Ectopic Pregnancy

Overview

A pregnancy normally grows inside the uterus (womb). An ectopic pregnancy happens when a fertilised egg settles and starts to grow somewhere outside the womb — most often in one of the fallopian tubes (the narrow tubes that carry eggs from the ovaries to the womb). Because these structures are not designed to hold a growing pregnancy, an ectopic pregnancy cannot develop into a healthy baby and needs to be treated promptly to keep you safe.

Ectopic pregnancy affects roughly 1 in every 80 to 90 pregnancies. That makes it relatively uncommon, but it is one of the leading causes of pregnancy-related emergencies in the first trimester (first 12 weeks). In the UK, the NHS reports around 11,000 ectopic pregnancies each year.

Any person who has a fallopian tube and can become pregnant can experience an ectopic pregnancy. It most often affects people aged 25 to 34, but it can happen at any reproductive age. Certain health history factors can raise the risk, though many people who have an ectopic pregnancy have no obvious risk factors at all.

Symptoms

Common symptoms

• Pain in the lower tummy (abdomen) — often on one side — which may start as a dull ache and become sharper
• Vaginal bleeding that is different from a normal period — often lighter, darker, or irregular
• A missed period or other early pregnancy signs such as breast tenderness or nausea
• Pain at the tip of the shoulder (this can happen when internal bleeding irritates the diaphragm, the muscle just beneath your lungs)
• Discomfort or pain when going to the toilet (opening your bowels or passing urine)
• Feeling dizzy, faint, or generally unwell

Symptoms in children

• Ectopic pregnancy does not occur in children who have not reached puberty. In adolescents who are sexually active and of reproductive age, symptoms are the same as in adults — lower abdominal pain, unusual vaginal bleeding, and missed periods. Any sexually active teenager with these symptoms should be assessed by a healthcare provider urgently.

Symptoms in older adults

• Ectopic pregnancy is uncommon near the end of the reproductive years but can still occur, including in people who have recently stopped or are about to stop having periods (perimenopause). Symptoms are the same as at any other reproductive age. Because periods may already be irregular at this stage, it can be easier to mistake an ectopic pregnancy for a menopausal change, so it is important to take a pregnancy test if there is any possibility of pregnancy.

Causes

Main causes

• In most cases, an ectopic pregnancy happens because the fertilised egg is unable to travel smoothly along the fallopian tube to the womb. This is often due to damage or narrowing in the tube.
• Inflammation or scarring of the fallopian tubes — often from a past infection — is the most common underlying reason.
• Sometimes no clear cause is found at all.

Risk factors

• Previous ectopic pregnancy — having had one before raises the chance of another
• Past pelvic inflammatory disease (PID) — an infection of the reproductive organs, often caused by sexually transmitted infections (STIs) such as chlamydia or gonorrhoea
• Previous surgery on the fallopian tubes or other pelvic surgery that may have caused scarring
• Endometriosis — a condition where tissue similar to the womb lining grows in other parts of the pelvis, which can affect the tubes
• Fertility treatments such as IVF (in vitro fertilisation — where an egg is fertilised outside the body and placed in the womb)
• Becoming pregnant while using certain forms of contraception (such as an intrauterine device, or coil) — pregnancy is rare with these methods, but if it does occur, the risk of it being ectopic is higher
• Smoking — research suggests smoking can affect how the fallopian tubes work
• Older age at the time of pregnancy (over 35)
• Having had multiple sexual partners, which increases the lifetime risk of STIs and therefore PID

When to see a doctor

See a doctor urgently if:

• If you have a positive pregnancy test and develop any lower abdominal pain or unusual bleeding — seek care the same day, even if symptoms seem mild
• If you are not sure whether you are pregnant but have lower abdominal pain and a missed or late period
• If you have any of the emergency symptoms listed above — call your local emergency number immediately rather than waiting for a GP appointment

Book a routine appointment if:

• If you have had a previous ectopic pregnancy and are trying to conceive — talk to your doctor before or as soon as you get a positive test so early monitoring can be arranged
• If you have known risk factors (such as PID or previous tube surgery) and are planning a pregnancy — a pre-pregnancy conversation with your healthcare provider is a good idea

Diagnosis

Doctors diagnose an ectopic pregnancy using a combination of your symptoms, a pregnancy test, blood tests, and an ultrasound scan (a scan that uses sound waves to create a picture of the inside of your body). Sometimes diagnosis needs a little time, as very early ectopic pregnancies are not always visible on the first scan.

Tests that may be done

• Urine pregnancy test — a simple test to confirm pregnancy
• Blood test to measure the pregnancy hormone hCG (human chorionic gonadotrophin) — levels are checked and sometimes repeated every 48 hours, as the way the number rises or falls gives important information
• Transvaginal ultrasound scan — a small probe gently placed inside the vagina gives a clearer picture of the uterus and tubes than a scan over the tummy at this early stage
• Abdominal ultrasound scan — used alongside or instead of the transvaginal scan in some cases
• Laparoscopy (keyhole surgery) — a small camera is passed into the abdomen under general anaesthetic; this is used both to confirm diagnosis and to treat the ectopic pregnancy when other tests are not conclusive or when surgery is immediately needed

What to expect at your appointment

If an ectopic pregnancy is suspected, you will likely be seen in an Early Pregnancy Unit (EPU) or an emergency department. Staff will take your history, do an examination, and arrange tests. You may need to stay for several hours or be admitted to hospital while results come back. The team will keep you informed at every step. It is completely understandable to feel anxious — ask questions whenever you need to.

Treatment

There are three main ways to treat an ectopic pregnancy: medication (using an injection to stop the pregnancy growing), surgery, or in a small number of carefully selected cases, careful monitoring known as expectant management. The right approach depends on how far along the pregnancy is, how stable you are, your symptoms, your blood test results, and your preferences. Your medical team will explain all suitable options for your situation.

Self-care at home

• Rest as much as you need during recovery — your body has been through a significant event
• Avoid strenuous physical activity, heavy lifting, or sexual intercourse until your medical team says it is safe
• Attend all follow-up appointments — blood tests to check hormone levels are essential to make sure treatment has worked completely
• Avoid alcohol during the treatment and recovery period, as it can interact with some treatments and slow healing
• Use reliable contraception for at least three months after treatment, or as long as your doctor advises, before trying to conceive again — this allows your body time to recover
• Reach out for emotional support — this is not just a physical experience, and many people find it deeply distressing

Medical treatments

When the ectopic pregnancy is detected early, is small, and you are medically stable, a doctor may offer a medicine given by injection that stops the pregnancy from growing further. Your body then gradually absorbs the pregnancy tissue. This approach avoids surgery but requires close follow-up with repeated blood tests — sometimes over several weeks — to make sure it has worked. Not everyone is suitable for this option; your doctor will assess this carefully. In other cases, surgery is needed. Surgery can often be done using keyhole (laparoscopic) techniques, meaning smaller cuts, less pain, and faster recovery compared to open surgery.

When is surgery considered?

Surgery is needed when the ectopic pregnancy has caused the fallopian tube to rupture (burst), when there is internal bleeding, when medication is not suitable or has not worked, or when the diagnosis is uncertain and needs to be confirmed directly. The most common operation removes the affected part of the fallopian tube along with the ectopic pregnancy. In some situations, surgeons can remove the ectopic pregnancy while preserving the tube, though this is not always possible or the safest choice. If a tube has ruptured, emergency surgery is performed immediately to stop the bleeding and stabilise you.

Living with this condition

Recovery after an ectopic pregnancy takes time — physically and emotionally. After medication, most people feel well enough to return to light activity within a week, though follow-up visits and blood tests continue for several weeks. After keyhole surgery, most people go home within one to two days and can return to normal activities within two to four weeks. Open surgery takes longer — usually four to six weeks. Your medical team will give you personalised advice about when to drive, return to work, and resume physical activity.

Lifestyle tips

• Attend every follow-up appointment and blood test — these are not optional extras, they confirm that treatment has been fully effective
• Give yourself permission to grieve — losing a pregnancy is a loss, whatever its circumstances, and your feelings are valid
• Talk openly with your partner or support network if you feel able to
• Avoid smoking — smoking affects fallopian tube health and can increase the risk of another ectopic pregnancy
• Get tested and treated for any sexually transmitted infections to protect your future reproductive health
• When you are ready to think about trying for a pregnancy again, speak with your healthcare provider first for personalised guidance

Diet and exercise

There is no specific diet required after an ectopic pregnancy. Eating a balanced, varied diet supports general recovery and overall wellbeing. Light walking is usually fine once you feel ready, but avoid anything strenuous until your medical team gives you the go-ahead. If you had surgery, your team will advise you on when it is safe to build up activity gradually. Listen to your body — tiredness is normal and rest is important.

Mental health and emotional wellbeing

An ectopic pregnancy can be emotionally devastating. It involves the loss of a pregnancy, often unexpectedly and in a frightening way. Feelings of grief, shock, guilt, anger, sadness, or anxiety about future pregnancies are all completely normal. Some people feel relieved after treatment and then feel guilty about that relief — this too is a normal response. These feelings may come and go for weeks or months. Please do not feel you have to cope alone. Talking to a counsellor, a support group, or a trusted person can make a real difference. If you feel persistently low, anxious, or unable to cope, please speak to your GP or mental health team. Crisis support is available — if you ever feel like harming yourself, please reach out to a crisis line or emergency service right away.

Prevention

There is no guaranteed way to prevent an ectopic pregnancy, and many people who experience one have no known risk factors. However, reducing your risk of sexually transmitted infections — particularly chlamydia and gonorrhoea, which can cause pelvic inflammatory disease and tube damage — is one of the most effective steps you can take. Using barrier contraception such as condoms consistently helps protect against STIs. Getting tested regularly for STIs if you have new or multiple partners, and seeking prompt treatment if an infection is found, also helps protect the health of your fallopian tubes.

Screening programmes

Routine screening for chlamydia is recommended for sexually active people under 25 in many countries, including as part of the UK's National Chlamydia Screening Programme. Early detection and treatment of chlamydia can prevent the tube damage that raises ectopic pregnancy risk. If you have had an ectopic pregnancy before, let your healthcare provider know as soon as you get a positive pregnancy test in the future — early ultrasound monitoring can be arranged to check where the pregnancy is growing.

Complications

If left untreated

• Rupture of the fallopian tube — the tube can split open as the pregnancy grows, causing sudden, severe internal bleeding
• Life-threatening internal haemorrhage (major blood loss inside the body) requiring emergency surgery and possibly blood transfusion
• Damage to surrounding organs if the pregnancy is in an unusual location such as the abdomen or cervix
• In very rare cases, an untreated ectopic pregnancy can be fatal — which is why early diagnosis and treatment are so important

Long-term outlook

With prompt diagnosis and treatment, the outlook after an ectopic pregnancy is generally very positive. Most people go on to have successful pregnancies in the future. Statistics suggest that around 65% of people have a healthy pregnancy within 18 months of an ectopic pregnancy. If one fallopian tube has been removed or damaged, the remaining tube can often carry out the work of both. Your healthcare provider can give you personalised advice about your own situation and future fertility. Recovery takes time — be patient and kind with yourself, and know that many people come through this experience and build the families they hoped for.

Find support

International organisations

• The Ectopic Pregnancy Trust ↗
• Tommy's — Pregnancy Loss Information and Support ↗
• March of Dimes — Ectopic Pregnancy ↗

Local organisations

• NHS — Ectopic Pregnancy Information ↗ · United Kingdom
• Jean Hailes for Women's Health — Ectopic Pregnancy ↗ · Australia
• Society of Obstetricians and Gynaecologists of Canada — Patient Resources ↗ · Canada

Helplines

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