Methotrexate Treatment for Ectopic Pregnancy
What Is Methotrexate?
Methotrexate is an antimetabolite drug, which has been available for many years for the treatment of certain types of cancer, rheumatoid arthritis and some skin diseases such as psoriasis. In the past several years, studies have demonstrated that methotrexate is also effective against certain types of ectopic (tubal) pregnancy. The use of methotrexate for the treatment of ectopic pregnancy is still considered experimental at this time but has been shown to be safe in short term follow-up from studies available to date.
How Does Methotrexate Work For Tubal Pregnancy?
Methotrexate acts to inhibit DNA synthesis and repair in actively growing cells such as are found in an ectopic pregnancy. The mode of action of methotrexate is to interfere with certain Vitamin B enzyme functions. This effect is only temporary but usually is enough to stop the growth of the ectopic pregnancy, which is then reabsorbed by the body. All other normal, healthy cells will usually recover rapidly and get back to normal within five to ten days.
How Do You Know If I Have A Tubal Pregnancy?
Ectopic or tubal pregnancy is diagnosised by blood tests (HCG or Human Chononic Gonadotrophin and Progesterone) and by vaginal ultrasound examination. Tubal pregnancy will often have an abnormal rate of rise of HCG as compared to a normal pregnancy. At a certain level of HCG hormone, we should be able to see a normal pregnancy in the uterus on vaginal ultrasound examination. This usually occurs about 5.5 weeks of pregnancy (from the first date of the last menstrual period.) It is often necessary to perform a D and C procedure (to remove tissue from the inside of the uterus) to tell a tubal pregnancy from an early miscarriage occurring inside the uterus.
What Are The Advantages Of Methotrexate Treatment?
In the past, either major or laparoscopic surgeries have been the only available treatment for tubal pregnancy. Surgery requires general anesthesia and several days to several weeks of recovery. Medical or drug treatment with methotrexate is intended to avoid surgery for this problem. Potential benefits include less discomfort, less scar tissue formation, faster recovery to normal activity, and much less cost.
How Is Methotrexate Given?
After all blood tests, ultrasounds, etc. are completed; the medication is given as an intramuscular injection at the office. You will be given specific instructions when to return for follow-up lab tests and office visits.
Is Methotrexate Always Successful For Tubal Pregnancy?
This treatment appears to be about 90-95% successful for the treatment of ectopic pregnancy. It is sometimes necessary to give a second course of medication if the first treatment is not adequate to stop the growth of the tubal pregnancy. Chances for successful treatment are best if the diagnosis is made early and treatment is given right away. Some women who receive methotrexate may still eventually require surgery to treat their tubal pregnancy, although this is uncommon.
What Are The Side Effects Of This Treatment?
Most women who received methotrexate treatment for ectopic pregnancy will experience a flu-like syndrome for 2-3 days after treatment. Symptoms can include muscle aches, feeling tired, mild nausea, dizziness, chills, abdominal cramps, and diarrhea. Much less common symptoms include skin rashes, vomiting, sores in the mouth area, and fever. All symptoms are temporary and will usually resolve in 3-7 days
Are There Any Serious Risks of Methotrexate Treatment?
The dose of this medication used to treat ectopic pregnancy is much smaller than the amount used to treat cancer, arthritis, or other conditions. High dosage and longer treatment protocols for methotrexate have resulted in rare serious complications such as leukopenia (low white blood cell count), liver damage, lung damage, anemia or bone marrow suppression, and damage to the intestinal system with internal bleeding. Studies on the use of this medication to date have not shown any permanent or long lasting health problems with the lower dose of methotrexate used for treatment of tubal pregnancy.
Is Methotrexate Treatment Still Considered Experimental?
Methotrexate has been used for many years for cancer and other conditions and is not an experimental drug. However, the use of this drug for tubal pregnancy is still considered experimental and the long-term safety of this treatment is not proven. Most of the treatment programs currently available are on strict research protocols. Because the only alternative involves surgery, the benefits of drug treatment for tubal pregnancy appear to outweigh the risks at this time. The final decision to use this medication is the responsibility of each patient.
If I Use Methotrexate, What Can I Do To Help The Treatment?
It is very important to return all follow-up blood tests and visit as recommended by your doctor. Since this treatment does not work in all cases, failure to return as directed could be life threatening. You should drink large amounts of fluids (water, juice, etc.) for two days after your injection. It is very important not to take ibuprofen (Motrin, Advil, Nuprin, etc.), aspirin, Anaprox, or any related anti-inflammatory drug for several days after methotrexate use, as these medications can increase the risk of side effects. Tylenol is considered safe to use. You should also avoid any sulfa drugs or vitamins containing Vitamin B for several days after methotrexate. We also strongly recommend that you refrain from sexual intercourse, vigorous physical activity, and alcohol intake until you are told that the tubal pregnancy is resolved.
