Ectopic pregnancy: Signs, causes and treatments

Imagine your fallopian tubes as the pathways guiding a fertilised egg to its home in the womb (uterus). Sometimes, these pathways face obstacles like blockages or damage, causing the egg to get stuck and attach to a fallopian tube.

The result is an ectopic pregnancy - a condition where the pregnancy develops outside the womb.

In the UK, 1 in 90 pregnancies (just over 1%) is an ectopic pregnancy ^{Footnote [1]}. Ectopic pregnancies can become life-threatening, so understanding the signs of an ectopic pregnancy to look out for is vital.

If you want to know more about ectopic pregnancy, what the symptoms are and how it’s treated, this article will help.

 

It’s when a fertilised egg starts to grow outside the lining of your womb. This usually happens in one of your fallopian tubes, which connects your ovaries to your womb. 

Unfortunately, if the fertilised egg gets stuck there, it can’t survive, and it’s not possible to save the pregnancy. Ectopic pregnancy puts your health at risk, too, so it must be treated quickly. 

 

The cause of an ectopic pregnancy isn’t always clear. A blockage or damage to your fallopian tubes can cause the fertilised egg to get stuck on its way to your womb.

Any woman can have an ectopic pregnancy. But your risk of ectopic pregnancy increases if…

• You've had a previous ectopic pregnancy.
• You have pelvic inflammatory disease (infections, often sexually transmitted, which can cause inflammation of your reproductive system and scarring of your fallopian tubes).
• You've had previous surgery on your fallopian tubes.
• You get pregnant while using contraception like an intrauterine device (IUD), intrauterine system (IUS) or the progesterone-only contraceptive pill (mini pill).
• You have fertility treatment, such as vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
• You’re 35 years old or older.
• You smoke
   

Ectopic pregnancy symptoms are different for each woman. Some may feel nothing, while others might have a few or many signs. If your periods are irregular or your birth control didn't work, you might not even realise you're pregnant.

The signs of an ectopic pregnancy are like miscarriage symptoms, so it can be tricky for you and your doctor to tell the difference at first. 

Symptoms of an ectopic pregnancy tend to start between the 4th and 12th week of pregnancy, and can include:

Abdominal pain: Pain in the lower abdomen, often on one side. It may be sharp or cramp-like and may come and go.

Vaginal bleeding: Spotting or bleeding, different from your usual period. It might start and stop, be lighter or heavier than normal or look watery and brown.

Shoulder tip pain: This is pain where your shoulder ends and your arm begins. The pain doesn't go away and may feel worse when lying down. 

Upset stomach: Nausea, vomiting and diarrhoea are also symptoms of an ectopic pregnancy. There are loads of reasons you can have an upset stomach, but it’s good to talk to a doctor, just in case.

Pain when going to the toilet: It’s best to get medical advice if you experience pain while using the loo, feel the need to go constantly, or have diarrhoea or constipation.

These symptoms could point to other health issues. If you’re a woman and you think you might be pregnant or have intense stomach pain, shoulder pain, or feel like you might faint, get medical help right away.

 

Getting an ectopic pregnancy diagnosis can be quick, but it can take longer (a week or more), especially if you're in the early stages of pregnancy.

Some common steps to diagnose an ectopic pregnancy are:

Consultation and examination

Your doctor will ask about your symptoms and medical history. They’ll also check your abdomen for pain, tenderness or abnormal masses. You may also get a vaginal (internal) examination with your consent.

Pregnancy test

If you haven’t had a positive pregnancy test yet, you’ll need to give a urine sample to check if you're pregnant. If your pregnancy test is negative, it’s unlikely it’s an ectopic pregnancy.

Blood test

Doctors use a blood test to check a hormone called human chorionic gonadotropin (hCG). They do this every few days to see if the hormone level changes. In an ectopic pregnancy, the increase may be slower than expected compared to a pregnancy that’s growing inside the womb.

Ultrasound scan

A transvaginal scan (where a probe is gently inserted into your vagina) helps your doctor see the location of your pregnancy. And you may need an external ultrasound scan (transabdominal scan).

Laparoscopy

This is a keyhole procedure (under general anaesthetic) where a surgeon inserts a thin, flexible tube with a camera into your abdomen to look at your reproductive organs.

 

Sadly, all treatments lead to the end of the ectopic pregnancy. Your healthcare team will talk to you about your treatment options and the benefits and risks of each.

There are three main treatments:

Expectant management

If the ectopic pregnancy is very early and there’s no immediate risk, you may be able to wait for the pregnancy to end naturally. Your hCG levels are monitored every few days until they’re back to normal to make sure the pregnancy has ended.  

You don't have to stay in the hospital, but you should go back if you notice more symptoms.

Medication

In some cases, you’ll be given medication (methotrexate) as an injection to stop the growing embryo, and it will slowly go away.

You might have to stay in the hospital overnight, and you'll have to come back every week to check your hCG levels.

Depending on the results, you might get more methotrexate, and blood tests will continue until the hormone is no longer in your blood. This could take a few weeks.

Surgery

If the ectopic pregnancy has progressed or there's a risk of rupture, you might need surgery to remove it.

The common way is through laparoscopic surgery (keyhole surgery), where the surgeon takes the ectopic tissue out and tries to save the affected fallopian tube. If a bigger cut is needed, you might have an open surgery called laparotomy.

Your doctor might suggest removing the affected fallopian tube (called a salpingectomy) to lower the chance of another ectopic pregnancy.

If you have only one fallopian tube or if your other tube isn’t healthy, the doctor might recommend a salpingotomy. This aims to remove the ectopic pregnancy without taking out the tube, so you can still get pregnant naturally but with a higher risk of another ectopic pregnancy.

Help and support

Having an ectopic pregnancy can be emotionally and physically challenging. Everyone's different, but it’s important to remember your feelings are valid, and you’ll likely have lots of emotions as you come to terms with the loss of a baby.

Getting help and support is crucial to managing and overcoming this loss. You may find looking for information, advice and support online helpful. Or ask your doctor about the support available to you.

Try to talk to someone about how you’re feeling if you can. Whether that’s a friend, loved one or healthcare professional, remember, you’re not alone in this journey.

 

If eligible under your policy, it's quite straightforward to claim for treatment for an ectopic pregnancy using your health insurance cover. The first step is to get a referral from your GP, or through our Digital GP app^ Then you can make a claim through MyAviva, over the phone, or online.

Once we’ve confirmed your claim meets the terms of your policy, we’ll pay for the treatment directly. Just be sure to tell us if you need more tests or treatment, or if your hospital or specialist changes.

It’s good to have one less thing to worry about. It takes Aviva.

^ These services are non-contractual and can be withdrawn or amended by Aviva at any time.