Expectant Management- is this normal?

[Lucywalks1975]

Hi there,

I had very low static HCG levels over a period of 4 weeks that peaked at 352, before coming down to 183, and then 53 at which point I was essentially discharged from the EPU and told to take a home pregnancy test 2 weeks after the 53 reading, to confirm negative (which will be next Monday). I had quite a heavy bleed, period like, just before my levels crashed from 183 to 53. This bleed lasted 9 days and now I am back to the original brown discharge that made me seek help from the EPU in the first place. I’ve gone full circle! Anyone have experience of how long the brown discharge will last after the bleed and when I can expect my first period. I’m assuming I cannot ovulate until the brown stuff passes.. therefore I may have a while to go yet.

Any help/advice appreciated. It’s been 10 days since the 53 reading and the home pregnancy test has a faint pregnant line still so obviously there’s still some HCG.. going a bit mad waiting!!

[EctopicPUL]

My experience was slightly different but just a warning that you can ovulate before the brown discharge ends so if you’re not trying to conceive, be aware of that.

[EPT Host 20]

Dear lucywalks1975,
I am so sorry to hear of your ectopic pregnancy and loss,
It is not unusual for women to bleed after ectopic pregnancy. This first bleed is a response to falling hormone levels and involves shedding of the uterine lining and is not classed as a period. The length of the bleeding can vary from woman to woman and some women do report spotting and bleeding for up to around six weeks after an ectopic pregnancy.

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.
As EctopicPUL, has rightly mentioned, before having a period you have to ovulate and it is possible to become pregnant without having a proper period first, if you are not using contraception. We and many doctors advise waiting at least two menstrual cycles before trying to conceive. It is important to allow time for your body to recover and emotions to surface and be worked through. This is so that you have some comfort that your body is returning to its natural rhythm and you have a last menstrual period date from which to date a new pregnancy - key information in checking you are not suffering from an ectopic pregnancy in the future. The first bleed soon after surgery for ectopic pregnancy is not classed as a period as it is the body's response to falling hormone levels.

Sending much love,
Karen x

The Ectopic Pregnancy Trust
Registered Charity Number: 1071811

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[Lucywalks1975]

Thanks for your replies!
Is it possible to ovulate before you have a negative home pregnancy test though?

I will try a home pregnancy test tomorrow, despite brown discharge then. I assumed that it had to end before I would get a negative on the test...

[EctopicPUL]

Yes, tests are very sensitive these days and you can ovulate before your hcg reaches 0

[Lucywalks1975]

Thanks for letting me know! Apart from for the reason of emotional healing after an ectopic, and also being able to time the pregnancy to ensure close monitoring, is there any proven medical reason on why conceiving before the first period is actually dangerous?
I had expectant management, it was a VERY early pregnancy that failed, and a very tiny pregnancy tissue that they think they found outside the uterus. Therefore to be honest, emotionally I’m ok, and physically I remained symptomless. Once I have a negative test, I’m likely to have unprotected sex with my partner again, and can’t actually find any reason other than the above, that means we shouldn’t...

[EctopicPUL]

I don’t think the standard charities suggest there is a reason with expectant management.

I have read more alternative stuff that also made sense, that it’s good to let any inflammation go down to reduce the chances of it happening again. Don’t know how much of that stuff is hippie stuff though.

[Lucywalks1975]

Yes that makes sense. But as I’ve had zero pain, then I’m not really sure what i’ll do. I guess I will wait for the negative test and then see how I feel. I’m not in a rush... and I’ve received no medical or surgical treatment. A (what I thought was a ‘normal’) period, then spotting 4 days after for a month until I had another 9 day bleed and now I’m spotting again. The test is still faintly positive but the numbers were so slow and the tissue was so small that I’m in two minds as to how much I will worry about waiting for another cycle. I think my body is doing as it should and flushing it fine!