3rd week after MTX_severe cramping and swollen stomach

[mermaid85]

Dear all,
On March 12th I had a shot of methotrexate and my HCGs started to drop from 438. Currently HCG levels are around 30. However, today I am experiencing severe cramping/pain on my left side, which comes and goes. I took paracetamol, but I still feel the throbbing pain when I move even a little bit. I do not have bleeding nor fever.

It's been 2,5 weeks post MTX and I would appreciate any explanation what this pain might be. Is it normal? Should I go to the ER, even though I do not have other symptoms of rupturing tube?

Thank you for your advice!

[Fertility-tales]

Hi

I had the same thing around 2 weeks after my shot of methotrexate. My hcg was falling, but the pain was unbearable. I was told it could be where the pregnancy is coming away and aborting from the tube as the methotrexate works. I had a scan which didn’t find anything sinister. But I think that a tube can still rupture at any point if you have a positive hcg (although I think it’d be really rare at such a low level). I can’t tell you what to do as I’m not a medic, but if you’re worried you could go to your out of hours service (is this A&E for you at this time?) or call 111. It’s not worth the risk, your health is so important.

I hope you’re ok, and I’m so sorry for your loss. Xx

[EPT Host 20]

Dear mermaid85,
I am so sorry to hear of your ectopic pregnancy and loss,
Sadly I am not medically trained so cannot give you specific advice on your symptoms, however whilst pain and discomfort can be normal following methotrexate injection, sadly there is still a risk of rupture with reducing or low hCG levels and I would always advise having worsening pain reviewed by a medical professional.

Sending much love,
Karen x

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[mermaid85]

Dear all,
Thank you for your kind reply. I followed your advice and went to ER as the pain was severe. The gynecologist on duty checked me with the vaginal ultrasound. She didn't see anything abnormal on the scan. She said there was some bleeding, which explained the cramping stomach. The doctor thought it could be my first period and gave me novalgin and buscopan painkillers, which eased the pain. However, I read that the period normally starts AFTER my HCGs fall to zero, which is not my case yet. The pain lasted for one more day and then subsided, and so did the bleeding. Just little spotting remained. So I assume my body was/is still trying to get rid of endometrium or something.

On Ectopic.org.uk I read that the period usually starts 2 to 6 weeks after HCGs drop to zero. Is this right?

Also, is it common to have such extreme cramping pain once per week for a day or two for several weeks after MTX until the pregnancy is resolved?

Thank you for your advice! It would help to understand what to expect.
Kind regards,
M85

[EPT Host 20]

Dear M85,

Experiencing some pain after an ectopic pregnancy is normal as your body has been through a great deal. Your body may be preparing to ovulate and many women experience ovulation pain when they did not before their ectopic pregnancy - including myself. You also may have a heightened perception because of the sad loss that you have had to go through. If you find you experience offensive smelling discharge or an increased temperature of more than 37°C or just want to be checked out to be on the safe side, it would be worth asking your doctors to run tests to check for infection.
If the pain persists, I suggest keeping a pain diary noting when the pain appears, the intensity on a scale of 0-10 and anything that helps the pain eg resting, hot water bottle, paracetamol etc. Visiting your doctors with this information helps them to assess how best to manage your symptoms.

The first bleed that occurs after treatment for ectopic pregnancy is not classed as a period. It is the body's response to falling hormone levels because you are sadly no longer pregnant. The body expels the lining of the uterus that had built up in preparation for the pregnancy because it is no longer needed. This process involves vaginal bleeding - it can be clotty or like one of your usual periods and some women have bleeding/spotting for up to six weeks.
Your periods can take a while to re-establish and they can re-start once hCG levels have fallen below about 100mIU/mL and most women find that their period arrives some time in the four weeks after their hCG levels have fallen to 0 if treated with Methotrexate.

As a gentle reminder following treatment with methotrexate, please do not undertake any strenuous exercise or lifting or housework while your hCG levels are dropping. While I do not want to alarm you, there remains the risk of rupture even with low or declining hCG levels. You should not resume exercise until your hCG levels are falling consistently and are in the low 100s.

Sending much love,
Karen x

**********************************************************************************************
If we have been able to help you, are you able to help us with a small donation or by volunteering?
Further information is available at www.ectopic.org.uk
Email us at ept@ectopic.org.uk.
Our helpline is 020 7733 2653 (available Monday to Friday 10am - 4pm).
Detailed medical information can be found on our website. Please remember online medical information is NO SUBSTITUTE for expert medical advice from your own health care team.
**********************************************************************************************

[Fertility-tales]

Hi

I started to bleed about 10 days after methotrexate (so when my hcg started to fall a bit quicker, it didn’t fall very fast at the start). This lasted a few days and I think it was the lining of my uterus which built up from the pregnancy. And then I had a period about 10 days after I got a negative pregnancy test, which was a bit sooner than I was expecting. It was much more painful than normal. After that my periods returned to normal, although my next period lasted a bit longer than it usually would be and ovulation pain was much more pronounced.

But everyone is different! I hope your pain has subsided now.

Xx

[Antoinette]

pls how did you eventually pull through because am going through stomach pains once in a while on the left side with swollen/ bloated stomach. I really need to know how to handle such pains till my hcg level drops completely. thanks