Ectopic Pregnancy: The Warning Signs

TL;DR: About 1 in 90 pregnancies in the UK is ectopic, meaning it implants outside the womb, usually in a fallopian tube. Warning signs include pain low on one side, bleeding that is different from your period, and pain in the tip of your shoulder. Sudden severe tummy pain with dizziness or fainting is an emergency. Most women go on to have healthy pregnancies afterwards.

You missed your period, the test came back positive, and then something felt off. A pain low on one side that will not settle. Spotting that looks brown and patchy rather than like your usual flow. Maybe you put it down to stress or a stomach bug and decided to wait and see. With most early pregnancy niggles, waiting is fine. With an ectopic pregnancy, knowing the warning signs and acting on them early can protect your health, your fertility and, in the worst cases, your life.

What is an ectopic pregnancy?

An ectopic pregnancy is one that implants and grows outside the womb, most often in a fallopian tube. A pregnancy cannot survive there, and as it grows it can stretch and split the tube, causing internal bleeding. The NHS estimates that around 1 in 90 pregnancies is ectopic, roughly 11,000 a year in the UK.

It helps to see this alongside other early pregnancy loss. A miscarriage happens inside the womb, while an ectopic pregnancy can become urgent quickly. We explain what to expect with miscarriage in miscarriage: what happens and how to cope. The two can look similar at first, which is exactly why bleeding or pain in early pregnancy deserves a check.

What are the warning signs of an ectopic pregnancy?

The main signs are tummy pain low down on one side, vaginal bleeding that differs from a normal period, pain in the tip of your shoulder, and discomfort when you pee or open your bowels. Symptoms usually appear between weeks 4 and 12, though some women have none until an early scan picks it up.

Here is what each one can feel like:

• One-sided pain. Low in the tummy, on one side. It can start suddenly or build gradually, and it may come and go.
• Bleeding that is not quite a period. The NHS describes it as bleeding that often starts and stops and may be watery and dark brown. Some women mistake it for a light period and do not realise they were pregnant.
• Shoulder tip pain. An odd ache where your shoulder ends and your arm begins. It can be a sign of internal bleeding, so it needs medical advice straight away.
• Bowel and bladder changes. Pressure in your bottom when you poo, pain when you pee, or diarrhoea.

Each of these on its own has plenty of harmless explanations. The pattern that matters is a combination of them when you are, or could be, pregnant. The NHS advises contacting your GP or NHS 111 in that situation, even if you have not yet had a positive test.

When is it an emergency?

If an ectopic pregnancy ruptures the tube, the bleeding can be life-threatening. The signs of rupture are a sharp, sudden, intense pain in your tummy together with feeling very dizzy or fainting, feeling sick, and looking very pale. Call 999 or go straight to A&E. In Nigeria, Kenya, Ghana or South Africa, go to the nearest hospital emergency unit rather than a pharmacy or chemist, and tell the staff you might be pregnant.

Timing matters. A ten-year review at a district hospital in Ghana found that 71 percent of women with an ectopic pregnancy had already ruptured by the time they arrived, and the odds of rupture rose with each extra week after a missed period. Coming in early is often the difference between a small procedure and emergency surgery.

Who is more at risk?

Any sexually active woman can have an ectopic pregnancy, and many have no risk factors at all. That said, the NHS and the Royal College of Obstetricians and Gynaecologists (RCOG) list several things that raise the chance:

• A previous ectopic pregnancy. The risk of another is around 7 to 10 in 100, compared with just over 1 in 100 for everyone else.
• Pelvic inflammatory disease (PID). PID is usually caused by sexually transmitted infections like chlamydia and gonorrhoea, and it can scar the fallopian tubes. The NHS notes that PID raises the risk of ectopic pregnancy and that not everyone with it has symptoms. This is one more reason regular STI testing matters, which we cover in our guide to STI symptoms, prevention and treatment.
• Getting pregnant with a coil in place. The coil (IUD or IUS) is very effective, so pregnancy while using one is rare. But the RCOG notes that if you do become pregnant with a coil fitted, or while taking the progestogen-only pill, an ectopic pregnancy is more likely. If you have a coil and get a positive test, seek care promptly. Our contraception comparison explains how each method works.
• Previous surgery on the fallopian tubes, pregnancy through IVF, smoking, and being over 35.

How is it diagnosed?

Diagnosis usually involves a transvaginal ultrasound scan and blood tests for the pregnancy hormone hCG, sometimes repeated over a few days. Very early on, a pregnancy may be too small to see anywhere, which the RCOG calls a pregnancy of unknown location. If that happens, you will be monitored with repeat tests until it is clear where the pregnancy is.

Pain on one side in early pregnancy is not always ectopic. An ovarian cyst, for example, can cause a similar one-sided ache. Our post on ovarian cysts explains the difference, and our pelvic pain guide covers other causes. Only a scan and blood tests can tell them apart.

What are the treatment options?

There are three main approaches, and the right one depends on your hCG levels, what the scan shows, your symptoms and your plans for future pregnancies. According to the NHS:

• Expectant management. If the pregnancy is small and you are well, it may resolve by itself, with close monitoring through blood tests.
• Methotrexate. A single injection that stops the pregnancy from growing. You will need reliable contraception for at least 3 months afterwards, because the medicine can harm a developing baby, and you should avoid alcohol while it clears.
• Keyhole surgery. Usually the affected tube is removed, called a salpingectomy, if the other tube looks healthy. The NHS calls this the most effective treatment and says it is not thought to reduce your chances of getting pregnant again. If your other tube is damaged or missing, the surgeon may remove just the pregnancy and keep the tube, which the RCOG says carries a higher risk of a future ectopic.

If your blood group is RhD negative, you were at least 12 weeks pregnant and you are having medicine or surgery, the NHS says you will usually be offered an anti-D injection.

Can I get pregnant again after an ectopic pregnancy?

Yes, most women can. The RCOG says the chances of a successful future pregnancy are good, and even with one fallopian tube your chances of conceiving are only slightly reduced. For most women, an ectopic pregnancy is a one-off.

When you are ready, contact your clinician as soon as you know you are pregnant. You may be offered a scan at 6 to 8 weeks to confirm the pregnancy is in the womb. The NHS suggests waiting at least two periods after treatment, or 3 months after methotrexate, before trying again. Our fertility tips can help when that time comes.

Give yourself room to grieve, too. An ectopic pregnancy is a loss, sometimes combined with the shock of an emergency, and it can affect partners as well. In the UK, the Ectopic Pregnancy Trust offers support, and your GP can refer you for counselling if you are struggling.

Keeping track can help you act sooner

Many ectopic pregnancies are caught later because the bleeding gets mistaken for a period. Knowing when your last period started, and what your normal flow looks like, makes it easier to notice when something is different. Asele's cycle tracking and symptom logging give you that record, and the Health Brief turns it into a clear summary to show a doctor. Amara can also help you think through symptoms in Yoruba, Hausa, Igbo, Swahili, French or English, though it never replaces urgent care. You can find us at Asele.

This post is education, not medical advice. If you might be pregnant and have one-sided pain, unusual bleeding or shoulder tip pain, get checked. If the pain is sudden and severe, or you feel faint, treat it as an emergency.

References

1. NHS. Ectopic pregnancy. nhs.uk
2. NHS. Ectopic pregnancy: symptoms. nhs.uk
3. NHS. Ectopic pregnancy: treatment. nhs.uk
4. Royal College of Obstetricians and Gynaecologists. Ectopic pregnancy: patient information leaflet. rcog.org.uk
5. NHS. Pelvic inflammatory disease. nhs.uk
6. Sefogah PE, et al. Factors Associated with Ruptured Ectopic Pregnancy: A 10-Year Review at a District Hospital in Ghana. Obstetrics and Gynecology International, 2022. pmc.ncbi.nlm.nih.gov