Ectopic Pregnancy: Symptoms, Causes, and Treatment
Updated: 3 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer: What is an ectopic pregnancy?
An ectopic pregnancy is a pregnancy in which the fertilized egg implants outside the main uterine cavity, most often in a fallopian tube. The egg cannot survive there, and growing tissue can cause life-threatening bleeding. Early signs are light bleeding and pelvic pain; shoulder pain or fainting can mean rupture. Treatment is methotrexate or surgery, sometimes emergency surgery. [1] [2]
What the research says
According to PubMed:
A past ectopic pregnancy and tubal or pelvic problems raise the risk the most. A meta-analysis of 11 studies with 25,051 patients found strong links with a history of ectopic pregnancy (OR 9.03, 95% CI 7.18 to 11.35), abdominal or pelvic surgery (OR 5.60), previous tubal ligation (OR 5.59), pelvic inflammatory disease (OR 4.00, 95% CI 3.46 to 4.61), and infertility (OR 3.70). (Brim et al., DOI).
Single-dose methotrexate holds up well against other tube-sparing options. A network meta-analysis of 35 randomized trials with 3,211 patients and 11 interventions found most options did not differ from single-dose methotrexate for success, expectant management had a lower success rate (RR 0.79, 95% CI 0.68 to 0.93), and multi-dose methotrexate caused more adverse events (OR 1.63, 95% CI 1.18 to 2.24). (Shi et al., DOI).
Treatment choice may affect later natural pregnancy, not repeat ectopic risk. In 20 observational studies with 3,530 participants, the odds of a later natural intrauterine pregnancy were higher after methotrexate than after surgery (OR 1.52, 95% CI 1.20 to 1.92) or salpingectomy (OR 2.11, 95% CI 1.52 to 2.93), with no significant difference in repeat ectopic pregnancy (OR 1.12 versus surgery). (Hao et al., DOI).
Study details are from PubMed abstracts.
Key facts at a glance
Key fact | What to know |
What it is | A pregnancy in which the fertilized egg implants outside the main cavity of the uterus [1] |
Most common location | Inside a fallopian tube (tubal pregnancy); also ovary, abdominal cavity, or cervix [1] |
Can it continue? | No. The egg cannot survive, and untreated growth may cause life-threatening bleeding [1] |
First warning signs | Light vaginal bleeding and pelvic pain [1] |
Emergency signs | Extreme lightheadedness, fainting, and shock from a ruptured tube [1] |
Main risk factors | Previous ectopic pregnancy, STI inflammation, fertility treatments, tubal surgery, certain birth control, smoking [1] |
How it is treated | Methotrexate injection, laparoscopic surgery, or emergency surgery [2] |
What an ectopic pregnancy is
Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when the fertilized egg implants and grows outside the main cavity of the uterus.
An ectopic pregnancy most often occurs in a fallopian tube, the tube that carries eggs from the ovaries to the uterus. This type is called a tubal pregnancy. Sometimes an ectopic pregnancy occurs in other areas of the body, such as the ovary, the abdominal cavity, or the lower part of the uterus (the cervix), which connects to the vagina.
An ectopic pregnancy cannot proceed normally. The fertilized egg cannot survive, and the growing tissue may cause life-threatening bleeding if left untreated.
Symptoms
You may not notice any symptoms at first. Some women who have an ectopic pregnancy notice the usual early signs of pregnancy: a missed period, breast tenderness, and nausea. If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy cannot continue as normal. As the fertilized egg grows in the improper place, signs and symptoms become more noticeable.
Early warning of ectopic pregnancy
Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain. If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated.
Emergency symptoms
If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting, and shock.
When to see a doctor
Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including severe abdominal or pelvic pain accompanied by vaginal bleeding, extreme lightheadedness or fainting, or shoulder pain.
Causes
A tubal pregnancy, the most common type of ectopic pregnancy, happens when a fertilized egg gets stuck on its way to the uterus. This often happens because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.
Risk factors
Some things make an ectopic pregnancy more likely:
Risk factor | What it means |
Previous ectopic pregnancy | If you have had this type of pregnancy before, you are more likely to have another [1] |
Inflammation or infection | Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and nearby organs [1] |
Fertility treatments | Research suggests women who have IVF or similar treatments are more likely to have an ectopic pregnancy; infertility itself may also raise the risk [1] |
Tubal surgery | Surgery to correct a closed or damaged fallopian tube can increase the risk [1] |
Choice of birth control | Pregnancy with an intrauterine device (IUD) in place is rare, but if it happens, it is more likely to be ectopic; pregnancy after tubal ligation (having your tubes tied) also raises the risk [1] |
Smoking | Cigarette smoking just before pregnancy increases the risk; the more you smoke, the greater the risk [1] |
Complications
An ectopic pregnancy can cause the fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding.
Can ectopic pregnancy be prevented?
There is no way to prevent an ectopic pregnancy. However, some steps can decrease your risk. Limiting the number of sexual partners and using a condom during sex helps to prevent sexually transmitted infections and may reduce the risk of pelvic inflammatory disease. Don't smoke. If you do, quit before you try to get pregnant.
How ectopic pregnancy is diagnosed
A pelvic exam can help a doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, a doctor cannot diagnose an ectopic pregnancy by examining you alone. Blood tests and an ultrasound are needed.
Test | What it does |
Pregnancy test (hCG blood test) | Confirms pregnancy; hormone levels increase during pregnancy. The test may be repeated every few days until ultrasound can confirm or rule out an ectopic pregnancy, usually about five to six weeks after conception [2] |
Transvaginal ultrasound | A wandlike device is placed into the vagina to create images of the uterus, ovaries, and fallopian tubes, showing the exact location of the pregnancy [2] |
Abdominal ultrasound | An ultrasound wand is moved over the belly to confirm pregnancy or evaluate internal bleeding [2] |
Other blood tests | A complete blood count checks for anemia or signs of blood loss; blood type tests may be ordered in case a transfusion is needed [2] |
Treatment options
A fertilized egg cannot develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery, or abdominal surgery.
Medication
An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection.
It is very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment. After the injection, the doctor will order another hCG blood test to determine how well treatment is working and whether more medication is needed.
Laparoscopic procedures
Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. A small incision is made in the abdomen, near or in the navel, and the doctor uses a thin tube equipped with a camera lens and light (a laparoscope) to view the tubal area.
In a salpingostomy, the ectopic pregnancy is removed and the tube is left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed. The procedure chosen depends on the amount of bleeding and damage, whether the tube has ruptured, and whether the other fallopian tube is normal or shows signs of prior damage.
Emergency surgery
If the ectopic pregnancy is causing heavy bleeding, emergency surgery may be needed. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed.
Coping and support
Losing a pregnancy is devastating, even if you have only known about it for a short time. Recognize the loss, and give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully. Rely on your partner, loved ones, and friends for support. You might also seek the help of a support group, grief counselor, or other mental health provider.
Your chances of a future pregnancy
Many women who have an ectopic pregnancy go on to have a future, healthy pregnancy. The female body normally has two fallopian tubes. If one is damaged or removed, an egg may join with a sperm in the other tube and then travel to the uterus. If both fallopian tubes have been injured or removed, in vitro fertilization (IVF) might still be an option. With this procedure, mature eggs are fertilized in a lab and then implanted into the uterus.
If you have had an ectopic pregnancy, your risk of having another one is increased. If you wish to try to get pregnant again, it is very important to see your doctor regularly. Early blood tests are recommended for all women who have had an ectopic pregnancy. Blood tests and ultrasound testing can alert your doctor if another ectopic pregnancy is developing.
Preparing for your appointment
Call your doctor's office if you have light vaginal bleeding or slight abdominal pain. The doctor might recommend an office visit or immediate medical care. Emergency medical help is needed for severe abdominal or pelvic pain with vaginal bleeding, extreme lightheadedness, or fainting: call 911 (or your local emergency number) or go to the hospital.
It can be helpful to jot down your questions before your visit. Questions to consider include: What kinds of tests do I need? What are the treatment options? What are my chances of having a healthy pregnancy in the future? How long should I wait before trying to become pregnant again? Will I need to follow any special precautions if I become pregnant again? Ask a loved one or friend to come with you, if possible. Sometimes it is difficult to remember all the information provided, especially in an emergency situation.
If you do not require emergency treatment and have not yet been diagnosed, your doctor will talk to you about your medical history and symptoms. You will be asked many questions about your menstrual cycle, fertility, and overall health, such as your last period, whether you could be pregnant, previous pregnancies and their outcomes, fertility treatments, where any pain is located, whether you have vaginal bleeding and whether it is more or less than your typical period, whether you feel lightheaded or dizzy, any reproductive surgery including having your tubes tied or a reversal, whether you have had a sexually transmitted infection, and the medications you take.
Conclusion and next steps
An ectopic pregnancy cannot continue as a normal pregnancy, and it cannot safely be left to resolve on its own. The growing tissue outside the uterus can rupture a fallopian tube and cause life-threatening bleeding, which is why early recognition and early treatment matter so much.
If you know you are pregnant and develop light vaginal bleeding, pelvic pain, or shoulder pain, contact your doctor right away. If you feel extreme lightheadedness or faint, or have severe abdominal or pelvic pain with bleeding, get emergency medical help immediately. With prompt care, whether medication, laparoscopic surgery, or emergency surgery, most women recover fully, and many go on to have healthy pregnancies in the future.
Next steps: If you have any signs or symptoms of an ectopic pregnancy, seek medical care promptly, and call 911 (or your local emergency number) for severe pain with bleeding, extreme lightheadedness, or fainting.
Frequently asked questions
What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus, most often inside a fallopian tube (a tubal pregnancy). It can also occur in the ovary, abdominal cavity, or cervix. The egg cannot survive, and the growing tissue may cause life-threatening bleeding if left untreated. [1]
What are the symptoms of an ectopic pregnancy?
You may first notice normal early pregnancy signs, including a missed period, breast tenderness, and nausea, and a pregnancy test will be positive. The first warning signs of an ectopic pregnancy are often light vaginal bleeding and pelvic pain. Shoulder pain, dizziness, or fainting may mean the fallopian tube has ruptured, which is a medical emergency. [1]
What causes an ectopic pregnancy?
A tubal pregnancy happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. [1]
Can an ectopic pregnancy be treated without surgery?
Yes, in many cases. An early ectopic pregnancy without unstable bleeding is most often treated with an injection of methotrexate, a medication that stops cell growth and dissolves existing cells. The diagnosis must be certain before this treatment, and follow-up hCG blood tests show whether more medication is needed. [2]
Can I have a healthy pregnancy after an ectopic pregnancy?
Many women who have had an ectopic pregnancy go on to have a future, healthy pregnancy. If one fallopian tube is damaged or removed, the other can often carry a pregnancy. If both tubes have been injured or removed, IVF might still be an option. Because the risk of another ectopic pregnancy is higher, early blood tests and ultrasound are recommended in future pregnancies. [2]
This article is for general education and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare professional about your individual situation.
Related Reading
Culdocentesis: Why It's Done, Procedure, Risks and Results explains the needle test that checks fluid behind the uterus.
Laparoscopy: What It Is, Uses, Procedure and Recovery explains the keyhole surgery often used to treat an ectopic pregnancy, how it works and when to call a doctor afterward.
Pregnancy Test: When to Take It, Types, Accuracy and Results: A pregnancy test turns positive even in an ectopic pregnancy; learn how urine and blood hCG tests work and what their results mean.
Learn more in our guide to Ultrasound: Types, How It Works, Preparation and Results.
Pelvic Ultrasound: Types, Preparation, What It Shows and Results explains the imaging test often used to find or rule out this condition.
Learn more in our guide to Transvaginal Ultrasound: Why It's Done, How to Prepare and What to Expect.
Pregnancy Ultrasound: Why It's Done, When You'll Have One, What to Expect and Results explains when pregnancy scans are done, what they check and why some people need extra ultrasounds.
Point-of-Care Ultrasound (POCUS): What It Is, Uses and How It Differs From a Standard Scan explains the bedside ultrasound clinicians use for quick, focused answers.
References
Mayo Clinic Staff. Ectopic pregnancy - Symptoms and causes. Mayo Clinic. March 12, 2022. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
Mayo Clinic Staff. Ectopic pregnancy - Diagnosis and treatment. Mayo Clinic. March 12, 2022. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093
Brim ACS, Barretto VRD, Reis-Oliveira JG, et al. Risk factors for ectopic pregnancy occurrence: systematic review and meta-analysis. Int J Gynaecol Obstet. 2024;168(3):919-932. PMID 39602079. https://doi.org/10.1002/ijgo.15965
Shi C, Wang H, Yang T, et al. Comparative efficacy of tube-sparing interventions for tubal ectopic pregnancy: a systematic review and network meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2026;325:115303. PMID 42468117. https://doi.org/10.1016/j.ejogrb.2026.115303
Hao HJ, Feng L, Dong LF, et al. Reproductive outcomes of ectopic pregnancy with conservative and surgical treatment: a systematic review and meta-analysis. Medicine (Baltimore). 2023;102(17):e33621. PMID 37115078. https://doi.org/10.1097/MD.0000000000033621
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