When Does Ectopic Pregnancy Pain Start & Can You Treat It?

Published May 31st, 2022 by Bridget Reed
Fact Checked by
Camille Freking
Medically Reviewed:
Dr. Angel Rivera

An ectopic pregnancy, or tubal pregnancy, happens when the fertilized egg attaches to an organ that’s not the uterus. This results in a pregnancy that’s “misplaced” and cannot continue.

Pain is a common symptom of an ectopic pregnancy. In some cases, severe pain can indicate a serious complication, which requires immediate medical attention.

This guide from USA Rx goes over what causes ectopic pregnancy pain, when it starts, and what you can do to treat it. 

What Is an Ectopic Pregnancy?

In a normal pregnancy, a fertilized egg attaches to the inside lining of the uterus, which can stretch and allow a baby to develop for nine months.

In rare cases, a fertilized egg can attach itself to an organ that’s not the uterus. Most often, this happens to the fallopian tubes, but it can also affect the ovaries, the cervix, or tissue on the abdomen called the omentum. 

Regardless of where the fertilized egg attaches, it will result in a pregnancy loss, as the pregnancy can’t continue if it’s outside the uterus. 

Most ectopic pregnancies fail after a few days without presenting any major symptoms. However, some ectopic pregnancies can continue to grow in a fallopian tube, which can cause painful symptoms. 

If an ectopic pregnancy is not addressed early on, it can continue to stretch the narrow fallopian tubes and eventually cause them to rupture.

This can cause extreme pain and heavy internal bleeding, posing a serious risk to the mother’s life. 

About 1-2% of pregnant women are affected by an ectopic pregnancy.

The risk of an ectopic pregnancy goes up for those who are older, use assisted reproductive technology, or smoke. 

Other causes for higher risk factors include:

  • Sexually transmitted infections like chlamydia or gonorrhea
  • The use of contraception like an intrauterine device (IUD)
  • A previous ectopic pregnancy
  • Scar tissue from fallopian tube surgery
  • In-vitro fertilization (or IVF) treatment
  • Endometriosis
  • Pelvic inflammatory disease (PID) 

What Are the Symptoms of an Ectopic Pregnancy?

Some ectopic pregnancies may not present any symptoms at all. However, most will have some signs that something is “off.” 

These are the most common signs and symptoms of an ectopic pregnancy that warrant immediate medical advice to help prevent a medical emergency:

  • Abdominal pain: This pain is typically felt on one side of the abdomen. It can vary in type from piercing to throbbing, and be moderate to intense. The pain may be constant or come and go. 
  • Vaginal bleeding: Some women may mistake vaginal bleeding caused by an ectopic pregnancy as their regular period. However, ectopic pregnancy bleeding may be much shorter (lasting only one or two days) and will usually be a dark red or brown color with blood clots. 
  • Dizziness: Due to excessive blood loss, dizziness or lightheadedness is a common symptom experienced during an ectopic pregnancy. In some cases, women with an ectopic pregnancy may even pass out. 
  • Shoulder pain: Although it may seem unrelated, an ectopic pregnancy can cause shoulder pain. This is because internal bleeding can irritate a nerve in the diaphragm that is connected to the shoulder. This is considered a sign that the ectopic pregnancy is progressing to a serious stage. 
  • Severe pain and bleeding: If a fallopian tube ruptures, it can cause heavy internal bleeding and severe pain in the pelvis and abdomen. Sometimes, there are no symptoms before a fallopian tube ruptures, which makes the pain and bleeding seem to come out of nowhere. A rupture is a life-threatening emergency that has to be treated immediately. 
  • Low blood pressure: A ruptured ectopic pregnancy can result in low blood pressure and internal bleeding. Emergency surgery may be required.

When Does Ectopic Pregnancy Pain Start?

In summary, ectopic pregnancy symptoms can be felt as soon as four weeks and as late as 10 weeks into the pregnancy.

If you notice anything is “off,” it’s important to see a healthcare professional as soon as possible to prevent possible complications. 

Ectopic pregnancy symptoms usually begin around the sixth week of pregnancy — this is about two weeks after the last day of your most recent period.

Some women may feel symptoms as early as four weeks into their pregnancy, while others may feel it as late as 10 weeks. 

Many women do not experience any noticeable symptoms during an ectopic pregnancy. Because many ectopic pregnancies end on their own, the woman may not even know that she had one.

Other women may not feel any symptoms until the ectopic pregnancy progresses and causes a rupture in a fallopian tube.

For others still, the symptoms of an ectopic can feel similar to the typical early signs of pregnancy, such as breast tenderness, cramping, or nausea. 

Can You Treat Ectopic Pregnancy Pain? 

If you experience ectopic pregnancy pain, you cannot treat the symptom without addressing the underlying condition.

If there is any chance that you might be experiencing an ectopic pregnancy, then it's important to see your doctor for immediate diagnosis and treatment. 

These diagnostic tests include a urine test and a blood test to look for lower levels of the pregnancy hormone human chorionic gonadotropin (hCG).

Lower hCG levels can indicate a potential issue since hormone levels should markedly increase as the pregnancy continues. 

In many cases, an ectopic pregnancy may resolve without causing any problems to the mother’s health — similar to a miscarriage.

If an ectopic pregnancy continues, it typically must be treated with medication or surgery.

Methotrexate is one medication commonly used to treat an ectopic pregnancy. Given as an injection, this medicine works by eliminating the cells growing in the fallopian tube.

When given in the early stages of an ectopic pregnancy, methotrexate is effective and is associated with very few side effects

If the ectopic pregnancy progresses to a later stage (beyond six weeks), it may require keyhole surgery or a laparoscopic operation (laparoscopy). 

Your doctor may choose to first monitor you with physical exams, blood tests, and ultrasounds before moving to an invasive option.

If they notice any complications, they may recommend surgery or other medical procedures. 

If a fallopian tube ruptures, then surgery will be required to prevent health complications or even death.

During the surgery, the surgeon will make an incision in the abdomen to either fix the fallopian tube or remove it. This surgery is often life-saving

In Conclusion

Ectopic pregnancy pain can start as early as four weeks or as late as 10 weeks into the pregnancy.

If you experience any abnormal symptoms in early pregnancy and beyond, or have risk factors that make an ectopic pregnancy more likely, see your doctor as soon as possible if you notice any of the symptoms discussed above, especially pain.

This will not only give you peace of mind, but can potentially prevent serious complications in your pregnancy. 

References and Sources: 

Ectopic Pregnancy | NCBI Bookshelf 

Methotrexate Treatment of Ectopic Pregnancy: Experience at Nizwa Hospital with Literature Review | PMC 

The Diagnosis and Treatment of Ectopic Pregnancy | PMC 

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