Bleeding and Periods
Commonly asked questions
Is the bleeding after treatment/monitoring of my ectopic pregnancy my period?
The bleeding you have after surgery, after treatment with methotrexate, or if you are managed expectantly, is not actually classed as your first period after the ectopic pregnancy. This is your body expelling the thickened lining of the uterus because you are, sadly, no longer pregnant.
Once the beta hCG levels (pregnancy hormones) in your body have dropped, the chemical signals to retain the thickened uterine lining that has built up in preparation for pregnancy, are no longer being produced and so the lining of the uterus is shed. The process involves vaginal bleeding and the material may be clotty, heavy, dark in appearance or appear just like one of your normal period bleeds.
How long will the bleeding last?
The length of time anyone bleeds varies greatly, as the bleeding is from the lining of the womb and is hormonally controlled. It will probably last a week or two, changing in colour from red to brown and diminishing. Some women report bleeding and spotting on and off for up to six weeks.
Provided you are not soaking a pad in less than an hour or the pain is so severe you can’t manage it with over-the-counter pain relief, such as paracetamol, you should try not to worry. If you have any concerns, you should seek a reassessment.
Should my bleeding have all these clots in it?
The bleeding that follows an ectopic pregnancy, particularly when treated with methotrexate, can be very heavy and clotty and result in the passing of what we call a decidual cast. This decidual cast can cause confusion and worry and it can often be mistaken for the tissue of their baby.
The lining of the uterus when we are pregnant, other than that which is taken up by the placenta, is called the decidua. The appearance of the normal lining of the uterus by the presence and action of progesterone (hormone that prepares the uterus for a fertilised egg) becomes decidualised. When an area of the decidua is shed we call it a decidual cast. It is thought to occur as a result of the lack of stability of the integrity of the lining and this lack of stability is because the hormones aren’t functioning properly in an ectopic pregnancy.
The sudden drop in hormones can cause the material inside the uterus to be shed in layers and the material that is passed can be grey, pink or white as well as appear like a clot or dark or frank red blood.
I haven't bled following my treatment with methotrexate.
Not experiencing bleeding after being treated with methotrexate is not uncommon. Some do not have bleeding with this type of treatment.
When can I expect a period after my ectopic and will it be painful?
Your periods can take a while to re-establish and they can re-start anything between four and ten weeks after treatment. Most find that their period arrives sometime around week six or seven after surgery, or, if treated without surgery, at some time in the four weeks after their hCG levels have fallen to below 100 mIU/mL.
Before you can have a period, you would usually have to ovulate. It is perfectly possible to ovulate within 14 days after surgical treatment and almost as soon with methotrexate treatment, so it is important to be aware that it is possible to become pregnant without having a proper period first if you are not using some form of contraception.
The first period may be more painful or less so than usual, heavier or lighter, last for longer or shorter than usual – there really is no set pattern. You should be able to manage the discomfort with over-the-counter pain relief and should not be soaking a pad in less than an hour. If this is not the case, you should seek medical attention.
Will my period cycle return to normal after my ectopic?
Before, they were 25/26 days but this time it has been 30 days and I have checked and am not pregnant. Is my changed menstrual cycle length ok?
The first period can occur up to six weeks after the ectopic pregnancy although it may not be like your normal period. It might be heavier or lighter and it may be more painful than expected. The period after that is usually more like your usual pattern. However, although there is no medical reason for it, women do very often report some irregularity to their cycle for several months after an ectopic pregnancy.
Broadly speaking, doctors consider menstrual (period) cycles of between 23 to 42 days to be within normal parameters. If the first day of your last period was more than 42 days ago, make an appointment with your doctor to discuss the possible reasons for this.
Will I still have a period every month after removal of one/both of my Fallopian tubes?
You will continue to have normal periods every month after the removal of one or both Fallopian tubes. The menstrual cycle is controlled by hormones produced in different sites in the body, predominantly in the ovaries, and a period is the shedding of the lining of the womb. The Fallopian tubes play no part in controlling your period cycle. Periods usually continue normally even in the very rare cases when one of the ovaries is removed as part of the surgical process.
Is it normal to have pain during ovulation after my ectopic?
After surgery for an ectopic pregnancy, you may have some adhesions which might cause some pelvic pain and pain at ovulation but this usually settles. Some do report that they can feel themselves ovulate, often because there is more awareness of sensations within our bodies after suffering an ectopic pregnancy.
Can an ectopic pregnancy affect my menopause?
There is no evidence that an ectopic pregnancy affects or changes the timing of menopause. However, if it was necessary to undertake surgery on the ovary or remove one of the ovaries, this can result in menopause developing slightly earlier although the impact does not appear to be significant.
My ovary was removed at the time of surgery does this mean my periods will change?
It is unlikely that your periods will change following the removal of your ovary. Typically, the remaining ovary compensates and produces sufficient hormones to control the menstrual cycle so your periods are likely to settle into a regular cycle over the next few months even though one of your ovaries has been removed.