Display Patient Information Leafelts

Treating an ectopic pregnancy with methotrexate

Date issued: June 2022

Review date: June 2024 

Ref: A-494 

PDF:  Treating an ectopic pregnancy with methotrexate final June 2022.pdf [pdf] 156KB

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 to 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

Here are some do’s and don'ts that you need to be aware of:


  • You will need to have several follow up appointments with us over the next few weeks to check your hormone levels it is very important to attend these.

  • You should drink plenty of fluids.

  • You can expect to have some vaginal bleeding, you do not need to contact us unless it is heavy, or you are worried.

  • If you have sudden severe pain or dizziness at any time, please seek medical advice and inform them that you have had Methotrexate for an ectopic pregnancy.


  • You should not take folic acid or multivitamins.

  • You should avoid eating ‘wind’ producing foods e.g., broccoli, cabbage, leaks and beans.

  • You should not have any alcohol until your follow up is complete.

  • You should not use tampons, have sexual intercourse, or have any internal examinations as this may cause rupture of the ectopic pregnancy.

You have 24 hour ‘open access’ to our care until treatment and follow up is complete. Please phone our Early Pregnancy Unit in normal working hours and Ocean suite out of hours, see back of leaflet for contact details.

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.

Emotional or psychological support:

Kirsty Willis (Bereavement midwife) 01752 433148

or kirstie.willis@nhs.net




Contact numbers:

Early Pregnancy Unit: Tel: 01752 430887 / 01752 245212

Monday to Friday: 08:00 – 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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