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Treating an ectopic pregnancy

Date issued: June 2021

Review date: June 2023

Ref: A-460

PDF:  Treating an ectopic pregnancy final June 2021.pdf[pdf] 576KB

This leaflet is provided to help answer some of the questions you may have about treating an ectopic with methotrexate. 

What is methotrexate?

Methotrexate is a medicine that can be used to treat an ectopic pregnancy without the need for surgery. The success rate is 90%. It is offered to women who are clinically well and do not have a very high level of the pregnancy hormone βhCG. The medicine is given by injection into a muscle and works by stopping the developing pregnancy from growing, reducing the risk of ectopic pregnancy rupture. Over time the pregnancy tissue is then re-absorbed by your body.

What happens after taking methotrexate?

You will require blood tests for βhCG levels at the start of treatment, days 4 and 7 after treatment,  then weekly until they are normal (<20iu/L). This can take approximately 3-8 weeks. About 15-20% of women will require a second injection and a very small number of women will need surgical management.

Side effects: You may experience some, all or none of these.

Nausea/vomiting/diarrhoea, headaches, mouth/lip ulcers, skin rash, colicky abdominal pain and sensitivity to light

Rare complications: These are very rare with a single treatment. Liver or kidney damage, inflammation of your lungs, bone marrow suppression causing low blood cells or platelets.

Planning for future pregnancy

You should not get pregnant for three months after your follow up is complete. Methotrexate can affect a developing pregnancy and so you will need to ensure that you use an effective method of contraception during this time. After three months, future pregnancies will be unaffected by the methotrexate.

The risk of recurrence of an ectopic pregnancy after 1 previous ectopic pregnancy is 10% and after 2 or more is 20-30%. All women who have had an ectopic pregnancy can self-refer to EPU for an early ultrasound scan from 6 weeks gestation in all future pregnancies, even if asymptomatic.

Other useful websites:



Contact numbers:

Early Pregnancy Unit: Tel: 01752 763676 / 01752 245212

Monday to Friday: 8:00 – 17:30

Ocean Suite (Gynaecology ward) Tel: 01752 430026

Monday to Friday 17:30 – 08:00,

All day Saturday and Sunday

Please remember that nothing is too trivial to talk about, if you are worried we’d like to know.

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