Pregnant women may experience lower tummy pain and/or bleeding in their pregnancy and this may be due to a number of causes. It is however very important that an ectopic pregnancy as the cause is excluded. If you are experiencing any of the following ectopic pregnancy symptoms, please contact your GP or your local Early Pregnancy Unit. You can also call the NHS Direct 111 service by dialing 111, or contact your out of hours GP service if your normal surgery is closed. You can also go to your local Accident and Emergency department (A&E).
The diagnosis of ectopic pregnancy may sometimes be difficult, and symptoms may occur from as early as 4 weeks pregnant and up to 12 weeks or even later. In addition, although there are a number of recognised risk factors (e.g. smoking, sexually transmitted infections, history of previous ectopic pregnancy, fertility treatment e.g. IVF); in over 50% of women diagnosed with an ectopic pregnancy, there are no identifiable risk factors.
Not all women experience symptoms. Some women experience symptoms that are also similar to other ailments such as gastroenteritis (tummy bug) and miscarriage, which are the most common ways to misdiagnose an ectopic pregnancy. Please do be vigilant and take pain that concerns you seriously until absolutely proven otherwise. If your instincts are screaming at you that something doesn’t feel right, it’s OK to trust them and ask for a reassessment at any time.
Please click on the list of symptoms for more detail:
- Missed or late period
A missed or late period
If you have missed one or more periods, the most likely reason is that you have become pregnant and it is progressing as it should. However, the fact that you may experience normal pregnancy symptoms, such as nausea, painful breasts or a swollen abdomen but no bleeding or pain, does not completely rule out an ectopic pregnancy, although this is rare. A true period should be normal flow and duration for you. A light period may in fact be abnormal bleeding in pregnancy and should be investigated with a pregnancy test.
- Vaginal bleeding
Ongoing bleeding that is sometimes red or brown/black and watery (like “prune juice”) should be investigated. The bleeding may be heavier or lighter than usual. When seeking medical attention/opinion, you will be asked for your last menstrual period which should be your last episode of a normal flow and duration bleeding. It is important that abnormal bleeding does not get confused with a normal period as health care professionals may think you are much less pregnant than you are. Prolonged off/on light and sometimes heavy bleeding are quite often seen in ectopic pregnancy and should always prompt a pregnancy test and if positive should be urgently investigated with an Early Pregnancy Unit referral.
- Pregnancy Test
Pregnancy test kits that are available now are very sensitive. They can be positive before you have missed your period. It is sensible to perform the test using urine with the most pregnancy hormone in it which will be the first urine passed in the morning. Very rarely a pregnancy test can give a falsely negative result. This is usually because the hormone level is very low. If you do a test and are surprised by a negative result it is sensible to repeat the test perhaps with a different pregnancy test kit. If it is still negative and you still think you are pregnant your doctor can do a blood test to measure the pregnancy hormone (hCG) very accurately.
If however you are in pain/bleeding and the home pregnancy test is negative but you think it should be positive ensure you are seen by a doctor urgently by attending Accident & Emergency or by contacting your specialist early pregnancy unit where you can be seen by both doctors and experienced nurses/midwives.
The blood test that the doctors would perform is for Human Chorionic Gonadotrophin (hCG). This is a hormone produced in pregnancy. The hormone is most commonly detected in the urine by using a pregnancy test, where it can be positive or negative. Blood tests can tell you the exact value of the hCG level in the blood. Your GP can do this test but it will take a few days to get the result, the hospital and EPU will get the result in a couple of hours. This is why if you have symptoms and a surprisingly negative urine pregnancy test it is better to be seen at the hospital.
- Abdominal Pain
It is not uncommon in pregnancy to experience a period like ache in your lower tummy and back. The following however should be investigated:
- One-sided pain in your tummy which may be persistent or intermittent, which means it can come and go. The pain may have begun suddenly or gradually.
- A generalised discomfort with bloating and a feeling of fullness (not associated with eating) when lying down, particularly in women who have already had a child.
- Significant lower abdominal and/or back pain.
- Shoulder tip pain
Shoulder tip pain
- The pain may have begun suddenly.
- Significant shoulder tip pain tends to develop with other symptoms such as feeling unwell, abdominal pain or vaginal bleeding, faintness, abdominal bloating and fullness, pain when opening your bowels.
It is caused by internal bleeding irritating the diaphragm (the muscle in your chest which helps you to breathe) when you breathe in and out. Shoulder tip pain is exactly where it says – not the neck or the back but the tip of your shoulder. If you look to the left over your shoulder and then cast your eyes down, the tip of your shoulder is where your shoulder ends and your arm starts.
Shoulders cause pain when we are stressed because we hold ourselves more rigidly and muscles in the back and neck go in to spasm or you may have slept in an awkward position – this is most likely not shoulder tip pain related to an ectopic pregnancy. Shoulder tip pain is very distinctive. You know when you have it because it is a very weird pain you have probably never experienced before.
- Bladder or Bowel Problems
Bladder or Bowel Problems
- Pain when you have your bowels open (go for a poo)
- Pain when you pass water (have a wee)
- Shooting / sharp vaginal pain
Some pain and a change in your normal bladder and bowel pattern are features of a normal pregnancy for some women. All the same, if you present at your GP or Earmy Pregnancy Unit with such symptoms, it would be reasonable to have an early pregnancy assessment.
- Feeling light-headed or faint, or actually fainting
- Often accompanied by sickness and looking pale
- Increasing or slowing pulse rate or falling blood pressure may also be present
If you are experiencing these symptoms with or without shoulder tip pain present, seek urgent medical attention. This may be via an ambulance.
Deciding whether your symptoms are getting worse
It is difficult at times to know what symptoms are concerning. If you are at all worried, you should seek medical advice. Contact your GP or local Early Pregnancy Unit for advice. Your GP will likely refer you to your local Early Pregnancy Unit for an assessment.
This may involve a blood test in the first instance or an ultrasound scan dependent on how many weeks pregnant you are and your symptoms.
It is important to remember that pregnancy symptoms are very common, and that not all women experiencing such symptoms have ectopic pregnancy as it is rare (incidence 1.14% in the UK). However, it is important to be vigilant and if in doubt, seek medical attention/advice.