Methotrexate to Treat an Ectopic Pregnancy

An ectopic pregnancy is when a fertilized egg implants outside the uterus. In most cases, it implants in a fallopian tube. This is a tube that goes from the uterus to an ovary. When this happens, the embryo can’t grow normally. In some cases, it may stop growing quickly. Or it may grow until the fallopian tube tears (ruptures). This can cause severe bleeding and a risk for death for the mother.

Methotrexate is a medicine that stops the embryo from growing. The tissue is then absorbed by the mother’s body. This treatment can prevent the rupture, bleeding, and risk of death to the mother. Methotrexate is often used instead of surgery to remove the embryo. Surgery has risks, such as bleeding, infection, scarring of the fallopian tube, infertility, and the risks of anesthesia.

Having methotrexate treatment

Methotrexate is most often given by a shot (injection) into a muscle. It can also be given through an IV (intravenous) line.

After having the shot, you may have:

  • Mild belly (abdominal) pain or cramping

  • Nausea and vomiting

  • Diarrhea

  • Extreme tiredness (fatigue)

Care at home

Once you are home, you can resume normal activities as you are able. You will have some bleeding and pain. While you are recovering, you can use acetaminophen for pain if advised by your healthcare provider. You may be told to flush the toilet twice after each use to clear the toilet of methotrexate. Follow your provider's specific instructions.

Until your healthcare provider says it’s OK, don't:

  • Take nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, or naproxen

  • Have foods or vitamins that contain folic acid or folate (for example, prenatal vitamins have folate)

  • Drink alcohol

  • Take penicillin or certain other antibiotics

  • Use tampons or douche

  • Have sex

Make sure to:

  • Stay out of the sun during the first week after your shot. Sun can cause a rash during this time.

  • Use birth control for at least 3 months after treatment.

  • Talk with a counselor if you feel sadness or grief after pregnancy loss.

Follow up

You will have blood tests several times in the weeks after you have the shot. This is to make sure that your pregnancy hormone (HCG) level is getting lower. This shows that the baby is no longer growing. It may take up to 4 weeks for your level to drop to 0. Most women need only 1 shot. If HCG levels are not low enough, your healthcare provider may give you a second shot. In some cases, this treatment does not work and surgery is needed. Your provider can tell you more about surgery for ectopic pregnancy.

When to call the healthcare provider

Call your healthcare provider if you have:

  • Lower belly pain that gets worse or doesn’t go away

  • Heavy vaginal bleeding

  • Nausea or vomiting that needs treatment

  • Dizziness, weakness, or fainting

  • Fever of 100.4°F (38°C) or higher, or as advised by your provider