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Second dose of methotrexate - please help!

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Posts: 9
Joined: Wed Oct 21, 2020 11:06 am

Second dose of methotrexate - please help!

Post by mowakasha »

Hi all,

Looking for advice

I had methotrexate last week and just had my day 7 bloods back. Day 4 my levels were 311 and day 7 they have dropped to 303 which is NOT 15%
The consultant has said they want to wait 2 days until Monday and repeat the bloods incase it drops more. Otherwise I’ll have to have second dose. I am SO FED UP. this is my third pregnancy (I have one son, first time was PUL or miscarriage).

I’m also terrified if I have a second dose I’ll have to wait for 6 months to conceive rather than 3 months. Does anyone have any advice re this and what the nhs say if you have to have second dose, does it double the amount of time waiting or is it still 3 months from last dose?

EPT Host 22
Posts: 388
Joined: Fri Nov 20, 2015 10:26 am

Re: Second dose of methotrexate - please help!

Post by EPT Host 22 »

Hi mowakasha,

I am so sorry to hear you are suffering from this ectopic pregnancy and loss. You are not alone in your experience and feelings, and I'll do my best to provide some reassurance.

The process of MTX can take some time, and as each woman is different, there is, unfortunately, no set time frame. We encourage women to prioritize their rest and recovery during these weeks, which means no heavy lifting and possibly taking time off from work. It is very easy to say, but so much harder to do.

As you've already shared, the second shot of MTX will be given if hCG levels do not fall as doctors would like. In general, the hCG level often rises on the day four blood test because the action of Methotrexate is not instantaneous, so the cells will have continued to divide for two or three days after the injection was given, and some cells release more hCG when they start to disappear. Your doctors are looking to see a drop in your hCG value of at least 15% between days four and seven. If there has not been a 15% drop, this is when the doctors will consider a second dose of Methotrexate or surgery.

Every 3-7 days, beta hCG levels will continue to be monitored to ensure that they are falling appropriately. Most women only need one injection but in up to a quarter of cases a further injection may be required if serum hCG levels are not decreasing.

You know your body the best, and while the hcg levels are decreasing, it's important to be mindful of your symptoms until you reach non-pregnant levels, under 5mIU/mL, as there is unfortunately still a chance of rupture. The symptoms of a deteriorating ectopic pregnancy, which include worsening or progressively increasing pain; vaginal bleeding; shortness of breath; feeling faint; and pain in the tip of the shoulder among others, may become noticeable. If you suffer any of these symptoms you will need to be reassessed. Your hospital would give you a number to contact for health advice if you feel that anything is changing, or you will have been told to report to the Accident and Emergency Department (A&E). If you have not been told what to do and need to speak to someone ring the hospital department which is treating you or the NHS 111 Service by dialing 111.

From the bottom of my heart, please be kind to yourself through your recovery. We are here for you whenever you need it.

With good wishes,


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