Call us right away if you:
- Have severe abdominal pain that keeps getting worse
- Are bleeding enough to soak a maxi pad each hour for 2 hours straight
What is methotrexate?
It is a medicine that can be used to treat an ectopic pregnancy. It stops certain cells from dividing by interfering with the folic acid in your body.
It is given by injection. You often only need 1 dose. Sometimes people will need a second dose to fully treat the ectopic pregnancy.
You will need to have blood tests to check the level of pregnancy hormone (hCG). You will get your blood drawn 3 separate times in the first week. Based on these results we will let you know if you need a second dose. Then you will need your blood drawn once a week until your hCG (pregnancy hormone) is negative.
What are the benefits?
Not every person with an ectopic pregnancy can be treated with methotrexate. There is a high chance of success if it can be used. This means you will not need surgery and the fallopian tube with the ectopic can stay in your body. Your provider will talk with you about your success rates. About 9 out of 10 people’s tubes stay open after treatment.
How often will I need follow up?
- Day 1. You will have your hCG level, blood type and other tests done. You will talk with your provider. You will get the methotrexate injection. You will get Rhogam® if you have a negative blood type.
- Day 4. You will have your hCG level drawn. Your hCG may rise on this day. This is normal.
- Day 7. You will have several labs drawn, including hCG. You will see your provider to talk about your lab results and symptoms. Your hCG should drop by at least 15% from your day 4 level.
- You will get your hCG level drawn every 7 days until your blood pregnancy test is negative.
Very important instructions for you to follow:
- Do not take any folic acid or prenatal vitamins. Stop taking all vitamins and supplements unless directed by your provider. This can be separately or in your multivitamin or prenatal vitamin. These lower the success of the methotrexate.
- Do not take any form of progesterone.
- Do not take any non-steroidal anti-inflammatory medicine for the next 10 days, such as:
- Do not lay in the sun or a tanning bed for at least 7 days.
- Do not drink alcohol until your hCG level is negative.
- Do not have sexual intercourse for at least 2 weeks after your last injection. Talk with your doctor before having sex again.
- Use condoms or other birth control until your hCG is negative and you want to try to get pregnant again.
- It is best to wait 3 months after methotrexate injection to try to get pregnant again. Talk with your provider about future pregnancy plans.
What happens after I get methotrexate?
- Mild to moderate cramping for 3 to 7 days
- Take your pain medicine as prescribed.
- Light vaginal bleeding
- Your period may not be normal.
- It may last longer than normal.
- You may pass some gray-pink tissue called a “cast” from the uterus. This is normal.
What are the side effects?
Common side effects are:
- Feeling tired
- Abdominal pain or cramping
- Nausea and/or vomiting for 24 hours
- Upset stomach, decreased appetite
- Sores in your mouth
- Redness, swelling, or pain at the injection site
- Having trouble sleeping
Rare side effects are:
- Hair loss
- Bone marrow suppression
- Pneumonitis (inflammation of the lungs)
- High liver enzymes