Pain after an ectopic pregnancy
Commonly asked questions
Should I expect any pain or discomfort after my treatment and how long will it last?
Early pregnancy loss through ectopic pregnancy is hugely demanding. Depending on what treatment option you have had, a varying amount of pain or discomfort may continue for several weeks afterwards as the healing process takes place and scarring continues to heal. This should lessen as time progresses. However, it is not unusual to still report some discomfort several months after an abdominal operation for ectopic pregnancy.
Also, after an operation, people often get aches and pains in places they did not expect. For example, the back, neck, hips and legs can all be very sore as well as the abdominal area. The healthcare professionals in the operating theatre take great care of you when you are asleep and try to move you into the positions they need you to be in very gently. However, because your muscles are very relaxed as a result of the anaesthetic, sometimes muscles can ache for several days after your ectopic pregnancy surgery. Take it easy, take the pain relief you were given in hospital and your aches should resolve over a few days.
With methotrexate treatment, many report feeling intense fatigue and it is important to rest. During methotrexate treatment, cramping abdominal (tummy) pain is the most common side effect and usually occurs during the first 2 to 3 days of treatment. Because abdominal pain is also a sign of a ruptured ectopic pregnancy which can be life-threatening and there can still be a risk of rupture with low or falling hCG levels (human chorionic gonadotropin), report any abdominal pain to your health professional.
I am experiencing abdominal pain several weeks/months after an ectopic pregnancy. Is this normal?
Following an ectopic pregnancy, it is not unusual to feel pain and discomfort in the lower abdomen for some time after your treatment. Awareness of such feelings can also be heightened as a result of the experience of pregnancy loss and because of the frightening and distressing experience you had to go through. There are a number of reasons why you may be aware of the aches in your abdominal area:
- It could be that your normal cycle is trying to resume and the pain you are experiencing may be due to your body preparing to ovulate, or your period might be about to arrive
- It could be that your awareness of your menstrual cycle and your ovulation have been heightened. Many women report that they are aware of ovulation pain after an ectopic, when they never experienced it before
- It might simply be down to heightened perception and awareness because of the experience you have been through of your previous ectopic pregnancy
There is no clinical evidence that adhesions (scar tissue) directly cause pain. However, some people do link discomfort to scar tissue even though this is anecdotal and not scientific. In addition, there is no evidence that shows that surgery to divide adhesions is helpful.
Some women report that they experience pain with future pregnancies which can be a reminder of the symptoms of an ectopic pregnancy and understandably causes worry.
Do I need to keep a pain diary?
Pain is unique to the individual and if it is persistent and is becoming worrying, we would suggest that you keep a pain diary. Record in your diary when your period starts, when the abdominal pain is experienced and how the pain would be scored on a scale of 0 to 10 (0 being no pain, 10 being severe pain requiring a trip to the hospital). Keep a record of what helps the pain, for example, heat (hot water bottle), exercise, rest, pain relief (make a note of what kind e.g., paracetamol). After about eight weeks, make a follow-up appointment with your doctor to discuss the diary records you have been keeping.
Keeping this diary enables you to follow-up with your doctor, armed with dates, times and evidence of how it is affecting you. This can be very helpful to medical practitioners when deciding how to manage the symptoms and side effects.
How can I tell if the pain I have means there is something wrong?
Pain is most usually the body’s way of telling you to rest. Whether you were treated with a major abdominal open surgery (laparotomy) or a keyhole procedure (laparoscopic surgery), some pain is normal after ectopic pregnancy treatment. You should expect to take things very easily for the first week or two after keyhole surgery or laparoscopy and for around six weeks after the major abdominal operation or laparotomy.
Many hospitals discharge their patients with some kind of pain relief. If yours did not, then ask your doctor if you can use some over-the-counter pain relief medications. A pharmacist can advise you and this would usually be sufficient to help you through the first few days. Pain is, however, unique to everyone and if you experience severe pain and are not responding to over-the-counter pain relief, then call your doctor or the NHS 111 Service or NHS GP at Hand for advice.
If your pain is associated with other symptoms, you may also need to consult with a doctor. Any of the following signs might suggest the pain you have needs further medical assessment from a healthcare professional:
- a rise in your normal body temperature greater than 37° C (98.6° F);
- increased vaginal discharge that smells offensive;
- raised lumps and bumps over the puncture sites or incision scars that are redder and hotter to touch than the rest of the surrounding skin;
- wound site which is not only weeping but appears to be oozing thick, creamy or white discharge;
- excessive vaginal bleeding soaking more than a pad in an hour.
A healthcare professional will conduct tests and investigations and evaluate you clinically to find the cause of these symptoms. They may be due to infection.
If you have had expectant management or medical management with methotrexate, you may also feel abdominal pain or discomfort. If your pregnancy hormone levels have not yet returned to non-pregnant and you experience abdominal pain, please report to your healthcare professionals as sadly rupture may still occur with low or falling hormone levels.
To help with my physical recovery, I put myself on bed rest for two weeks. We did nothing, morning till night, I was in bed sleeping on and off… I felt that I could start doing stuff after my hCG levels were back to normal. I felt I could start being myself again.