Ectopic Pregnancy: Symptoms, Diagnosis and What Happens Next

You might be a few days into early pregnancy when something feels off: a one-sided ache, some spotting, a pain in your shoulder that makes no sense at all. Then someone says the words “ectopic pregnancy” and it’s hard not to spiral straight to the worst-case scenario.

Ectopic pregnancy is more common than most people realise, affecting 1-2% of pregnancies, so around 1 in 90 pregnancies in the UK, and as a gynaecologist, I am often looking after people who find themselves in this scary and unpredictable position. Whilst ectopic pregnancy can be dangerous if undetected, it can be managed safely when monitored carefully but still leaves its own pyschological mark.

This guide walks you through what an ectopic pregnancy actually is, the symptoms to know about, how it’s diagnosed, and what treatment looks like.

What is an ectopic pregnancy?

An ectopic pregnancy is when a fertilised egg implants somewhere outside the main cavity of the uterus, most commonly in one of the fallopian tubes, though rarely it can implant on an ovary, the cervix, or elsewhere in the abdomen. Wherever it implants, that tissue can’t support a growing pregnancy the way the uterus can, and the pregnancy cannot continue safely. Unfortunately, it isn’t possible to move an ectopic pregnancy into the uterus, so it needs to be treated or removed.

Why does it happen?

Usually it comes down to something slowing the fertilised egg’s journey down the fallopian tube towards the uterus. Risk factors include previous pelvic infection or inflammation, previous ectopic pregnancy, previous tubal surgery, endometriosis, smoking, and pregnancy with an intrauterine device or coil in place. That said, in many cases there’s no clear reason at all, and it isn’t something you could have prevented.

5 symptoms of an ectopic pregnancy you should watch out for

Any of these symptoms in early pregnancy are worth getting checked urgently, especially in combination:

• Persistent or one-sided lower abdominal or pelvic pain
• Vaginal bleeding that’s different from a normal period, often lighter, darker or more watery
• Pain in the tip of your shoulder
• Feeling faint, dizzy or actually fainting
• Bowel symptoms like pain when opening your bowels or on passing urine.

If you have sudden severe abdominal pain together with feeling faint or fainting, that’s a medical emergency and needs urgent attention, as it can signal internal bleeding.

How is it diagnosed?

Diagnosis usually involves a transvaginal ultrasound scan to look for the pregnancy, alongside blood tests measuring hCG, the pregnancy hormone, sometimes repeated 48 hours apart to see how the level is rising.
If a pregnancy can’t be seen inside the uterus on scan but your hCG level is above a certain threshold, that raises suspicion of an ectopic pregnancy, and you’ll usually be monitored closely with follow-up scans and blood tests until a clear diagnosis is reached.

What are the treatment options?

Treatment depends on your symptoms, hCG level and scan findings, and your doctor will talk you through the options that are safe and suitable for you.
Expectant management means monitoring closely with repeat blood tests, used when hCG is low and falling on its own.
Medical management is not typically used except in certain situations but involves an injection of methotrexate, a medicine that stops the pregnancy tissue growing, suitable when hCG is below a certain level and you have no significant pain.
Surgical management, usually a laparoscopic salpingectomy removing the affected fallopian tube, or occasionally a salpingostomy which removes the pregnancy while trying to preserve the tube, is used when there’s significant pain, a high hCG level, or signs of internal bleeding.

Recovery and follow-up

With expectant or medical management, you’ll have repeat blood tests until your hCG level falls to zero, which can take several weeks. After surgery, recovery from a laparoscopic procedure is generally around one to two weeks before returning to normal activities, though everyone heals at their own pace, and it’s normal to need time emotionally as well as physically after this kind of loss.

What does this mean for future pregnancies?

The reassuring news is that most people who’ve had an ectopic pregnancy go on to have a healthy pregnancy afterwards, even if one fallopian tube has been removed, because the remaining tube can usually pick up an egg from either ovary. Your care team will usually recommend waiting until you’ve had at least one normal period before trying again, and an early scan in your next pregnancy to check where it’s implanted.

An ectopic pregnancy can be frightening and it’s often unexpected, but recognising the symptoms early and seeking help quickly makes a genuine difference to your safety and your options for treatment. If anything about your pregnancy feels wrong, trust that instinct and get it checked.