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Period Pains or Ectopic Pregnancy? 5 Things You Should Know

Alan Lindemann, M.D | September 19, 2021

Ectopic pregnancy occurs when a fertilized egg grows outside the uterus, usually in the fallopian tube. Many people who experience this condition end up in the hospital with abdominal pain and have no idea that they’re pregnant because they mistake ectopic pregnancy bleeding for menstruation.

Dr. Alan Lindemann answers 5 important questions that can help women and birthing people discover ectopic pregnancy before it becomes an emergency.

What are the risk factors for ectopic pregnancy?

The risk factors for ectopic pregnancy include the following:

What kind of pain is associated with ectopic pregnancy?

The pain from ectopic pregnancies usually starts on either the right or left lower quadrant of the abdomen. Initially, the pain is from stretching of the fallopian tube, but eventually, the pain may become excruciating from bleeding. Almost all ectopic pregnancies—more than 90%—occur in a fallopian tube, but the fertilized egg can implant on the ovaries or any other intraperitoneal organ. They can also implant in the cervix or wall of the uterus, especially as the fallopian tube passes through it.

What kind of abnormal bleeding can be associated with ectopic pregnancy?

Often the bleeding with implantation of the embryo is considered to be a period, but it is usually lighter and sooner than a normal period would be expected. Women with ectopic pregnancies usually present to the physician with the second episode of bleeding. With ectopic pregnancies, abnormal bleeding may start around seven weeks after the last normal menstrual period. When presented with a patient with a possible ectopic pregnancy, physicians need to ask when the last NORMAL period occurred.

How dangerous are ectopic pregnancies?

As the pregnancy grows, it can cause the tube to burst (rupture). A rupture can cause major internal bleeding. This can be a life-threatening emergency that needs immediate surgery. Advances in the quality of ultrasound have improved outcomes from ectopic pregnancies. The advances in measuring the level of human chorionic gonadotropin (hCG) have also increased the ability to diagnose ectopic pregnancies accurately.

What is the treatment for ectopic pregnancies?

In the United States, surgery is the standard treatment for ectopic pregnancies. There are some countries in which the standard of care for the treatment of ectopic pregnancies is treating the patient with methotrexate rather than surgery. Surgical treatment resolves the ectopic pregnancy immediately. Methotrexate works over time, and that time may vary from patient to patient. Whether methotrexate can be used to treat an ectopic pregnancy depends upon the patient’s level of hCG and amount of bleeding, so sometimes surgery is the only option.

Alan Lindemann, M.D: An obstetrician and maternal mortality expert, “Rural Doc” Alan Lindemann, M.D. teaches women and their families how to create the outcomes they want for their own personal health and pregnancy. In his nearly 40 years of practice, he has delivered around 6,000 babies and achieved a maternal mortality rate of zero! Learn more at

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