Is Ectopic Pregnancy Possible? Symptoms and Testing

Is it possible to have an ectopic pregnancy?

Hello, Doctor.
I apologize for interrupting you during your busy schedule.
I would like to ask about my recent menstrual cycle, which was from March 1 to March 7.
I had unprotected intercourse on the 10th, and on the afternoon of the 16th, I started experiencing some light bleeding (bright red) but not much.
There was no bleeding on the 17th, and I had a little bleeding in the morning on the 18th and 19th.
On the 19th, I bought a pregnancy test, which came back negative.
That evening, I visited a gynecologist who prescribed medication and performed an internal examination, stating that I might be experiencing hormonal imbalance (I mentioned that I was taking skin whitening medication, which the doctor said could affect my hormones, so I stopped taking it after the 19th).
However, since taking the prescribed medication, I have continued to have intermittent light bleeding, resembling spotting, with no abdominal pain.
The doctor advised me to take the medication for two weeks, but I am worried about the possibility of an ectopic pregnancy.
Should I take another pregnancy test? When would be the best time to test for accuracy? Are there any other tests that could provide more certainty? Thank you very much for taking the time to respond!

JoJo, 30~39 year old female. Ask Date: 2021/03/25

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please take a home pregnancy test or consult a gynecologist for evaluation four weeks after sexual intercourse.
2.
If the pregnancy test is positive and accompanied by abdominal pain, it is recommended to go to the hospital for a blood test and a transvaginal ultrasound to rule out the risk of an ectopic pregnancy.

Reply Date: 2021/03/25

More Info

Ectopic pregnancy, or a pregnancy that occurs outside the uterus, typically in the fallopian tubes, is indeed a serious condition that can present with various symptoms. Your situation, characterized by irregular bleeding and a negative pregnancy test, raises valid concerns about the possibility of an ectopic pregnancy, especially given the recent sexual activity without contraception.

Firstly, it is important to understand the typical symptoms of ectopic pregnancy. Common signs include abdominal or pelvic pain, vaginal bleeding, and sometimes gastrointestinal symptoms. However, some women may experience very mild symptoms or none at all, making diagnosis challenging. In your case, the intermittent light bleeding you described could be attributed to hormonal fluctuations, especially if you have a history of irregular menstrual cycles. Hormonal imbalances can lead to spotting or breakthrough bleeding, which may mimic the signs of early pregnancy or complications like ectopic pregnancy.

Regarding your negative pregnancy test on March 19, it is essential to note that home pregnancy tests are generally reliable but can yield false negatives, particularly if taken too early. The hormone human chorionic gonadotropin (hCG), which is produced during pregnancy, may not be at detectable levels if implantation has just occurred or if the pregnancy is ectopic. If you continue to experience symptoms or if your bleeding persists, it is advisable to repeat the pregnancy test a few days later, as hCG levels typically double every 48 to 72 hours in a normal pregnancy.

In addition to repeating the pregnancy test, you should consider further evaluation. An ultrasound, particularly a transvaginal ultrasound, can provide valuable information about the location of the pregnancy and whether it is developing normally within the uterus. If an ectopic pregnancy is suspected, the ultrasound may reveal a mass in the fallopian tube or other areas outside the uterus, along with the absence of a gestational sac in the uterine cavity.

If you experience severe abdominal pain, dizziness, or fainting, these could be signs of a ruptured ectopic pregnancy, which is a medical emergency requiring immediate attention. In such cases, it is crucial to seek emergency medical care.

In summary, while your symptoms may be related to hormonal imbalances, the possibility of an ectopic pregnancy cannot be ruled out without further testing. It is advisable to follow up with your healthcare provider, repeat the pregnancy test in a few days, and consider an ultrasound for a more definitive diagnosis. Your health and safety are paramount, so do not hesitate to seek medical attention if your symptoms worsen or if you have any concerns.

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