PMS symptoms occur in the week or two weeks before your period (menstruation or monthly bleeding). The symptoms usually go away after your period starts. PMS can affect menstruating women of any age. It is also different for each woman. PMS may be just a monthly bother or it may be so severe that it makes it hard to even get through the day. Monthly periods stop during menopause, bringing an end to PMS.
The causes of PMS are not clear. It is linked to the changing hormones during the menstrual cycle. Some women may be affected more than others by changing hormone levels during the menstrual cycle. Stress and emotional problems do not seem to cause PMS, but they may make it worse.
Diagnosis of PMS is usually based on your symptoms, when they occur, and how much they affect your life.
PMS often includes both physical and emotional symptoms. Common symptoms are:
• acne
• breast swelling and tenderness
• feeling tired
• having trouble sleeping
• upset stomach, bloating, constipation, or diarrhea
• headache or backache
• appetite changes or food cravings
• joint or muscle pain
• trouble concentrating or remembering
• tension, irritability, mood swings, or crying spells
• anxiety or depression
Symptoms vary from one woman to another. If you think you have PMS, keep track of which symptoms you have and how severe they are for a few months. You can use a calendar to write down the symptoms you have each day or you can use a form to track your symptoms. If you go to the doctor for your PMS, take this form with you.
Estimates of the percentage of women affected by PMS vary widely. According to the American College of Obstetricians and Gynecologists, at least 85 percent of menstruating women have at least one PMS symptom as part of their monthly cycle. Most of these women have symptoms that are fairly mild and do not need treatment. Some women (about three to eight percent of menstruating women) have a more severe form of PMS, called Premenstrual Dysphoric Disorder (PMDD).
PMS occurs more often in women who:
are between their late 20s and early 40s
have at least one child
have a family history of depression
have a past medical history of either postpartum depression or a mood disorder
The most helpful diagnostic tool is the menstrual diary, which documents physical and emotional symptoms over months. If the changes occur consistently around ovulation (midcycle, or days 7-10 into the menstrual cycle) and persist until the menstrual flow begins, then PMS is probably the accurate diagnosis. Keeping a menstrual diary not only helps the healthcare provider to make the diagnosis, but it also promotes a better understanding by the patient of her own body and moods. Once the diagnosis of PMS is made and understood, the patient can better cope with the symptoms.
The diagnosis of PMS can be difficult because many medical and psychological conditions can mimic or worsen symptoms of PMS. There are no laboratory tests to determine if a woman has PMS. When laboratory tests are performed, they are used to exclude other conditions that can mimic PMS.
What is the treatment for PMS?
Many things have been tried to ease the symptoms of PMS. No treatment works for every woman, so you may need to try different ones to see what works. If your PMS is not so bad that you need to see a doctor, some lifestyle changes may help you feel better. Below are some lifestyle changes that may help ease your symptoms.
• Take a multivitamin every day that includes 400 micrograms of folic acid. A calcium supplement with vitamin D can help keep bones strong and may help ease some PMS symptoms
Amounts of Calcium You Need Each Day
Ages
Milligrams per day
9-18
1300
19-50
1000
51 and older
1200
Pregnant or nursing women need the same amount of calcium as other women of the same age.
Exercise regularly.
Eat healthy foods, including fruits, vegetables, and whole grains.
Avoid salt, sugary foods, caffeine, and alcohol, especially when you are having PMS symptoms.
Get enough sleep. Try to get 8 hours of sleep each night.
Find healthy ways to cope with stress. Talk to your friends, exercise, or write in a journal.
Don't smoke
Over-the-counter pain relievers such as ibuprofen, aspirin, or naproxen may help ease cramps, headaches, backaches, and breast tenderness.
In more severe cases of PMS, prescription medicines may be used to ease symptoms. One approach has been to use drugs such as birth control pills to stop ovulation from occurring. Women on the pill report fewer PMS symptoms, such as cramps and headaches, as well as lighter periods.
There is evidence that a brain chemical called serotonin plays a role in a severe form of PMS, called Premenstrual Dysphoric Disorder (PMDD). The main symptoms, which can be disabling, include:
feelings of sadness or despair, or possibly suicidal thoughts
feelings of tension or anxiety
panic attacks
mood swings, crying
lasting irritability or anger that affects other people
disinterest in daily activities and relationships
trouble thinking or focusing
tiredness or low energy
food cravings or binge eating
having trouble sleeping
feeling out of control
physical symptoms, such as bloating, breast tenderness, headaches, and joint or muscle pain
You must have five or more of these symptoms to be diagnosed with PMDD. Symptoms occur during the week before your period and go away after bleeding starts.
Making some lifestyle changes may help ease PMDD symptoms. Antidepressants called Selective Serotonin Reuptake Inhibitors (SSRIs) that change serotonin levels in the brain have also been shown to help some women with PMDD. The Food and Drug Administration (FDA) has approved three medications for the treatment of PMDD:
sertraline (Zoloft®)
fluoxetine (Sarafem®)
paroxetine HCI (Paxil CR®)
Individual counseling, group counseling, and stress management may also help relieve symptoms.
Pelvic pain can be caused by an infection or inflammation. An infection doesn't have to affect the reproductive organs to cause pelvic pain. Pain caused by the bladder, bowel, or appendix can produce pain in the pelvic region; diverticulitis , irritable bowel syndrome , kidney or bladder stones, as well as muscle spasms or strains are some examples of non-reproductive causes of pelvic or lower abdominal pain.
2. Disease
Other causes of pelvic pain can include pelvic inflammatory disease (PID), vaginal infections , vaginitis , and sexually transmitted diseases (STDs). All of these require a visit to your healthcare provider who will take a medical history, and do a physical exam which may include diagnostic testing.
3. Cyst
Women who have ovarian cysts may experience sharp pain if a cyst leaks fluid or bleeds a little, or more severe, sharp, and continuous pain when a large cyst twists. Fortunately, most small cysts will dissolve without medical intervention after 2 or 3 menstrual cycles; however large cysts and those that don't rectify themselves after a few months may require surgery to remove the cysts.
An ectopic pregnancy is one that starts outside the uterus , usually in one of the fallopian tubes. Pain caused by an ectopic pregnancy usually starts on one side of the abdomen soon after a missed period , and may include spotting or vaginal bleeding. Ectopic pregnancies can be life-threatening if medical intervention is not sought immediately. The fallopian tubes can burst and cause bleeding in the abdomen, if left untreated. In some cases surgery is required to remove the affected fallopian tube.
Chronic Pelvic Pain
Chronic pelvic pain can be intermittent or constant. Intermittent chronic pelvic pain usually has a specific cause, while constant pelvic pain may be the result of more than one problem. A common example of chronic pelvic pain is dysmenorrhea or menstrual cramps .
Surgery or Serious Illness
Women who have had surgery or serious illness such as PID , endometriosis , or severe infections sometimes experience chronic pelvic pain as a result of adhesions or scar tissue that forms during the healing process. Adhesions cause the surfaces of organs and structures inside the abdomen to bind to each other.
Fibroid Tumors
Fibroid tumors (a non-cancerous, benign growth from the muscle of the uterus) often have no symptoms; however when symptoms do appear they can include pelvic pain or pressure, as well as menstrual abnormalities.
Other causes of chronic pelvic pain include endometriosis , adenomyosis , and ovulation pain . Sometimes an illness starts with intermittent pelvic pain that becomes constant over time, this is often a signal that the problem has become worse. A change in the intensity of pelvic pain can also be due to a woman's ability to cope with pain becoming lessened causing the pain to feel more severe even though the underlying cause has not worsened.
Many fibroids cause no symptoms at all. But a fibroid that grows rapidly in your uterus can cause one or more of the following problems:
1. Abnormal uterine bleeding
2. Difficulty urinating or having bowel movements
3. Achiness, heaviness, or fullness
4. Back pain
5. Difficulty getting pregnant
Only rarely, if fibroids are allowed to grow unchecked, will they lead to serious problems such as cancer.
Medical Evaluation When fibroids are suspected, a medical evaluation can determine whether you have fibroids, rule out other problems, and help you and your doctor decide which treatment, if any, is best for you. Before a diagnosis is reached, your doctor will ask you questions about your medical history and perform a pelvic exam. Your doctor may also suggest that you have one or more diagnostic tests, which can help provide details on the size and location of any fibroids.
Medical Exam
To look for signs of fibroids and to begin to plan your treatment, your doctor may ask you about one or more of the following:
1. The pattern of your menstrual bleeding.
2. When, if ever, you experience pelvic pain
3. Your birth control method, if any
4. Your family history of fibroids
5. Your plans to have children
Pelvic Exam During a pelvic exam, your doctor examines your reproductive organs. The tenderness, texture, and overall size of your uterus are checked. If you have abnormal bleeding, your doctor will also check your vagina and cervix for signs of infection or small breaks in the skin. Samples of cervical cells may be taken for closer examination (a Pap test) to check for infection or cancer. Since fibroids can grow on the back wall of your uterus, your doctor may also do a rectal exam.
What are the diagnostic tests for fibroids? Three common tests can provide close-up views of the inside or outside of your uterus and confirm the size and general location of fibroids. Ultrasound is quick and painless. Hysteroscopy and laparoscopy are slightly more involved procedures.
1. Ultrasound is often used to monitor the growth of fibroids. An instrument is placed on your lower abdomen or inserted into your vagina. Sound waves bounce off your reproductive organs, creating a picture on a video screen.
2. Hysteroscopy is used to evaluate fibroids that extend into the uterine cavity. During hysteroscopy, your doctor looks directly at the inside of your uterus through a hysteroscope, a thin "telescope" with a light attached.
3. Laparoscopy allows your doctor to check for fibroids by providing an outside view of your reproductive organs. Your doctor inserts a laparoscope, another type of "telescope," through a small incision near your navel.
Treatment options You and your doctor may choose one of three types of treatment: simply monitoring the fibroids, removing the fibroids, or removing your entire uterus . Your decision will depend partly on the severity of your symptoms. It will also depend on the size and condition of the fibroids and how fast they're growing. If your doctor recommends removing your uterus, you will also need to consider your plans for future children and how important it is for you to keep your uterus. Your doctor can describe the risks and benefits of all your treatment options.
1. Waiting and watching the fibroids with regular pelvic exams or ultrasound may be a good option if the fibroids are small or if you're nearing menopause (the end of menstrual cycles). At menopause, fibroids often shrink naturally due to decreasing levels of estrogen, a hormone that makes fibroids grow.
2. If you are taking hormones, your fibroids may require special monitoring. Your doctor may recommend that you try another birth control method if you are taking birth control pills and the fibroids are growing. If you are on hormone replacement therapy, you may need to try a lower dose.
3. If you are pregnant, the fibroids may grow rapidly, but most don't cause serious problems. Surgery to remove fibroids is usually not done at this time. However, you may need a cesarean (surgical delivery), especially if the fibroids are large or block the vagina, or if you've had previous uterine surgery
How can Fibroids be removed? Fibroids can be removed either through the vagina with hysteroscopy (if inside the uterine cavity) or through an abdominal incision with abdominal myomectomy (open outdated surgery) or laparoscopically (latest technology - tiny key hole incisions). These procedures preserve your uterus and your ability to have children, but fibroids may later return. Your doctor may prescribe anti-estrogen medications to shrink the fibroids before surgery. During surgery, you'll have general anesthesia (which allows you to sleep during the procedure).
Removing Your Uterus
Having a hysterectomy (removal of the uterus) guarantees that fibroids will never return: But it also means you won't be able to have children. For women with large or many fibroids or unbearable symptoms, hysterectomy may be the best solution. The uterus and cervix may be removed either through a small abdominal incision or through the vagina, under general anesthesia. The ovaries are often kept in place to allow the continued production of hormones.
Endometrial ablation
Endometrial ablation may be an alternative for women with heavy bleeding who have a few small fibroids. During this procedure, the uterine lining and any fibroids extending into the uterine cavity are destroyed with electric or laser energy. Afterward, uterine bleeding usually decreases or stops. Recovery from ablation is rapid. However, if fibroids continue to grow, you may later need a hysterectomy
.
Recovery Treating your fibroids is likely to relieve your symptoms. But your doctor will want to schedule regular checkups to monitor your progress and make sure your fibroids don't return. If you have had surgery, ask your doctor about any additional follow-up visits you might need.
No one knows for sure what causes endometriosis. Some think that menstrual blood carrying endometrial cells may back up through the fallopian tubes, spilling onto the pelvic organs. Others believe endometrial cells may be present in the pelvic cavity from birth. Some cases of endometriosis may be caused by exposure to toxic substances.
The normal endometrium lines the inside of the uterus. It is made up of tissue, blood, and mucus. Every month, the endometrium thickens with blood. This is so it can nurture an egg if one is fertilized.
With endometriosis , endometrial tissue growths are scattered throughout your pelvic cavity. These growths, called implants, can occur on the reproductive organs, bladder, or bowel. Just like other endometrial tissue, these implants fill with blood.
What are the symptoms of endometriosis?
If you have endometriosis, you may have one or more of these symptoms:
1.cramps and menstrual pain severe enough to keep you in bed a few days each month
2. severe pelvic pain during your period
3. trouble getting pregnant (infertility)
4. pain during sexual intercourse
What are the types of Endometriosis? 1. Classic blue-gray spots
2. Raspberry spots with shagy tissue
3. Flat or raised white tissue, like scarring
4. Clear "berries" with small peaks
5. Chocolate cysts filled with old blood
Medical Evaluation The earlier endometriosis is diagnosed, the sooner you can get relief. You also have a better chance of preventing infertility and major surgery. Your evaluation may begin with a medical history. A pelvic exam and one or more lab tests may be done. You may be recommend a laparoscopy. With this minor surgical procedure, your doctor can see into your pelvic cavity and look for endometrial growth
Menstrual History- Your menstrual cycle may give clues as to whether you have endometriosis. At what age did your periods begin? Did your cramps or other symptoms start with your first period or years later? In what ways does the pain affect your lifestyle or cause emotional distress? These questions and others will help diagnose your problem.
Pelvic Exam -
This exam can help find the source of your pain. Your doctor feels for any lumps or tenderness and looks at your cervix and vagina to rule out inflammation. You may also have a rectovaginal exam (one finger inserted in the rectum) to check for endometriosis
.
Lab Tests A blood test and urine analysis may be done to help rule out other conditions. You might also have an ultrasound to make a "picture" of any abnormal tissue that might be endometriosis. If your bowel movements are painful around your periods, a barium enema (an x-ray of the lower bowel) may help find the source of your pain.
How can Endometriosis be treated? If you have endometriosis, you have three options.
They are hormone therapy, surgery, or a combination of both Surgery
Almost every woman with endometriosis considers surgery at some time in her life. Surgery can range from the most minor procedure (laparoscopy) to complete removal of all reproductive organs. Your doctor will discuss your surgery options and their effects on your fertility with you. The best option for you will depend on your age, the severity of your disease, and whether you want to have children.
a) Hormone Therapy - It regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and endometrial implants. This treatment may be used before, instead of, or after surgery. The doctor will discuss side effects and dosage with you.
1. GnRH Agonists GnRH agonists are forms of the gonadotropin releasing hormone.
How they work: Over time, GnRH agonists keep the pituitary gland from producing Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). This stops production of estrogen and progesterone. You quit ovulating and stop having your period. Your endometrium may shrink. GnRH agonists are usually prescribed for 6 months or longer. Treatment results may last for 6 months or longer after therapy.
Side effects: Hot flashes, insomnia, headaches, and vaginal dryness. Bone density may decrease slightly during treatment, but is usually regained after treatment is stopped.
2. Danazol
Danazol is a hormone.
How it works:
Danazol blocks FSH and LH at the pituitary gland. This means that estrogen and progesterone levels stay low. You quit ovulating and stop having your periods. Your endometrium may shrink. Danazol is often used for 6 months or longer. Treatment results may last 6 months or longer after therapy. It may be repeated later, if needed.
Side effects: Weight gain, hair growth, acne, hot flashes, vaginal dryness, sleep problems, headache, decreased sex drive, and emotional changes. Liver problems may require you to stop treatment.
3. Birth Control Pills Birth control pills contain estrogen and progestin, a form of progesterone. They may be taken every day for several months or prescribed in cycles, 3 weeks on and 1 week off.
How they work: Birth control pills regulate the levels of estrogen and progesterone in your body. Ovulation, bleeding, and endometrial growth are controlled. Birth control pills may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.
Side effects: Weight gain, nausea, blood clots, and phlebitis (inflammation of veins).
4. Progestins -
Progestins are a form of progesterone.
How they work: Progestins keep estrogen and progesterone levels low. This prevents ovulation and limits endometrial growth. Progestins may be used for 6 months or longer. Treatment results may last for 6 months or longer after therapy.
Side effects:
Midcycle bleeding, weight gain, headaches, stomach upset, acne.
5. Other Medicines
This medicine helps you have less cramping and pain during your period. Many women also find relief in over-the-counter medicines such as aspirin and other anti-inflammatories. These work best if taken early in the pain cycle.
Surgery
1. Surgical Laparoscopy Laparoscopy is often used for mild or moderate endometriosis. Looking through the laparoscope, your doctor uses tiny surgical tools to remove implants. Implants may be trimmed (excision), burned away (cautery), or removed with a laser. Because your doctor operates through tiny incisions, you will have less bleeding and scarring than with other surgeries. Laparoscopy preserves your ability to have children. You will need 3 to 10 days to recover.
3. Hysterectomy
Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed. This surgery is often advised if your disease is severe but involves mainly your uterus. It may also be used if other methods have failed to relieve your symptoms and if you're past childbearing age or interest. Because your fertility is lost, this decision is best made after discussing it with your doctor and partner. Hysterectomy can be done Hyparoscopially.
4. Total Hysterectomy with Bilateral Salpingo-oophorectomy-
With this procedure, all of your reproductive organs-uterus, ovaries and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed. This surgery is advised for the most severe endometriosis when you're past childbearing age. It is the most complete treatment for endometriosis. But you may have symptoms of menopause once your ovaries are removed. This is also done Laparoscopically.
Living with Endometriosis
Once you know you have endometriosis, you can learn to manage your symptoms and live a comfortable, active life. One of the biggest hurdles you may face is accepting that this is a disease you may live with throughout your childbearing years. Only a few women never have symptoms again after treatment. Most women have symptoms off and on until menopause. Then symptoms usually subside or disappear. For some women, pregnancy relieves symptoms, but only temporarily. In the meantime, there is a lot you can do to help yourself feel better.
Emotions
Along with cycles of pain, you may have emotional cycles or mood swings. You may feel angry if you're up all night with cramps. You may feel depressed if you can't do the things you used to do. Your feelings about being a woman and your sexuality may also be affected. Don't suffer in silence. Talking to someone you trust can really help.
Managing Pain You can manage your pain by taking medication suggested by your Doctor. A hot bath or heating pad may also relieve your pain. Some women find relief in meditation, yoga, acupuncture, nutritional therapies, and other alternative treatments. To divert there attention from the pain.
Exercise Exercise often helps relieve pain, especially cramps. But don't exercise if it makes the pain worse. Keeping yourself healthy can help you feel better all over and keep your mind off minor pain.
A Partner's Role
Some men are afraid to touch women in pain. Others think the pain is all in her head? Your partner needs to know that endometriosis causes real pain and distress. If wants help, tell him what he can do to help you better. You may feel better with low-back massage or by being left alone for a while.
Communicating About Sex Many women with endometriosis have pain with sex during the worst part of their cycles. Others have pain throughout the month. Talk with your partner about other ways you can both show affection. You may also want to find positions for intercourse that are more comfortable.
Early Detection
Women can teach their daughters that severe cramps or pain aren't normal during their period. A teenager with heavy cramps or irregular, heavy bleeding should be evaluated. This is especially important if the mother has endometriosis.
A sonogram uses sound waves to make pictures of organs in the body. It's a good way for your doctor to look at your ovaries. This kind of sonogram can be done 2 ways, either through your abdomen or your vagina. Neither type is painful. The sonogram usually lasts about 30 minutes. It will give your doctor valuable information about the size and the appearance of your cyst.
Your doctor might test the level of a protein called CA-125 in your blood. Sometimes this blood test is done in women with an ovarian cyst to see if their cyst could be cancerous. A normal CA-125 level is less than 35. However, this test is not always an accurate way to tell if a woman has ovarian cancer. For example, some women who do have ovarian cancer have a normal CA-125 level. Also, this level can sometimes be high in women who do not have cancer, particularly if they are in their childbearing years. For these reasons, the CA-125 blood test is usually only recommended for women who are at high risk for ovarian cancer.
The answer depends on several things, such as your age, whether you are having periods, the size of the cyst, its appearance and your symptoms.
If you're having periods, only mild symptoms and the cyst is functional, you probably won't need to have surgery. If the cyst doesn't go away after several menstrual periods, if it gets larger or if it doesn't look like a functional cyst on the sonogram, your doctor may want you to have an operation to remove it. There are many different types of ovarian cysts in women of childbearing age that do require surgery. Fortunately, cysts in women of this age are almost always benign (noncancerous).
If you're past menopause and have an ovarian cyst, your doctor will probably want you to have surgery. Ovarian cancer is rare, but women 50 to 70 years of age are at greater risk. Women who are diagnosed at an early stage do much better than women who are diagnosed later.
If the cyst is small (about the size of a plum or smaller) and if it looks benign on the sonogram, your doctor may decide to do a laparoscopy. This type of surgery is done with a lighted instrument called a laparoscope that's like a slender telescope. This is put into your abdomen through a small incision (cut) just above or just below your navel (belly button). With the laparoscope, your doctor can see your organs. Often the cyst can be removed through small incisions at the pubic hair line.
If the cyst looks too big to remove with the laparoscope or if it looks suspicious in any way, your doctor will probably do a laparotomy. A laparotomy uses a bigger incision to remove the cyst or possibly the entire affected ovary and fallopian tube. While you are under general anesthesia (which puts you in a sleep-like state) the cyst can be tested to find out if it is cancer. If it is cancer, your doctor may need to remove both of the ovaries, the uterus, a fold of fatty tissue called the omentum and some lymph nodes. It's very important that you talk to your doctor about all of this before the surgery. Your doctor will also talk to you about the risks of each kind of surgery, how long you are likely to be in the hospital and how long it will be before you can go back to your normal activities.
The fertilized egg normally spends four to five days travelling down the tube from the ovary to the womb where it implants and begins to develop. The most common reason for an ectopic pregnancy is when the fallopian tube has been damaged, and this causes a blockage or narrowing which prevents the egg from reaching its destination. Instead, it implants in the wall of the tube.
In a few cases, the egg implants in an ovary, in the cervix, directly in the abdomen, or even in an earlier c-section scar. In rare cases, a woman may have a normal pregnancy in her uterus and an ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it's more likely to happen if you've had fertility treatments, such as in-vitro fertilization.
An ectopic pregnancy can happen to any woman, but there are circumstances, which make it more likely. These might include:
• If you've had pelvic inflammatory disease (which is most often caused by the sexually transmitted infection Chlamydia or or gonorrhea) as this can cause damage and scarring to the fallopian tubes. Some experts believe that up to half of all ectopic pregnancies are related to the Chlamydia infection. Experts also believe that if Chlamydia has affected your fallopian tubes then your risk of an ectopic pregnancy is much increased.
• If you have tubal endometriosis . You may be more at risk because this increases the risk of scarring.
• If you've had any abdominal surgery, including an appendix removal or a caesarian section .
• If you have a contraceptive coil fitted. While this will prevent a pregnancy in the womb, it's less effective at preventing one in the tube.
• If you are taking the contraceptive mini-pill. This has been associated with a slightly higher rate of ectopic pregnancy.
• One-sided pain in the lower abdomen that is severe and persistent is the most common symptom. Many women describe it as an intense stabbing pain. Any woman who experiences this and who could possibly be pregnant should see a doctor.
• Vaginal bleeding . You might not know that you're pregnant and mistake this for a period, but the blood is usually different from a normal period - often dark and watery.
• Shoulder-tip pain. This can happen if there is internal bleeding which irritates other internal body organs, such as the diaphragm.
If you have any of these symptoms, go to hospital right away. You're likely to be referred for an ultrasound examination and a sensitive pregnancy test (unless the tube has ruptured, in which case you'll go straight to surgery).
The scan may be done using an intravaginal probe, as the pregnancy may not show up using an abdominal scan. You might also have a blood hormone test if the scan isn't conclusive.
If an ectopic pregnancy is suspected you will probably be taken to theatre for a laparoscopic examination (where a narrow viewing instrument is put into your abdomen through a tiny cut) to inspect your tubes. If an ectopic is discovered, the surgeon can remove this using the laparoscope to cut the tube and remove the pregnancy, leaving the tube intact.
If the tube has ruptured, sometimes abdominal surgery is needed rather than laparoscopic surgery (although not always) to remove the pregnancy and tubal damage. In some cases, a blood transfusion may be needed to replace lost blood.
In some hospitals the drug methotrexate, which terminates the pregnancy, can be used instead of surgery. This treatment is most effective in very early pregnancy and it can be used where there is no bleeding and the tube has not ruptured. The pregnancy is lost and reabsorbed by the mother, who will then experience bleeding for a couple of weeks. Methotrexate may also be used if the ectopic is picked up very early on and the levels of the pregnancy hormone HCG are still fairly low.
However, do let your doctor know if you are breastfeeding an older child or if you have certain health conditions. In such cases, your doctor may not prescribe the medicine and would look at other options, which may include surgery.
Note: If your blood is Rh-negative, you'll need a shot of Rh immunoglobulin after being treated for an ectopic pregnancy (unless the baby's father is also Rh negative).
The answer to this is yes, possibly.
If your fallopian tubes are undamaged after an ectopic pregnancy, then your chances of conceiving again remain the same. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced. Up to 10 % of women may become infertile after an ectopic.
Some 65 % of women will conceive again within 18 months of an ectopic, but if both your fallopian tubes were damaged or ruptured, you may need to think about IVF treatment.
There's about a 10 per cent risk of having another one. However, the risk is difficult to generalise about because of the differences in individual circumstances and the extent of the damage that takes place. That means that your overall chances of having a normal pregnancy next time around are still high.
You should arrange for a follow up appointment and ask for clear advice about your own future pregnancies from a consultant obstetrician.
There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current Chlamydia infection you can have a course of antibiotics to clear it up and reduce further damage to your tubes.
When you do become pregnant again, see your doctor as soon as you can as you would be referred to an early pregnancy unit for a scan to check that your pregnancy is developing in the right place.
Normally women who've had a laparoscopy are advised to wait three to four months before trying to conceive again. If you have had abdominal surgery, it's best to wait for six months to allow scarring to heal.
