Ectopic pregnancy symptoms often start with light vaginal bleeding and pain low on one side of your pelvis, while sudden severe belly pain, shoulder tip pain, dizziness or fainting can mean a rupture and need 911 right away.
An ectopic pregnancy happens when a fertilized egg implants outside the uterus, most often in a fallopian tube, where it cannot grow safely. Knowing the ectopic pregnancy symptoms (pelvic or one-sided belly pain and vaginal bleeding, plus the rupture signs of shoulder tip pain, dizziness or fainting) can help you get care fast.
Below: the early and emergency signs, timing, risk factors, diagnosis, treatment and what comes next, based on ACOG, Mayo Clinic, MedlinePlus, Cleveland Clinic, the NHS and the Merck Manual.
Key Takeaways
An ectopic pregnancy implants outside the uterus, usually in a fallopian tube, and cannot continue.
Early signs are often light vaginal bleeding and pain low on one side; some people have no symptoms at first.
Sudden severe pain, shoulder tip pain, dizziness or fainting can mean rupture: call 911.
Diagnosis uses repeat hCG blood tests and a transvaginal ultrasound.
Treatment is medicine, surgery or close monitoring, and most people can get pregnant again.
Table of Contents
Ectopic Pregnancy Symptoms: The Short Answer
Quick Answer
An ectopic pregnancy is a pregnancy that implants outside the uterus, most often in a fallopian tube (Mayo Clinic). The most common first ectopic pregnancy symptoms are light vaginal bleeding and pelvic pain, often low on one side. Sudden severe belly pain, shoulder tip pain, feeling very dizzy or fainting can mean a rupture with internal bleeding: call 911 or go to the emergency room right away.
Mayo Clinic notes that some people have no symptoms at first, and a home pregnancy test is still positive. Only an exam, blood tests and an ultrasound can tell where a pregnancy is growing, so call your provider about any new pain or bleeding.
What Is an Ectopic Pregnancy?
Cleveland Clinic says about 90% of ectopic pregnancies are in a fallopian tube. Less often, they implant in the ovary, the abdominal cavity, the cervix, or, per ACOG, a cesarean scar.
ACOG states that a tubal ectopic pregnancy will never be viable, and that an ectopic pregnancy in any location is life threatening, because the site can rupture and bleed heavily as it grows.
How common is it? Cleveland Clinic and the Merck Manual both put it at about 2% of pregnancies. The NHS estimates about 1 in every 90 pregnancies in the UK. Treated before a rupture, it is rarely fatal for the mother, according to the Merck Manual.
Early Signs of an Ectopic Pregnancy
At first, an ectopic pregnancy can feel like a normal pregnancy, with a missed period, sore breasts and nausea (Mayo Clinic), the same signs we describe in 4 weeks pregnant and 5 weeks pregnant. The signs that point toward a problem are:
Vaginal bleeding or spotting: Mayo Clinic says light bleeding and pelvic pain are often the first warning signs. The NHS describes the bleeding as often starting and stopping, and it may be watery and dark brown.
Pain low on one side: The NHS says the pain is usually low down on one side of your belly. It may start suddenly or slowly and may be constant or come and go.
Shoulder tip pain: an unusual pain where your shoulder ends and your arm begins. The NHS says it can be a sign of internal bleeding, so get medical help right away.
Pressure when you poop or pee: the NHS lists discomfort when peeing or pooing, and Mayo Clinic notes an urge to have a bowel movement if blood leaks from the tube.
Dizziness or weakness: listed by Cleveland Clinic, along with lower back pain.
When do symptoms start? The NHS says symptoms tend to develop between the 4th and 12th week of pregnancy, and Cleveland Clinic says most people find out around 8 weeks. The Merck Manual notes a tubal pregnancy usually ruptures after about 6 to 16 weeks, and symptoms may be absent until then. See our 6 weeks pregnant, 7 weeks pregnant and first trimester guides for what is typical at that stage.
None of these alone proves an ectopic pregnancy. Spotting can have other causes (see implantation bleeding), and the NHS notes that bathroom symptoms can also come from a urinary tract infection or a stomach bug. The NHS advice: if you could be pregnant and have a mix of these symptoms, get medical advice even before a positive test.
Baby on the way? Get ahead on sleep.
Our free two-minute quiz builds a gentle, personalized sleep plan you can use from the first weeks at home.
This side-by-side can help you decide how quickly to call. Only your care team can tell where your pregnancy is.
Symptom
Common in a normal early pregnancy
Warning sign of a possible ectopic pregnancy
Positive pregnancy test
Yes
Also positive; a test cannot tell you where the pregnancy is (Mayo Clinic)
Spotting
Light spotting can be normal
Bleeding that starts and stops, often watery and dark brown (NHS), especially with pain
Cramping
Mild, on and off, both sides
Pain low on one side, constant or worsening (NHS, MedlinePlus)
Shoulder pain
Not a typical pregnancy symptom
Shoulder tip pain can signal internal bleeding: get help now (NHS)
Bathroom pain or pressure
Constipation is common
Pain when pooping or peeing, rectal pressure or an urge to poop (NHS, Mayo Clinic, MedlinePlus)
Dizziness
Mild lightheadedness can happen
Feeling very dizzy, weak, pale or fainting: call 911 (Mayo Clinic, NHS)
Belly pain
Mild stretching or twinges
Sudden, sharp, severe pain: call 911 (NHS, Cleveland Clinic)
Normal early pregnancy symptoms vs ectopic pregnancy warning signs. Sources: Mayo Clinic, NHS, MedlinePlus, Cleveland Clinic.
Signs of a Ruptured Ectopic Pregnancy (Emergency)
As an ectopic pregnancy grows, it can burst the fallopian tube. Mayo Clinic says a rupture can cause heavy bleeding inside the belly, leading to extreme lightheadedness, fainting and shock. The NHS says surgery is then needed as soon as possible.
Call 911 or go to the nearest emergency room if you are or could be pregnant and have any of these:
Sudden, sharp and intense pain in your belly or pelvis (NHS, MedlinePlus).
Feeling extremely lightheaded or very dizzy, or fainting (Mayo Clinic, NHS).
Shoulder pain (Mayo Clinic).
Intense pressure in your rectum (MedlinePlus).
Looking very pale or feeling sick along with belly pain (NHS).
Does Your Belly Grow With an Ectopic Pregnancy?
Not in a way you can rely on. In an ectopic pregnancy, the uterus is not holding the pregnancy. The Merck Manual notes the uterus may be slightly enlarged on exam, but often less than expected for how far along you are.
Early belly size varies a lot from person to person (see our pregnant belly by month guide), so a flat or bloated belly tells you nothing either way. Watch for pain, bleeding, dizziness and shoulder pain instead. If your belly suddenly becomes swollen, hard or very painful, treat it as an emergency.
Risk Factors: Who Is More Likely to Have an Ectopic Pregnancy?
A previous ectopic pregnancy: the NHS puts the risk of another at about 10%.
Pelvic inflammatory disease or sexually transmitted infections: such as chlamydia and gonorrhea, which can scar the tubes (Mayo Clinic).
Tubal surgery: including tubal ligation or its reversal (Mayo Clinic, MedlinePlus).
Infertility and fertility treatment: including IVF (Mayo Clinic, Cleveland Clinic).
Getting pregnant with an IUD in place: rare, but the Merck Manual says about half of pregnancies that do happen with an IUD in place are ectopic.
Smoking: Mayo Clinic says the more you smoke before pregnancy, the higher the risk.
Endometriosis: listed by Cleveland Clinic and MedlinePlus.
Age over 35: listed by Cleveland Clinic, MedlinePlus and the NHS.
Risk factors are not destiny. Cleveland Clinic notes that up to 50% of people who have an ectopic pregnancy have none of these risk factors.
A rare twist: a heterotopic pregnancy is one pregnancy in the uterus and another outside it at the same time. The Merck Manual puts it at about 1 in 10,000 to 30,000 pregnancies, but 1% to 2% after assisted reproduction.
How Doctors Diagnose an Ectopic Pregnancy
Mayo Clinic says a doctor cannot diagnose an ectopic pregnancy from an exam alone. Diagnosis usually combines:
A pregnancy test and blood hCG levels: The Merck Manual says that in a healthy early pregnancy, the hormone hCG roughly doubles every 1.4 to 2.1 days, while in an ectopic pregnancy or a miscarriage, levels are often lower than expected and rise more slowly. Mayo Clinic says it may be rechecked every few days. Learn more in our hCG levels by week guide.
Transvaginal ultrasound: a small wand placed in the vagina shows where the pregnancy is (Mayo Clinic). MedlinePlus explains that if hCG is above a certain level and no pregnancy sac is seen in the uterus, an ectopic pregnancy may be present.
Other blood tests: such as a complete blood count to check for blood loss, and your blood type in case you need a transfusion (Mayo Clinic).
If it is too early to see the pregnancy anywhere, your team will repeat tests. Mayo Clinic notes ultrasound can usually confirm or rule out an ectopic pregnancy about five to six weeks after conception.
Ectopic Pregnancy Treatment Options
Can an ectopic pregnancy be saved or moved? No. ACOG states it cannot move, or be moved, to a place in the uterus where it can safely grow to delivery, and Cleveland Clinic and the NHS agree it cannot continue. Treatment protects your life and, when possible, your tube and future fertility.
The option you are offered depends on things like your hCG level, whether there is bleeding and your overall health (Mayo Clinic, Merck Manual). The NHS describes three approaches:
Treatment
What it involves
Who it may suit
Expectant management (wait and see)
Close monitoring with blood tests; another treatment is used if the pregnancy does not resolve on its own (NHS)
Only when your provider judges it suitable, with close follow-up (NHS)
Methotrexate
A medicine given by injection that stops the pregnancy cells from growing, followed by repeat hCG tests (Mayo Clinic, Cleveland Clinic)
Early, unruptured ectopic pregnancy without unstable bleeding (Mayo Clinic)
Laparoscopic surgery
Keyhole surgery to remove the pregnancy, with or without the tube; open surgery (laparotomy) for heavy bleeding (Mayo Clinic)
Rupture, or when medicine is not an option or does not work (Cleveland Clinic, ACOG)
About methotrexate. Mayo Clinic says the diagnosis must be certain first. The Merck Manual reports a success rate of about 90%, with follow-up hCG tests until the level reaches zero; if it does not fall enough, a second dose or surgery may be needed. Cleveland Clinic notes that methotrexate cannot be used if the tube has ruptured. The Merck Manual lists breastfeeding among the reasons it is not used.
About surgery. Mayo Clinic describes two laparoscopic options: a salpingostomy removes the pregnancy and leaves the tube to heal, and a salpingectomy removes the pregnancy along with the tube. The choice depends on bleeding, tube damage and whether your other tube is healthy; a ruptured tube usually has to be removed.
Rh-negative blood type. If your blood type is Rh negative, the Merck Manual says you should receive Rh immune globulin whether you are treated with medicine or surgery.
Coping and Pregnancy After an Ectopic Pregnancy
An ectopic pregnancy is a pregnancy loss, often a sudden and frightening one. Mayo Clinic advises you to recognize the loss and give yourself time to grieve, and to lean on your partner, friends, a support group, a grief counselor or another mental health provider. The NHS notes grief can last several months.
Most people can get pregnant again. Mayo Clinic explains that if one tube is damaged or removed, an egg can still be fertilized in the other tube and travel to the uterus, and IVF may be an option if both tubes are damaged or removed. Cleveland Clinic says most people with a past ectopic pregnancy go on to have successful pregnancies.
Your risk of another ectopic is higher: about 10% according to the NHS, which still calls it small. Mayo Clinic recommends early blood tests and an ultrasound in your next pregnancy.
How long to wait: the NHS suggests waiting at least two periods after treatment and at least three months after methotrexate. Cleveland Clinic suggests about three months. Follow your own provider’s advice.
Call early next time: tell your provider about your history as soon as you have a positive test (NHS, Mayo Clinic). And when you decide when to tell people you are pregnant, it is fine to wait until you feel ready.
Call 911 or go to the emergency room now if you are or might be pregnant and you have:
Sudden, sharp or severe pain in your belly or pelvis.
Shoulder tip pain.
Extreme lightheadedness, fainting, or feeling like you might pass out.
Heavy vaginal bleeding, or looking very pale and feeling sick along with belly pain.
These are rupture signs listed by Mayo Clinic, the NHS and MedlinePlus. Do not drive yourself.
Call your provider’s office the same day if you have:
Any vaginal bleeding or spotting in early pregnancy, especially with cramping.
Pain low on one side of your belly, even if it is mild.
A new positive test with a history of ectopic pregnancy, tubal surgery, PID or IVF, or with an IUD in place.
Questions about your hCG results or an ultrasound that could not find the pregnancy.
Unsure which list fits? Call anyway. This article is general education, not medical advice.
Frequently Asked Questions
What are the first ectopic pregnancy symptoms?
Mayo Clinic says light vaginal bleeding and pelvic pain are often the first warning signs. The NHS adds that pain is usually low on one side and bleeding may start and stop. Some people have no symptoms at first, so call your provider about any pain or bleeding in early pregnancy.
How soon do ectopic pregnancy symptoms start?
There is no exact week. The NHS says symptoms usually develop between the 4th and 12th week of pregnancy, and Cleveland Clinic says most people find out around 8 weeks. Some have no symptoms until a rupture, so call early if you are at higher risk.
Will a pregnancy test be positive with an ectopic pregnancy?
Yes. Mayo Clinic says a pregnancy test is still positive because the pregnancy hormone hCG is still being made. A home test cannot show where the pregnancy is. Only blood hCG tests and an ultrasound, ordered by your provider, can confirm whether the pregnancy is in the uterus.
What does ectopic pregnancy pain feel like?
The NHS describes pain low down on one side of the belly that may come on suddenly or slowly and may be constant or come and go. Some people feel pain at the tip of the shoulder or pressure when pooping. Sudden, sharp, severe pain can mean a rupture and needs emergency care right away.
Does your belly grow with an ectopic pregnancy?
Not in a way you can rely on. The uterus does not hold the pregnancy, and the Merck Manual notes it is often smaller than expected for dates. Watch for pain, bleeding, dizziness and shoulder pain instead, and treat a suddenly swollen, painful belly as an emergency.
Can an ectopic pregnancy be saved?
No. ACOG states that an ectopic pregnancy cannot move or be moved to the uterus where it could grow to delivery, and Cleveland Clinic and the NHS agree it cannot continue. Treatment protects your health and, when possible, your future fertility.
Calmer days, better nights.
Betteroo builds a personalized sleep plan for your baby. Take the free two-minute quiz and have it ready before the newborn weeks.
