When Will Menstruation Return After Medication for Ectopic Pregnancy?

When does menstruation return after medication treatment for ectopic pregnancy?

Hello, Doctor.
I discovered I had a chronic ectopic pregnancy in early September and underwent examinations and follow-ups.
I received two injections of Methotrexate on October 2 and October 9.
From early September to October 13, I experienced intermittent bleeding.
From October 16 to November 1, there was no bleeding.
On October 16, my B-hCG level was 70, and on October 27, it was 10.
After that, I did not return for a follow-up.
However, on November 2, I noticed vaginal bleeding again.
I would like to know if this could be my menstrual period.
The doctor mentioned that menstruation might return in 4 to 6 weeks.
Should I see a doctor again? I do not feel any discomfort in my body.
Is this normal menstruation?

emily, 20~29 year old female. Ask Date: 2006/11/02

Dr. Lin Zhaopei reply Obstetrics and Gynecology

Theoretically, once the B-hCG level drops to 25, menstrual cycle functionality begins to resume.
However, the initial menstrual periods may not have ovulatory function, which means 1.
the dates may not be very accurate, and 2.
it may not be possible to conceive again immediately.
On October 27, the B-hCG level was 10, and there was bleeding again on November 2.
This bleeding is primarily due to hormonal imbalance and can somewhat be considered a menstrual period.
However, the menstrual cycle in December may not be very regular.
If there are no discomforts, there is no need to return for a follow-up appointment at this time.

Reply Date: 2006/11/02

More Info

After undergoing treatment for an ectopic pregnancy, particularly with the administration of Methotrexate (MTX), it is common for women to experience irregular bleeding or spotting as their body adjusts and recovers. The timeline for the return of menstruation can vary significantly from one individual to another, but generally, it is expected to resume within 4 to 6 weeks after the last MTX injection.

In your case, you received two doses of MTX on October 2nd and October 9th, and you noted that you had intermittent bleeding from early September until October 13th, followed by a cessation of bleeding until November 2nd, when you experienced vaginal bleeding again. The B-hCG levels you reported also indicate a decline, which is a positive sign that the treatment is working, as the hormone levels should decrease after the resolution of an ectopic pregnancy.

The bleeding you experienced on November 2nd could potentially be your first menstrual period following the treatment, especially since it has been several weeks since your last injection of MTX. However, it is important to note that the first period after such treatment can sometimes be irregular and may not resemble your typical menstrual cycle. It can be lighter or heavier than usual, and the duration may also vary.

Given that you are not experiencing any discomfort or other concerning symptoms, this could be a normal part of your recovery process. However, it is always prudent to keep in touch with your healthcare provider, especially if you notice any significant changes in your bleeding pattern, such as an increase in flow, the presence of large clots, or if you experience any pain or discomfort.

If the bleeding continues or if you have any concerns about whether it is indeed your menstrual period or if it could be related to other issues, it would be wise to schedule a follow-up appointment with your doctor. They can perform an examination and possibly check your hormone levels again to ensure everything is progressing as expected.

In summary, while it is likely that the bleeding you are experiencing could be your menstrual cycle returning after the MTX treatment, it is essential to monitor your symptoms and maintain open communication with your healthcare provider to ensure your health and well-being during this recovery phase.

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