What is amenorrhea?

What is amenorrhea?

Amenorrhea is a condition in which there is an absense of menstrual periods in a woman. There are two types of amenorrhea, 1) primary and 2) secondary. Treatment of amenorrhea depends on the type (primary or secondary). In prmiray, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options.

Amenorrhea is the medical term for the absence of menstrual periods, either on a permanent or temporary basis. Amenorrhea can be classified as primary or secondary. In primary amenorrhea, menstrual periods have never begun (by age 16), whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.

The menstrual cycle can be influenced by many internal factors such as transient changes in hormonal levels, stress, and illness, as well as external or environmental factors. Missing one menstrual period is rarely a sign of a serious problem or an underlying medical condition, but amenorrhea of longer duration may signal the presence of a disease or chronic condition.

What causes amenorrhea?

The normal menstrual cycle occurs because of changing levels of hormones made and secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located at the base of the brain, which is, in turn, controlled by hormones produced in the hypothalamus of the brain. Disorders that affect any component of this regulatory cycle can lead to amenorrhea. However, a common cause of amenorrhea in young females sometimes overlooked or misunderstood by the individual and others, is an undiagnosed pregnancy. Amenorrhea in pregnancy is a normal physiological function. Occasionally, the same underlying problem can cause or contribute to either primary or secondary amenorrhea. For example, hypothalamic problems, anorexia or extreme exercise can play a major role in causing amenorrhea depending on the age of the person and if she has experienced menarche.

Primary amenorrhea

Primary amenorrhea is typically the result of a genetic or anatomic condition in young females that never develop menstrual periods (by age 16) and is not pregnant. Many genetic conditions that are characterized by amenorrhea are conditions in which some or all of the normal internal female organs either fail to form normally during fetal development or fail to function properly. Diseases of the pituitary gland and hypothalamus (a region of the brain important for the control of hormone production) can also cause primary amenorrhea since these areas play a critical role in the regulation of ovarian hormones.

Gonadal dysgenesis is the name of a condition in which the ovaries are prematurely depleted of follicles and oocytes (egg cells) leading to premature failure of the ovaries. It is one of the most common cases of primary amenorrhea in young women.

Another genetic cause is Turner syndrome, in which women are lacking all or part of one of the two X chromosomes normally present in the female. In Turner syndrome, the ovaries are replaced by scar tissue and estrogen production is minimal, resulting in amenorrhea. Estrogen-induced maturation of the external female genitalia and sex characteristics also fails to occur in Turner syndrome.

Other conditions that may be causes of primary amenorrhea include androgen insensitivity (in which individuals have XY (male) chromosomes but do not develop the external characteristics of males due to a lack of response to testosterone and its effects), congenital adrenal hyperplasia, and polycystic ovary syndrome (PCOS).

Secondary amenorrhea

Pregnancy is an obvious cause of amenorrhea and is the most common reason for secondary amenorrhea. Further causes are varied and may include conditions that affect the ovaries, uterus, hypothalamus, or pituitary gland.

Hypothalamic amenorrhea is defined as amenorrhea that is due to a disruption in the regulator hormones produced by the hypothalamus in the brain. These hormones influence the pituitary gland, which in turn sends signals to the ovaries to produce the characteristic cyclic hormones. A number of conditions can affect the hypothalamus and lead to hypothalamic amenorrhea, such as:

• extreme weight loss,
  
• emotional or physical stress,
  
• rigorous exercise, and
  
• severe illness.

Other types of medical conditions can cause secondary amenorrhea:

• tumors or other diseases of the pituitary gland that lead to elevated levels of thehormone prolactin (which is involved in milk production) also cause amenorrhea due to the elevated prolactin levels;
  
• hypothyroidism;
  
• elevated levels of androgens (male hormones), either from outside sources or from disorders that cause the body to produce too high levels of male hormones;
  
• ovarian failure (premature ovarian failure or early menopause);
  
• polycystic ovary syndrome; and
  
• Asherman's syndrome is an example of uterine disease that causes amenorrhea. It results from scarring of the uterine lining following instrumentation (such asdilation and curettage) of the uterine cavity to manage postpartum bleeding or infection.

Post-pill amenorrhea

Women who have stopped taking oral contraceptive pills should experience the return ofmenstruation within three months after discontinuing pill use. Previously, it was believed that birth control pills increased a woman's risk of amenorrhea following use of the pill, but this has been proven not to be the case. Women who do not resume menstruation after three months have passed since oral contraceptive pills were stopped should be evaluated for causes of secondary amenorrhea.

What are the symptoms of amenorrhea?

Primary or secondary amenorrhea (respectively) is considered to be present when a girl has:

• not developed menstrual periods by age 16; or
  
• a woman who has previously had a menstrual cycle stops having menstrual periods for three cycles in a row, or for a time period of six months or more and is not pregnant.

Other symptoms and signs may be present, which are highly variable and depend upon the underlying cause of the amenorrhea. For example, symptoms of hormonal imbalance or male hormone excess can include irregular menstrual periods, unwanted hair growth, deepening of the voice, and acne. Elevated prolactin levels as a cause of amenorrhea can result in galactorrhea (a milky discharge from the nipples that is not related to normal breastfeeding).

When should I seek medical care for amenorrhea?

It is always appropriate to seek medical attention for amenorrhea. Amenorrhea that is not related to pregnancy or the menopausal transition (time when there has been no menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified, and the female is at the end of her biological-determined child bearing years) should be further investigated to rule out serious conditions that may result in amenorrhea.

How is amenorrhea diagnosed?

The diagnosis of amenorrhea requires a careful medical history to document the presence of amenorrhea as well as any other coexisting medical conditions that may be the cause of amenorrhea. A physical examination, including a pelvic examination is also performed.

Depending upon the results of the history and physical examination further diagnostic tests may be ordered. Blood tests may be ordered to examine the levels of ovarian, pituitary, and thyroid hormones. These tests may include measurements of prolactin, follicle-stimulating hormone (FSA), estrogen, thyrotropin, dehydroepiandrosterone sulfate (DHEA-S), and testosterone. For some individuals, a pregnancy test is the first test performed.

Imaging studies, such as ultrasound, X-ray, and CT or MRI scanning may also be recommended in certain individuals to help establish the cause of amenorrhea

Treatment of both primary and secondary amenorrhea is determined by the precise cause of the amenorrhea. Treatment goals can be to relieve symptoms of hormonal imbalance, to establish menstruation, prevent complications associated with amenorrhea, and/or to achieve fertility, although not all of these goals can be achieved in every case.

In cases in which genetic or anatomical abnormalities are the cause of amenorrhea (typically primary amenorrhea), surgery may be recommended to correct anatomical abnormalities.

Hypothalamic amenorrhea that is related to weight loss, excessive exercise, physical illness, or emotional stress can typically be corrected by addressing the underlying cause. For example, weight gain and reduction in intensity of exercise can usually restore menstrual periods in women who have developed amenorrhea due to weight loss or overly intensive exercise, respectively, who do not have additional causes of amenorrhea. In some cases, nutritional counseling may be of benefit.

In premature ovarian failure, hormone therapy may be recommended both to avoid the unpleasant symptoms of estrogen depletion as well as prevent complications (see below) of low estrogen level such as osteoporosis. This may consist of oral contraceptive pills for those women who do not desire pregnancy or alternative estrogen and progesterone medications. While postmenopausal hormone therapy has been associated with certain health risks in older women, younger women with premature ovarian failure can benefit from this therapy to prevent bone loss.

Women with PCOS (polycystic ovary syndrome) may benefit from treatments that reduce the level or activity of male hormones, or androgens.

Dopamine agonist medications such as bromocriptine (Parlodel) can reduce elevated prolactin levels, which may be responsible for amenorrhea. Consequently, medication levels may be adjusted by the person's physician if appropriate.

Assisted reproductive technologies and the administration of gonadotropin medications (drugs that stimulate follicle maturation in the ovaries) can be appropriate for women with some types of amenorrhea who wish to attempt to become pregnant.

While many companies and individuals have marketed herbal therapies as a treatment for amenorrhea, none of these have been conclusively proved to be of benefit. Herbal therapies are not regulated by the U.S. FDA and the quality of herbal preparations is not tested. Herbal remedies have been associated with serious and even fatal side effects in rare cases, and some preparations have been shown to contain high levels of toxins. Before deciding to take a natural or alternative remedy for amenorrhea, it is wise to seek the advice of your health care practitioner

What are the complications of amenorrhea?

Infertility is a significant complication of amenorrhea for women who desire to become pregnant. Osteopenia (a reduction in bone density) or osteoporosis is a complication of low estrogen levels, which may occur with prolonged amenorrhea. Other complications of amenorrhea depend upon the underlying cause of the amenorrhea.

Can amenorrhea be prevented?

Amenorrhea is a symptom and not a disease in itself. Therefore, amenorrhea can be prevented only to the extent that the underlying cause can be prevented. For example, amenorrhea that results from genetic or inborn conditions cannot be prevented. On the other hand, amenorrhea that results from self-imposed stringent dieting or intensive exercise is typically preventable.

What is the outlook for a woman suffering from amenorrhea?

The outlook for amenorrhea varies widely and is dependent upon the cause of the amenorrhea. Hypothalamic amenorrhea that is a result of stress, exercise, or weight loss generally can be corrected if the responsible factors can be corrected. Medical and hormonal therapies can be of great benefit in preventing unpleasant side effects or complications of amenorrhea in many women.

Amenorrhea At A Glance

• Amenorrhea refers to the absence of menstrual periods; it may be either primary (meaning a woman never developed menstrual periods) or secondary (absence of menstrual periods in a woman who was previously menstruating).
  
• Genetic or inborn conditions are the most common causes of primary amenorrhea.
  
• Amenorrhea may result from disorders of the ovaries, pituitary gland, or hypothalamus.
  
• Intensive exercising, extreme weight loss, physical illness, and stress can all result in amenorrhea.
  
• Amenorrhea is a symptom and not a disease in itself, so amenorrhea can be prevented only to the extent that the underlying cause can be prevented.
  
• Infertility and bone loss (osteoporosis) are complications of amenorrhea.
  
• Treatments may include surgical correction of anatomical abnormalities, medications or hormone therapies, and treatment of any underlying conditions responsible for amenorrhea.
  
• The outlook for amenorrhea varies according to the cause of the amenorrhea.

Medications

• Birth Control Pills (Oral Contraceptives)
• bromocriptine-oral, Parlodel

Birth Control: IUD (Intrauterine Devices)

Introduction to birth control

If a woman is sexually active and she is fertile and physically able to become pregnant, she needs to ask herself, "Do I want to become pregnant now?" If her answer is "No," she must use some method of birth control (contraception).

Terminology used to describe birth control methods include contraception, pregnancyprevention, fertility control, and family planning. But no matter what the process is called, sexually active people can choose from a plethora of methods to reduce the possibility of their becoming pregnant. Nevertheless, no method of birth control available today offers perfect protection against sexually transmitted infections (sexually transmitted diseases, or STDs), except abstinence.

In simple terms, all methods of birth control are based on either preventing a man'ssperm from reaching and entering a woman's egg (fertilization) or preventing the fertilized egg from implanting in the woman's uterus (her womb) and starting to grow. New methods of birth control are being developed and tested all the time. And what is appropriate for a couple at one point may change with time and circumstances.

Unfortunately, no birth control method, except abstinence, is considered to be 100% effective.

What are intrauterine devices (IUDs)?

The intrauterine device (IUD) is a method of birth control designed for insertion into a woman's uterus so that changes occur in the uterus that make it difficult for fertilization of an egg and implantation of a pregnancy. IUDs approved for use in the U.S. contain medications that are released over time to facilitate the contraceptive effect.

The IUD is a small "T"-shaped device with a monofilament tail that is inserted into the uterus by a health care practitioner in the office setting. When inserted into the uterus, the arms of the "T" are folded down, but they then open out to form the top of the "T". The device rests inside the uterus with the base of the T just above the cervix and the arms of the T extending horizontally across the uterus. A short piece of monofilament string attached to the IUD extends through the cervix into the vagina. This string makes it possible to be sure that the IUD is still in the uterus.

What are the types of intrauterine devices (IUDs)?

Intrauterine devices (IUDs) come in two different types:

• The TCu380A (Paragard) is a copper-containing IUD. It releases copper from a copper wire that is wrapped around the base. The released copper contributes to an inflammatory reaction in the uterus that helps prevent fertilization of the egg. It is approved to remain in place for up to 10 years.
  
• Levonorgestrel-releasing IUD (Mirena): This form of IUD releases a progestin hormone from the vertical part of the T. Progestin acts to thicken cervical mucus, creating a barrier to sperm, as well as renders the lining of the uterus inhospitable to implantation of a pregnancy. This form of IUD is approved for up to five years of use.

How does an intrauterine device (IUD) work?

It is not fully understood how IUDs work. They are thought to prevent conception by causing a brief localized inflammation that begins about 24 hours after insertion. This causes an inflammatory reaction inside the uterus that attracts white blood cells. The white blood cells produce substances that are toxic or poisonous to sperm. The progesterone-releasing IUDs also cause a subtle change in the endometrial environment that impairs the implantation of the egg in the uterine wall. This type of IUD also alters the cervical mucus, which, in turn, inhibits sperm from passing through the cervix.

IUDs are only available by prescription and must be properly inserted by a health care professional. A pelvic exam is required to insert an IUD. The IUD is usually inserted into the uterus during a woman's menstrual period although it can be done at any time during her monthly cycle as long as she is not pregnant.

The woman must check her IUD every month to be sure that the IUD is still in place. Sometimes, the uterus expels (pushes out) the IUD. The spontaneous expulsion rate has been reported to be as high as 10% during the first year of use. Expulsions may not cause any specific symptoms and can be overlooked. In addition to the woman checking the IUD, the device must also be checked periodically by a health care professional.

What are the advantages of an intrauterine device (IUD)?

The advantages of the IUD include the fact that it is highly effective in preventing conception, is reversible, and starts working almost immediately. A woman with an IUD does not need to use other birth control methods before she has sexual intercourse, and once the IUD is removed, there is a quick return to fertility. The levonorgestrel-releasing IUD (99% effectiveness) is replaced every five years. The copper IUD is also 99% effective and only needs to be replaced every 10 years.

What are the side effects of an intrauterine device (IUD)?

Side effects of the IUD are limited primarily to the uterus. These include:

• cramps,
• spotting,
• heavy menstrual flow,
• infection,
• pelvic inflammatory disease (PID), and
• infertility.

It is also possible for the IUD to pass through (perforate) the uterine wall and enter the abdominal cavity, where it must be retrieved surgically. Perforation of or trauma to the uterus by the IUD occurs in 1/1,000 insertions. Warning signs of possible complications from an IUD include abdominal pain, heavy bleeding, abnormal spotting or bleeding, and a smelly vaginal discharge. If a woman experiences any of these signs, she should contact her health care professional.

What are the risks and complications of intrauterine devices (IUDs)?

An IUD may not be appropriate for women who have heavy menstrual bleeding, had previous pelvic infections, have more than one sexual partner, or plan on getting pregnant. This is because IUDs do not protect against sexually transmitted infections (STDs) and should not be in place if a woman intends to become pregnant.

If women become pregnant with their IUDs in place, 40-50% of the pregnancies end in miscarriage.

Women who use non-progesterone types of IUDs are 50% less likely to have an ectopic pregnancy compared to women using no contraception. When a woman using an IUD does become pregnant, the pregnancy is more likely to be ectopic, but still ectopic pregnancy in a user of an IUD is a rare occurrence.

Serious complications due to infection associated with an IUD may prevent a woman from being able to become pregnant in the future.

Also, with the progesterone-releasing IUD (levonorgestrel IUD), a reduction in menstrual flow and a decrease in painful menstrual cramping are often observed with continued use. This is because the progesterone hormone can cause thinning of the lining of the uterus. These menstrual changes are not dangerous in any way and do not mean that the contraceptive action of the IUD is diminished.

The IUD provides no protection against sexually transmitted diseases (STDs).

• Menstrual Cramps
• Sexually Transmitted Diseases in Women (STDs)
• Miscarriage
• Vaginal Bleeding
• Pelvic Inflammatory Disease
• Trichomoniasis (Vaginal Infection)
• Ectopic Pregnancy
• Infertility
• Menstruation
• Birth Control (Options)
• Menstrual Cramps and Premenstrual Syndrome (PMS) Medication Guide
• Sexual Health: FAQs About Sex and Relationships
• Sexually Transmitted Diseases and Pregnancy (STDs)
• Reproductive Health

What is trichomoniasis and how do you get it?

Trichomoniasis (pronounced trih-kuh-muh-nye-uh-sus), also called "trick," is a sexually transmitted disease (STD). It is caused by a parasite that can be passed from one person to another. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva contact with an infected partner. The vulva is the genital area outside the vagina. Women can get the disease from infected men or women.

While trichomoniasis is usually passed sexually, it may be picked up from contact with damp or moist objects such as towels, wet clothing, or a toilet seat, if the genital area gets in contact with these damp or moist objects.

What are the symptoms of trichomoniasis?

Many women do not have any symptoms, but still have the STD. If women do have symptoms, they usually appear 5 to 28 days after exposure and can include:

• yellow, green, or gray vaginal discharge (often foamy) with a strong odor
  
• discomfort during sex and when urinating
  
• irritation and itching in the genital area
  
• lower abdominal pain in rare cases

If you have any of these symptoms, stop having sex and contact your doctor right away.

Is there a test for trichomoniasis?

To tell if you have trichomoniasis, your doctor or nurse will do a pelvic exam and lab test. During the pelvic exam, your doctor may be able to see small red sores inside the vagina or on the cervix. Your doctor will also take a fluid sample from the vagina and look for the parasite under a microscope or send the sample to a lab for analysis. Other tests, like a vaginal culture or DNA test can also be used for testing.

How is trichomoniasis treated?

Trichomoniasis can usually be cured with the prescription drug, metronidazole (also called Flagyl), or with a related drug, tinidazole. Topical medicines, or medicines applied to the skin, may be used in people who are allergic to metronidazole and tinidazole. The topical medicines are less effective and may not cure you. They might, however, ease the symptoms.

All women and men diagnosed with trichomoniasis should be treated. Even without symptoms, it can be passed to others. Having trichomoniasis also increases a person's chances of getting HIV. People being treated for trichomoniasis should avoid sex until they and their sex partners complete treatment and have no symptoms. Having trichomoniasis once does not protect a person from getting it again.

Does trichomoniasis cause problems during pregnancy?

Yes. Trichomoniasis can cause babies to be born early or at a low birth weight (less than five pounds). The Centers for Disease Control and Prevention (CDC) recommends that women with trichomoniasis who have symptoms should be treated, but women without symptoms do not need to be treated.

During the first 3 months of pregnancy, many experts feel that women shouldn't take metronidazole (Flagyl) because it may hurt the baby. However, most doctors feel that metronidazole can be given safely after the end of the first trimester.

How is trichomoniasis prevented?

There are things you can do to protect yourself from trichomoniasis:

• Don't have sex. The best way to prevent trichomoniasis or any STD is to practice abstinence, or not having vaginal, oral, or anal sex.
  
• Be faithful. Have a sexual relationship with one partner who has been tested for trichomoniasis and is not infected is another way to reduce your chances of getting infected. Be faithful to each other, meaning that you only have sex with each other and no one else.
  
• Use condoms. Protect yourself with a condom EVERY time you have vaginal, anal, or oral sex. Condoms should be used for any type of sex with every partner. For vaginal sex, use a latex male condom or a female polyurethane condom. For anal sex, use a latex male condom. For oral sex, use a dental dam. A dental dam is a rubbery material that can be placed over the anus or the vagina before sexual contact.
  
• Don't share swimsuits or towels. The trichomoniasis parasite can live outside the body for up to 45 minutes and can be contracted through contact with damp or moist objects that have the parasite on them.
  
• Know that some methods of birth control, like birth control pills, shots, implants, ordiaphragms, will not protect you from STDs. If you use one of these methods, be sure to also use a latex condom or dental dam (used for oral sex) correctly every time you have sex.
  
• Talk with your sex partner(s) about STDs and using condoms. It's up to you to make sure you are protected. Remember, it's YOUR body! For more information, call the Centers for Disease Control and Prevention at (800) 232-4636.
  
• Talk frankly with your doctor or nurse and your sex partner(s) about any STDs you or your partner have or had. Try not to be embarrassed.

• metronidazole, Flagyl - Explains the medication metronidazole (Flagyl) an antibiotic drug used against anaerobic bacterteria and certain parasites like giardia and ameba that can infect parts of the human body. Article includes descriptions, uses, drug interactions, and side effects.
• Pelvic Exam - Learn about a pelvic exam, a routine exam used to evaluate organs in a woman's body including the gential organs, ovaries, uterus, cervix, Fallopian tubes, bladder, and rectum.
• Sexually Transmitted Diseases in Women (STDs) - Learn and become aware of common STDs in women, including descriptions, symptoms, diagnosis, and treatments of each type of infection.

Ectopic Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. The vast majority of ectopic pregnancies occur in the Fallopian tube (98%), however, they can occur in other locations, such as the ovary, cervix, and abdominal cavity. An ectopic pregnancy occurs in about one in 50 pregnancies.

The major health risk of ectopic pregnancy is rupture leading tointernal bleeding. Before the 19th century, the mortality rate (the death rate) from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to five percent because of surgical intervention. With current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The major reason for a poor outcome is failure to seek early medical attention. Ectopic pregnancy remains the leading cause of pregnancy-related death in the first trimester of pregnancy.

What are the risk factors for ectopic pregnancy?

There are multiple factors that increase a women's likelihood of having an ectopic pregnancy, but it is important to note that ectopic pregnancies can occur in women without any of these risk factors.

The greatest risk factor for an ectopic pregnancy is a prior history of an ectopic pregnancy. The recurrence rate is 15% after the first ectopic pregnancy, and 30% after the second.

Any disruption of the normal architecture of the Fallopian tubes can be a risk factor for ectopic pregnancy. Previous surgery on the Fallopian tubes such as tubal sterilization or reconstructive procedures, can lead to scarring and disruption of the normalanatomy of the tubes and increases the risk of an ectopic pregnancy. Likewise, infection, congenital abnormalities, or tumors of the Fallopian tubes can increase a woman's risk of having an ectopic pregnancy.

Infection in the pelvis is another risk factor for ectopic pregnancy. Pelvic infections are usually caused by sexually-transmitted organisms, such as chlamydia or gonorrhea. However, non-sexually transmitted bacteria can also cause pelvic infection and increase the risk of an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or obstructing the Fallopian tubes. Normally, the inner lining of the Fallopian tubes is coated with small hair-like projections called cilia. These cilia are important to transport the egg smoothly from the ovary through the Fallopian tube and into the uterus. If these cilia are damaged by infection, egg transport becomes disrupted. The fertilized egg can settle in the Fallopian tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise, infection-related scarring and partial blockage of the Fallopian tubes can also prevent the egg from reaching the uterus.

Like pelvic infections, conditions such as endometriosis, fibroid tumors, or pelvic scar tissue (pelvic adhesions), can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy.

Approximately 50% of pregnancies in women using intrauterine devices (IUDs) will be located outside of the uterus. However, the total number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall number of ectopic pregnancies related to IUDs is very low.

Cigarette smoking around the time of conception has also been associated with an increased risk of ectopic pregnancy. This risk was observed to be dose-dependent, which means that the risk is dependent upon the individual woman's habits and increases with the number of cigarettes smoked.

What are symptoms of an ectopic pregnancy?

The classic symptoms of ectopic pregnancy include:

• abdominal pain,
• the absence of menstrual periods (amenorrhea), and
• vaginal bleeding.

The woman may not be aware that she is pregnant. These characteristic symptoms occur in ruptured ectopic pregnancies (those accompanied by severe internal bleeding) and non-ruptured ectopic pregnancies. However, while these symptoms are typical for an ectopic pregnancy, they do not mean an ectopic pregnancy is necessarily present and could represent other conditions. In fact, these symptoms also occur with a threatened abortion (miscarriage) in non-ectopic pregnancies.

The symptoms of an ectopic pregnancy typically occur six to eight weeks after the last normal menstrual period, but they may occur later if the ectopic pregnancy is not located in the Fallopian tube. Other symptoms of pregnancy (nausea, breast discomfort, etc.) may also be present in ectopic pregnancy. Weakness, dizziness, and a sense of passing out upon standing can represent serious internal bleeding from a ruptured ectopic pregnancy and require immediate medical attention.

How is ectopic pregnancy diagnosed?

The first step in the diagnosis is an interview and examination by the doctor. Occasionally, the doctor may feel a tender mass during the pelvic examination. If an ectopic pregnancy is suspected, the combination of blood hormone tests and pelvicultrasound can usually help to establish the diagnosis.. Transvaginal ultrasound is the most useful test to visualize an ectopic pregnancy. In this test, an ultrasound probe is inserted into the vagina, and pelvic images are visible on a monitor. Transvaginal ultrasound can reveal the gestational sac in either a normal (intrauterine) pregnancy or an ectopic pregnancy, but often the findings are not conclusive. Rather than a gestational sac containing a visible embryo, the examination may simply reveal a mass in the area of the Fallopian tubes or elsewhere that is suggestive of, but not conclusive for, an ectopic pregnancy. The ultrasound can also demonstrate the absence of pregnancy within the uterus.

The beta subunit of human chorionic gonadotrophin (beta HCG) blood levels are also used in the diagnosis of ectopic pregnancy. Beta HCG levels normally rise during pregnancy. An abnormal pattern in the rise of this hormone can be a clue to the presence of an ectopic pregnancy. In rare cases, laparoscopy may be needed to ultimately confirm a diagnosis of ectopic pregnancy. During laparoscopy, viewing instruments are inserted through small incisions in the abdominal wall to visualize the structures in the abdomen and pelvis, thereby revealing the site of the ectopic pregnancy.

What is the health risk of an ectopic pregnancy?

Some women spontaneously absorb their ectopic pregnancy with no apparent ill effects, and can be observed without treatment. However, the true incidence of spontaneous resolution of ectopic pregnancies is unknown. It is not possible to predict which women will spontaneously resolve their ectopic pregnancies.

The most feared complication of an ectopic pregnancy is internal bleeding, causing pelvic and abdominal pain, shock, and even death. Therefore, bleeding in an ectopic pregnancy may require immediate surgical attention. Bleeding results from the rupture of the Fallopian tube or from blood leaking from the end of the tube as the growing placentaerodes into the veins and arteries located inside the tubal wall. Blood coming from the tube can be very irritating to other tissues and organs in the pelvis and abdomen, and result in significant pain. The pelvic blood can lead to scar tissue formation and problems with becoming pregnant in the future. The scar tissue can also increase the risk of future ectopic pregnancies.

What treatment options are available for ectopic pregnancy?

Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding. However, because of the risk of rupture and potential dire consequences, most women with a diagnosed ectopic pregnancy are treated with medications or surgery.

For those who require intervention, the most common treatment is surgery. Two surgical options are available; laparotomy and laparoscopy. Laparotomy is an open procedure whereby a transverse (bikini line) incision is made across the lower abdomen. Laparoscopy involves inserting viewing instruments into the pelvis through tiny incisions in the skin. For many surgeons and patients, laparoscopy is preferred over laparotomy because of the tiny incisions used and the speedy recovery afterwards. Under optimal conditions, a small incision can be made in the Fallopian tube and the ectopic pregnancy removed, leaving the Fallopian tube intact. However, certain conditions make laparoscopy less effective or unavailable as an alternative. These include massive pelvic scar tissue and excessive blood in the abdomen or pelvis. In some instances, the location or extent of damage may require removal of a portion of the Fallopian tube, the entire tube, the ovary, and even the uterus.

Medical therapy can also be successful in treating certain groups of women who have an ectopic pregnancy. This treatment method involves the use of an anti-cancer drug called methotrexate. This drug acts by killing the growing cells of the placenta, thereby inducing miscarriage of the ectopic pregnancy. Some patients may not respond to methotrexate, and will require surgical treatment. Methotrexate is gaining popularity because of its high success rate and low rate of side effects. There are certain factors, including the size of the mass associated with the ectopic pregnancy and the blood beta HCG concentrations that help doctors decide which women are candidates for medical rather than surgical treatment.

Although there have been a few reported cases of women giving birth by cesarean section to live infants that were located outside the uterus, this is extremely rare. The chance of carrying an ectopic pregnancy to full term is so remote, and the risk to the woman so great, that it can never be recommended. It would be ideal if an ectopic pregnancy in the Fallopian tube could be saved by surgery to relocate it into the uterus. This concept has yet to become a accepted as a successful procedure.

Overall, there have been great advances in the early diagnosis and treatment of ectopic pregnancy, and the mortality from this condition has decreased dramatically.

Ectopic Pregnancy At A Glance

• An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.
• Risk factors for ectopic pregnancy include previous ectopic pregnancies and conditions (surgery, infection) that disrupt the normal anatomy of the Fallopian tubes.
• The major health risk of an ectopic pregnancy is internal bleeding.
• Diagnosis of ectopic pregnancy is usually established by blood hormone tests and pelvic ultrasound..
• Treatment options for ectopic pregnancy include both surgery and medication.

Patient Discussions: Ectopic Pregnancy - Symptoms Experienced

I just found out last week my pregnancy was ectopic. I already have one son and my husband and I have been trying unsuccessfully for our second. When we found out we were pregnant again we were so happy, but the doctor was so cautious he wouldn't even give us a due date until I held the pregnancy for 2 more weeks. I started spotting and cramping, which broke our hearts, but it never turned into a full blood stream like my previous miscarriages. I went to the ER and after spending 12 hours in the ER, they ruled it ectopic and scheduled me for an immediate tubal removal. They removed my left fallopian tube. I haven't yet been back to the doctor to get my stitches out and talk about things, but we're so scared I won't be able to carry a successful full term pregnancy again. It is so nice to hear some successful stories on here.Published: August 06 ::

Comment from: tatyana, 19-24 Female (Patient)

I have always wanted to have a baby since I got married. It has been a whole year of trying to get pregnant until finally I became pregnant. I think it took long because of the birth control methods. When I first found out I was pregnant I was at the clinic in which I was seen in the emergency side for cramps and brown spotting. When the doctor told me I was pregnant I couldn't believe it, I was so happy I couldn't wait to get home and tell my husband. Even though I was happy I was still shocked when the doctor told me that I could be having a miscarriage. She then told me to come back for blood tests. Three days later I got up to use the bathroom and I had the worst abdominal pain ever, it followed down to my pelvic area and my back was aching. The next thing I remember is my husband trying to wake me up. My husband called the ambulance and was rushed into the ER. It was the longest 11 hours of my life. After many tests and ultra sounds the doctor then told me I had to have emergency surgery because I had some internal bleeding. 2 hours later the surgery was over and the nurses were very comforting. They told me everything went well and that the other tube and my eggs appeared to look healthy. They told me that I can get pregnant again, but I know that the chances of having another ectopic is possible because the doctor warned me. It has been almost a week and I’m recovering well. I have a follow up soon and I will be asking a lot of questions. I am not going to give up on getting pregnant, but it is going to take time to heal!Published: August 06 ::

Comment from: Selma, 25-34 Female (Patient)

It was my second pregnancy. (I have an 8 year old.) I think I was six weeks pregnant. I had a period two weeks ago for two days. My HCG was not increasing normally. The doctor did a quick ultrasound in the office and found nothing in the uterus. She suggested that it was an ectopic pregnancy. I was sent to the emergency room for the methotrexate injection, but they did their own tests and confirmed with a new ultrasound that it was ectopic pregnancy. I am now waiting for the HCG levels to decrease. Also, my main symptom for about two weeks was rectal pain during intercourse and while moving bowels. I also had left-sided pain intermittently.Published: June 22 ::

Comment from: Loved, 25-34 Female (Patient)

Friday night my husband and I went to sleep like usual. About 30 minutes later really sharp and cramp like pain began. Due to the fact that this was my first pregnancy I had no clue what to expect. I dragged myself to the bathroom and passed out there. I woke up to my husband's screaming my name. Then the vomiting started. Our OB suggested we go to ER. After all ultra sounds, proof of extremely low blood pressure, internal blood and a surgery that removed the ectopic pregnancy and its remains. I slowly started recovering. I got to the hospital around 11 pm Friday night and left the hospital around 9pm Saturday night. It was the longest 22 hours of my life. I am still extremely depressed for losing my baby and knowing that the chances of me having a normal and healthy pregnancy are not so great. However, I am glad we got to the hospital in time before I bled to death. Please take it seriously and seek professional care as soon as you suspect something could be wrong, i.e. Lightheadedness, abdominal pain, neck or shoulder pain.Published: June 05 ::

Comment from: Gills, 25-34 Female (Patient)

I had my ectopic pregnancy when I was 22 years old, and I will never forget how bad the pain was and how unwell I became. My symptoms started with spotting, and then I began having shoulder pain, which was very uncomfortable and worsened during the night. This was followed by extreme abdominal pain. It started like a stomach ache and then got worse. I also had diarrhea and constantly felt as if I needed to poo/pee. I was first diagnosed and sent home from the hospital with a stomach bug. (Good job, guys!) I got a second opinion, and was then diagnosed with an ectopic pregnancy. I had my left tube removed completely. I became pregnant six months later and now have a gorgeous daughter. I am now 25 and still worry about this happening again in the future.Published: April 16 ::

Comment from: Lola, 25-34 Female (Patient)

In the case of my ectopic pregnancy, I took the Plan B pill right after the condom broke. I got my period a week later. Normally it lasts seven days. This time it lasted a month and a half! I finally went to the doctor, and was told that I was pregnant. I got an ultrasound the next day but the doctor could not find anything in my uterus. Plus, I was still bleeding with heavy a flow and clotting. They did notice that there was a lump on the underside of my uterus and ruled it an ectopic pregnancy.Published: April 15 ::