Methotrexate for ectopic pregnancy

Methotrexate for ectopic pregnancy
Medically reviewed by Dr. Marsha Dunkely


Methotrexate offers a non-surgical approach to managing ectopic pregnancies by halting cell division. Administered via injection, typically in one dose, it disrupts folic acid metabolism, effectively stopping the pregnancy’s progression. Regular blood tests monitor hormone levels, guiding the need for additional doses. Ectopic pregnancies, mostly occurring in fallopian tubes, pose grave risks if untreated, including rupture and internal bleeding. Methotrexate administration aims to mitigate these dangers and safely resolve ectopic pregnancies.

Can we treat an ectopic pregnancy with methotrexate?

Methotrexate treatment for ectopic pregnancy boasts a remarkable success rate, exceeding 95% while maintaining a favorable safety profile with minimal side effects when administered in small doses. Notably, this approach circumvents the necessity for general anesthesia and surgical intervention, offering a less invasive alternative.

Research indicates promising outcomes, with 93.8% of patients achieving successful termination of ectopic pregnancies following the administration of a second dose of methotrexate. These findings highlight the efficacy and reliability of methotrexate as a primary treatment modality for ectopic pregnancies.

How is methotrexate given for ectopic pregnancy?

Methotrexate stands as the predominant medication for treating ectopic pregnancy, exerting its effects by inhibiting cell growth, ultimately leading to the cessation of the pregnancy. Subsequently, the body naturally absorbs the pregnancy for 4 to 6 weeks, obviating the need for surgical removal of the fallopian tube.

Methotrexate administration typically involves oral intake, with dosages divided into two and spaced two hours apart. The dosage regimen commonly consists of 60 mg/m2 utilizing standard 2.5 mg methotrexate tablets. This approach ensures effective delivery of the medication and facilitates the desired therapeutic outcomes in managing ectopic pregnancies.

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What should be avoided during treatment with methotrexate?

During methotrexate treatment for ectopic pregnancy, certain precautions are essential to ensure the medication’s efficacy and safety. Here’s what to avoid:

  1. Anti-inflammatory medicines: Common over-the-counter medications like ibuprofen (Nurofen®), diclofenac (Voltaren®), and aspirin can heighten the risk of methotrexate side effects. It’s crucial to refrain from taking these medicines throughout the methotrexate treatment period and for one week post-treatment.
  1. Products containing folic acid: Multivitamins and folic acid products should be avoided, as they can diminish the effectiveness of methotrexate treatment. It’s advisable to avoid folic acid products during treatment, seeking guidance from a healthcare provider or pharmacist if needed.
  1. Alcohol consumption: Alcohol intake can exacerbate methotrexate side effects. It’s recommended to abstain from alcohol for at least seven days following methotrexate treatment.

Additional precautions include:

  • Discontinuing folic acid or prenatal vitamins can reduce the success of methotrexate.
  • Avoiding progesterone supplements.
  • Refraining from non-steroidal anti-inflammatory medicines like Advil®, Aleve®, and Motrin® for ten days post-treatment.
  • Avoid prolonged sun exposure or tanning bed use for at least seven days.
  • Abstaining from sexual intercourse for a minimum of two weeks after the last methotrexate injection. Consult with a healthcare provider before resuming sexual activity.
  • Using condoms or other forms of birth control until hCG levels normalize and when considering future pregnancy plans.

The optimal timing for attempting pregnancy again is typically recommended three months post-methotrexate medication, but individual circumstances may vary. 

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What to expect after taking methotrexate for ectopic pregnancy?

Following methotrexate administration for ectopic pregnancy, patients may experience several post-treatment effects. These typically include:

  • Mild to moderate cramping may occur for 3 to 7 days post-treatment. Patients are advised to take prescribed pain medication to alleviate discomfort effectively.
  • Light vaginal bleeding or irregularities in menstrual patterns may be expected, potentially lasting longer than usual. Passing gray-pink tissue, termed a “cast,” from the uterus is also normal.
  • Similar to menstrual symptoms, patients may encounter mild to moderate abdominal pain and vaginal bleeding resembling a period.
  • Healthcare providers typically recommend undergoing blood tests 2 to 3 times weekly for 2 to 3 weeks post-treatment. These tests evaluate the efficacy of methotrexate in halting the pregnancy and guide further management decisions.

Adhering to prescribed pain management strategies and attending scheduled follow-up appointments are crucial for optimal recovery and monitoring progress.

How quickly does methotrexate work for ectopic pregnancy?

Methotrexate’s efficacy in resolving ectopic pregnancy typically manifests within a relatively short timeframe. According to the American College of Obstetricians and Gynaecologists, resolution post-methotrexate treatment generally occurs within 2 to 4 weeks, although in some cases, it may take up to 8 weeks.

The effectiveness of methotrexate is closely monitored through blood tests to assess the level of pregnancy hormones in the bloodstream. Typically, the pregnancy hormone level declines within 2 to 4 days post-treatment. Based on these blood test results, healthcare providers determine the need for additional methotrexate injections or alternative interventions.

Is this method of ectopic pregnancy treatment suitable for me?

The suitability of methotrexate treatment for ectopic pregnancy varies depending on individual circumstances. Some factors may influence its suitability and success:

  • Patients in good overall health are typically better candidates for methotrexate treatment.
  • The treatment is more likely to succeed if the fallopian tube has not ruptured.
  • Methotrexate treatment is typically considered when the pregnancy hormone (hCG) level is below a certain threshold, as determined by the healthcare provider.
  • The presence of severe abdominal bleeding may necessitate surgical intervention.

Advantages Over Surgery

  • Methotrexate treatment may be preferable for individuals with medical conditions that increase the risks associated with general anesthesia.
  • Individuals with adhesions from prior surgeries or infections may benefit from methotrexate treatment.
  • Methotrexate treatment is particularly advantageous if the ectopic pregnancy is situated in specific locations, such as the neck of the womb or where the fallopian tube enters the womb.

Conditions precluding methotrexate treatment:

However, methotrexate treatment may not be appropriate if you have the following conditions:

  • Ongoing infection
  • Severe anemia or blood cell deficiencies
  • Kidney or liver problems
  • Active infection, including HIV/AIDS
  • Peptic ulcer or ulcerative colitis

It’s essential to discuss your medical history and individual circumstances with your healthcare provider to determine the most suitable treatment approach for ectopic pregnancy.

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When should I see a doctor?

Notify your healthcare provider if you experience any new or worsening symptoms, such as severe abdominal pain, heavy vaginal bleeding, dizziness, or fainting. These could indicate complications requiring immediate medical attention.


What are the signs that methotrexate is working for ectopic pregnancy?

The pregnancy hormone level should decrease within 2 to 4 days post-treatment. Based on these blood test results, your healthcare provider will determine if an additional methotrexate dose is required.

Is there anything I should avoid while taking methotrexate?

While there are no specific foods to avoid while taking methotrexate, it’s essential to be mindful of potential interactions and side effects. Methotrexate may weaken your immune system, so avoiding unpasteurized milk and soft cheeses is advisable to reduce the risk of infection. Limiting caffeine consumption from coffee, tea, cola, energy drinks, and chocolate is also recommended.

What happens after I get methotrexate?

After taking methotrexate, you may experience side effects such as nausea, vomiting, decreased appetite, and mouth sores. These symptoms typically resolve within 24 hours post-treatment.

How long does methotrexate stay in your system for ectopic pregnancy?

Due to concerns regarding the persistence of methotrexate (MTX) and its metabolites in organs, potentially impacting pregnancy or fetal development, it’s generally recommended to wait 3 to 6 months after stopping therapy before attempting pregnancy.

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  • Cecchino, Gustavo Nardini, Edward Araujo Júnior, and Julio Elito Júnior. “Methotrexate for ectopic pregnancy: when and how.” Archives of gynecology and obstetrics 290 (2014): 417-423.
  • Marret, Henri, Arnaud Fauconnier, Gil Dubernard, Hélène Misme, Laurence Lagarce, Magali Lesavre, Hervé Fernandez et al. “Overview and guidelines of off-label use of methotrexate in ectopic pregnancy: report by CNGOF.” European Journal of Obstetrics & Gynecology and Reproductive Biology 205 (2016): 105-109.
  • Svirsky, Ran, Uri Rozovski, Zvi Vaknin, Moty Pansky, David Schneider, and Reuvit Halperin. “The safety of conception occurring shortly after methotrexate treatment of an ectopic pregnancy.” Reproductive Toxicology 27, no. 1 (2009): 85-87.
  • Bonin, Lucie, Cécile Pedreiro, Stéphanie Moret, Gautier Chene, Pascal Gaucherand, and Géry Lamblin. “Predictive factors for the methotrexate treatment outcome in ectopic pregnancy: A comparative study of 400 cases.” European Journal of Obstetrics & Gynecology and Reproductive Biology 208 (2017): 23-30.


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