October 18, 2026

Ectopic pregnancy: symptoms, causes and when to go to A&E

If you’ve heard the word “ectopic” at an appointment or you’ve had unusual spotting with pain on one side and you’re not sure what’s normal, I understand how worrying it feels ❤️. Let me walk you through what an ectopic pregnancy is, why it happens, what signs to watch for and when to get urgent medical help.

Ectopic pregnancy symptoms

What is an ectopic pregnancy and where does it happen?

In a typical pregnancy the fertilised egg travels along the fallopian tube into the uterus, where it implants and starts to grow. In an ectopic pregnancy it implants outside the uterus and cannot continue to term.

Most often (around 90% of cases) it stays in one of the fallopian tubes — a tubal pregnancy — but, much less commonly, it can implant in the ovary, in the scar of a previous caesarean or in the abdominal cavity.

Where it implants	How common	What it means
Fallopian tube (tubal pregnancy)	Around 90% of cases	The tube can’t stretch like the uterus: this is the site with the highest risk of rupture and bleeding
Ovary	Uncommon	Usually picked up later and generally needs surgery
Scar of a previous caesarean	Uncommon	It can grow towards the uterine wall and is monitored very closely from the start
Abdominal cavity	Uncommon	Harder to diagnose; treatment is tailored to each case

Fallopian tubes are very narrow and are not designed to host a growing embryo. If the pregnancy continues it can stretch and damage the tube, with a risk of rupture and internal bleeding. That’s why it is always a medical emergency that your doctor needs to assess.

Risk factors

There is rarely a single cause, and sometimes it happens without any known risk factor. These are the factors most linked to an ectopic pregnancy:

Previous ectopic pregnancy: the risk of recurrence is higher.
Tubal surgery (tubal ligation or reversal surgery to try for pregnancy again).
Pelvic inflammatory disease (PID) or untreated sexually transmitted infections that can scar the tubes.
Endometriosis and pelvic adhesions.
Smoking: nicotine affects the cilia that move the egg towards the uterus.
Age 35-44 and assisted reproduction treatments such as IVF.
Intrauterine device (IUD): the IUD is very effective at preventing pregnancy; in the very unlikely event that a pregnancy occurs with an IUD in place, it is more likely to be ectopic.
Congenital tube defects and other anatomical variations.

Having one of these factors does not mean you will have an ectopic pregnancy — it just means you should tell your doctor about it at your first visit.

Warning signs and symptoms

At first an ectopic can feel just like any early pregnancy: missed period, tender breasts, nausea or fatigue. That’s why it can be hard to tell apart early on. If you’ve had a positive test you can take our free online pregnancy test to reflect on your symptoms while you book an appointment — and if you fancy a distraction, try our finger pregnancy test game: it’s just a game, not a real test.

Red flags that always need urgent assessment are:

Intense lower abdominal pain, usually on one side, that can get worse when you urinate, have a bowel movement, cough or move.
Vaginal bleeding that is light, dark or intermittent (different from a period). It can be confused with what discharge looks like in pregnancy, but if it comes with localised pain, get checked.
Shoulder tip pain (especially when breathing deeply), pressure in the rectum or low back pain.
Severe dizziness, weakness, pallor or fainting, which may signal internal bleeding.
Persistent nausea and generally feeling unwell together with abdominal pain.

If you recognise any of these — especially strong one-sided pain + bleeding + dizziness — go to A&E without waiting. Don’t stay home to see how it goes.

More on when bleeding can be normal and when it isn’t in early pregnancy symptoms and how pregnancy tests work.

How is it diagnosed?

Diagnosis is always made by health professionals, usually with two tests combined:

Beta-hCG blood test: in a pregnancy inside the uterus the hormone typically doubles every 48 hours early on; in an ectopic it may rise more slowly or irregularly, but on its own it doesn’t confirm the diagnosis.
Transvaginal ultrasound: shows where the gestational sac is. If the sac is not seen inside the uterus despite a high beta-hCG and there is pain or free fluid, suspicion rises.

Sometimes the blood test and scan need to be repeated after 48 hours. In the meantime you will be asked to rest and avoid exertion. Keep your follow-up appointments even if pain eases.

Can an ectopic pregnancy be saved? Treatment

I know this is the most painful question, and I want to be completely clear and gentle: an ectopic pregnancy cannot continue or be moved into the uterus ❤️. The aim of treatment is to protect your health and, where possible, preserve future fertility.

Depending on when it is diagnosed and how stable you are, your doctor may suggest:

Expectant management (close observation) if beta-hCG is low and falling on its own and there is no pain or risk of rupture.
Methotrexate (medication that stops tissue growth) when it is caught early, there is no rupture and you are stable. It needs blood test follow-up and you will be asked to avoid alcohol, high-dose folic acid and intercourse until your doctor says otherwise.
Surgery (usually keyhole laparoscopy) if rupture or bleeding is suspected, pain is severe or medication is not suitable. Sometimes the tube can be saved, sometimes it needs to be removed to stop bleeding.

After an ectopic you need physical and emotional recovery time. Talk to your doctor about when it is safe to try again — usually at least 2–3 months after methotrexate — and about folic acid supplementation.

Complications of an ectopic pregnancy explains in more detail what can happen if it is not treated promptly and why speed matters.

Can it be prevented?

There is no guaranteed way to prevent it, but you can lower the risk:

Get any genital infection treated promptly and keep up with gynaecological check-ups.
Use protection to prevent sexually transmitted infections.
Don’t smoke.
If you’ve had an ectopic, PID or tubal surgery, mention it at the first visit of your next pregnancy so you can be monitored earlier (early beta-hCG and scan).

When to go to A&E right away

Go the same day if you have a positive test + strong one-sided abdominal pain + bleeding, or if you develop shoulder pain, dizziness, fainting or pallor. Don’t drive alone and, if you can, bring someone with you. Take your test results and the date of your last period.

FAQ

Does a pregnancy test show positive if it’s ectopic? Usually yes, because hCG is present. A positive test cannot tell whether the pregnancy is inside or outside the uterus — that’s why a scan is essential. I explain how to read results in how pregnancy tests work.

Can it be mistaken for a normal pregnancy at first? Early on, yes — the symptoms are similar. The difference tends to appear when localised pain, light bleeding or dizziness develop. If in doubt, always get checked.

Is an ectopic always painful? Not from day one, but most end up causing low abdominal pain, often on one side. Mild, brief discomfort can be normal in early pregnancy, but strong, continuous or worsening pain needs urgent assessment.

Can I get pregnant again afterwards? In many cases, yes. Having had an ectopic slightly raises the risk of another one, but it doesn’t rule out a future pregnancy inside the uterus. Your doctor will advise early monitoring next time.

Does an IUD cause ectopic pregnancies? It doesn’t cause them. The IUD prevents pregnancy very effectively. What happens is that, on the rare occasion a pregnancy does occur with an IUD, the proportion that are ectopic is higher.

How long does beta-hCG take to fall after treatment? It depends on the case and the treatment. With methotrexate or surgery the hormone falls over days or weeks and you will have checks until it reaches zero. Follow the advice and don’t try for a new pregnancy until you are discharged.

Sources

This article is for information only and does not replace medical advice. If you think you may have an ectopic pregnancy or you have severe pain or dizziness, contact your doctor or go to A&E ❤️.

I’m here to support you: if you want to reflect on your symptoms you can take the online test and, for a little distraction, try our fingerprint game — it’s just a game, not a medical test.