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Lack of bleeding after MTX

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Posts: 8
Joined: Tue Nov 19, 2019 3:33 pm

Lack of bleeding after MTX

Post by BMNov19 »

So following FET 6 weeks ago and I discovered that i had a positive pregnancy test but was bleeding. Eventually had a viability scan two weeks ago where I was told there was no sac in either tube or uterus. My bloods were about hcg600 and went back a week later expecting them to drop. They had risen to 800 so was referred to EPU where eventually they discovered a small ectopic pregnancy very close to my right ovary. Last Thursday I got given methotrexate. About an hour after I started bleeding a bit more heavily and passed a few clots, which felt quite soon for meds to take effect. Day 4 bloods were 600ish so going down. Since yesterday (day 5) bleeding has stopped and I'm worried tomorrow that my bloods may have plateaued or started to rise again. Am I just being paranoid? If I needed a second injection does that mean 6months of not conceiving?

Just so desperate for this bit of the journey to end. Today - for the first time in a while - I'm an emotional wreck and not trusting it will be good news tomorrow in the day 7 tests.

Thanks for any words of wisdom or personal experiences in advance. Just worried I'm going to be one of those women who it takes forever for hcg to leave my system! Just want some heavy bleeding to get it all out!

EPT Host 20
Posts: 1587
Joined: Thu May 31, 2012 9:58 pm

Re: Lack of bleeding after MTX

Post by EPT Host 20 »

Dear BMNov19,
I am so sorry to hear of your ectopic pregnancy and loss.
I too had methotrexate injection and I found my bleeding became heavier around a week after the injection. This is because the hCG level often rises on the day four blood test because the action of Methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. This is when you may start bleeding. If there has not been a 15% drop, this is when the doctors will consider a second dose of Methotrexate or surgery.

Some doctors (mistakenly) think that because they have administered a second dose of Methotrexate that that they must also double the recovery time for the body. However, even in a second dose of Methotrexate, the dosage is still much lower than for treatment of other conditions and is still metabolised by the body very quickly.
Our medical advice is that, if you have two injections, you should rely on your blood test results as an indicator of what is happening in your body and wait until your hCG levels have fallen to below 5mIU/mL in blood tests and then can restart taking vitamin/folic acid supplements for 12 weeks before you try to conceive. This is because the Methotrexate may have reduced the level of folate in your body which is needed to ensure a baby develops healthily. The Methotrexate is metabolised quickly but it can affect the quality of your cells, including those of your eggs and the quality of your blood for up to three months after it has been given. The medicine can also affect the way your liver works and so you need to give your body time to recover properly before a new pregnancy is considered. A shortage of folate could result in a greater chance of a baby having a neural tube defect such as hare lip, cleft palate, or even spina bifida or other NT defects. This is why the "wait" and then taking folic acid for 12 weeks before trying to conceive is so important.

I am afraid it is difficult to predict how long it will take for your hormone levels reach non-pregnant levels. As we are all individual, our bodies respond differently to the drug and it depends on factors like how high levels reached and our unique physiology. What I can say is that it can take a number of weeks and, while it can take some time, it is not as invasive a procedure as surgery. Also, in terms of chances of future successful pregnancies, studies do not show a significant difference between treatment routes, whether surgical, medical using methotrexate or expectant management (allowing time for the body to resolve the pregnancy itself).

Sending much love,
Karen x
The Ectopic Pregnancy Trust
Registered Charity Number: 1071811

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Posts: 8
Joined: Tue Nov 19, 2019 3:33 pm

Re: Lack of bleeding after MTX

Post by BMNov19 »

Thanks for your reply.
Just an update for anyone reading this and finding it useful.
Thankfully my bloods (day 7) are continuing to drop slowly (912 day 1, 689 day 4, 604 day 7) so no second injection recommended currently.
I still think it's a long journey ahead, but will bear in mind your advice about waiting for hcg levels to be normal and then 12 weeks of folic acid.

The other reassuring comment I was given today was that bleeding is not reliable for telling us what hcg is doing. Think I also spotted an earlier post which commented on this too, which has put my mind at ease.

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