Medicine can only be used for early ectopic pregnancies that have not ruptured. Depending on where the ectopic growth is and what type of surgery would otherwise be used, medicine may be less likely than surgical treatment to cause fallopian tube damage.

Medicine is most likely to work when an early ectopic pregnancy is not causing bleeding and:

• Your pregnancy hormone (hCG, or human chorionic gonadotropin) level is low (less than 5,000).
• It has been 6 weeks or less since your last menstrual period.
• The embryo has no heart activity.

For an ectopic pregnancy that is more developed, surgery is a safer and more dependable treatment.

Medication Choices

Methotrexate is used to stop the growth of an early ectopic pregnancy. It can also be used after surgical ectopic treatment to ensure that all ectopic cell growth has stopped.

If your blood type is Rh-negative, Rh immunoglobulin is used to protect any future pregnancies against Rh sensitization. For more information, see the topic Rh Sensitization During Pregnancy.

What To Think About

Methotrexate treatment is usually the first choice for ending an early ectopic pregnancy. If the pregnancy is further along, surgery is safer and more likely to be effective than medicine.

Regular follow-up blood tests are needed for days to weeks after the medicine is injected.

Methotrexate can cause unpleasant side effects, such as nausea, indigestion, and diarrhea. For information about how to minimize side effects, see these tips for managing methotrexate treatment.

Sudden abdominal pain affects about 1 in 4 women who have the higher, more effective dose of methotrexate. This may be related to the medicine itself or to the movement of the pregnancy out of the fallopian tube.¹⁰

Methotrexate versus surgery

If your ectopic pregnancy is not too far advanced and has not ruptured, methotrexate may be a treatment option for you. Successful methotrexate treatment of an early ectopic pregnancy avoids the risks of surgery, may be less likely to damage the fallopian tube than surgery, and is more likely to preserve your fertility after treatment.

If you are not concerned with preserving fertility, surgery for an ectopic pregnancy is faster than methotrexate treatment and will likely cause less bleeding.