for

Ectopic Pregnancy

Reproductive Health Specialists

Methotrexate for Ectopic Pregnancy

●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

-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.

●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 generalanesthesia 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.