Returning to Day-to-Day Activities
Commonly asked questions
When can I start to exercise?
This depends on how you were treated and, if you had an operation, the type of surgery you had. If you had keyhole surgery, you could start gentle exercise within two weeks of the operation. If you had open surgery then you should wait six weeks for your abdomen to heal. If you were treated with methotrexate or expectant management, you should not resume exercise until your hCG is at non-pregnant level. Exercise, like swimming, is usually safe as long as the wounds are healing or your hCG levels are low, as this is a non-impact sport.
Will I be safe to drive?
Driving is not prohibited after medical treatment with methotrexate or expectant management but you should feel comfortable to be able to do an emergency stop before you take control of any vehicle.
With surgery, however, you are very likely to be advised by medical professionals not to drive. The length of time you are advised not to drive for will depend upon the surgery you had.
You will also need to check with your insurers when they consider it safe for you to drive after the more major procedure of laparotomy (open cut to the tummy rather than keyhole) because different brokers’ and underwriters’ policies vary.
When can I return to work?
This depends on how you were treated and what type of work you do. In general, after six weeks you should be able to return to most jobs from a physical point of view, but many need to take more time off to help them deal with the psychological (emotional) impact of the loss of their pregnancy and the frightening experience they felt being diagnosed with and treated for an ectopic pregnancy.
In some cases, you could return to work within a few weeks if you had keyhole surgery and your job is not too strenuous, but you may feel tired and find it difficult to cope emotionally. Coming back part-time, if this is an option, may be a good idea.
On having medical or expectant management, some choose to work through their treatment but many find managing the loss of a pregnancy in this way too difficult to work through and need some emotional recovery time after treatment. Being treated with methotrexate is also very tiring and work can therefore be exhausting.
The important thing is to be gentle with yourself. Although you may have made a good physical recovery, you may not be ready emotionally and you should never feel embarrassed to approach your GP if you need more time off work for emotional recovery. This is very common and doctors are supportive and very sympathetic to how you are feeling and are likely to write a note without any hesitation.
Why should I avoid alcohol after methotrexate?
Drinking alcohol is advised against after medical management treatment because methotrexate is metabolised in the liver in a similar way to alcohol and is known to alter liver enzymes in the short term. Traces of the drug can, therefore, be found in the liver up to 100 days after the last dose. Because the liver is already very stretched through having to work too hard, alcohol can cause you to feel very ill, especially during the first couple of weeks after your treatment. It could also potentially damage your liver.
Is it safe to breastfeed following methotrexate treatment?
The advice given to mothers who are taking regular oral doses of methotrexate as long-term treatment, not for an ectopic pregnancy but to treat another entirely different condition, is NOT to breastfeed during their treatment. This is because methotrexate is excreted into breast milk in low concentrations and may accumulate in neonatal tissues. The American Academy of Paediatrics therefore considers methotrexate to be contraindicated during breastfeeding citing several potential problems, including immune suppression, neutropenia, adverse effects on growth, and carcinogenesis.
However, the advice for those who have had methotrexate for the treatment of ectopic pregnancy is different. In treating ectopic pregnancy, methotrexate is usually given as a one-off dose (or occasionally two doses) by injection into a large muscle to antagonise and deplete folic acid (vitamin B9). The dosage is lower than treating other conditions and does not have the opportunity to accumulate in the neonatal tissues.
If your baby is less than a year old and if breast milk is the sole source of nutrition, we advise avoiding breast feeding for at least four weeks following treatment with methotrexate. If your child has been weaned, and is taking a balanced diet of mixed foods with an occasional breast feed for comfort, you may choose to start feeding again sooner than this.
In ectopic pregnancy, when one dose of methotrexate has been given, the risk is not the accumulation in neonatal tissues, rather the risk is that the milk will be of poor quality and of little nutritional use, due to the missing essential vitamins on which the body depends to support the division of rapidly dividing cells. This is very significant in small children as they are growing and relying on this crucial process.
When can I have sex?
If you are being treated with medical management (methotrexate) or are being expectantly managed, you should avoid sexual activity which involves penetration until your hCG blood levels are down to less than 5 <mIU/mL. As hCG levels drop, the risk of rupture diminishes but, unfortunately, the risk remains even with very low hCG levels. For this reason, anything that increases intra-abdominal pressure, such as sexual intercourse, is best avoided.
Allowing the body to recover, ovulation to occur and the first period to arrive is often suggested by doctors as the ideal waiting period before beginning to have full penetrative intercourse (sex) again, which means waiting until around six weeks. This allows for healing of the muscles and gives you more confidence that your body is returning to its normal rhythm. Some couples, however, feel they want to have sex before this time and, ultimately, the decision about when to have sexual intercourse again is one for you and your partner and should be based on when you both feel ready. If you choose to wait, it does not mean that you cannot find other ways to be intimate should you choose to.
It is important to remember that medical professionals recommend that you do not get pregnant for two menstrual (period) cycles or three months after an ectopic pregnancy and, if you do want to have sex before this time, the issue of contraception needs to be considered. Questions about contraception are answered further down the page.
When should I start taking pre-natal vitamins after methotrexate?
If you have had either one or two injections of methotrexate you should wait until your hCG levels have fallen to below 5mIU/mL (your doctor will advise you when this is through blood tests) and then take a folic acid supplement 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 cleft lip, cleft palate, or even spina bifida or other neural tube defects.
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