Possible Implantation Bleeding

Patient

Q: I am concerned about possibly being pregnant and symptoms I'm experiencing. I had an ectopic pregnancy approximately 2 years ago, which required a series of methotrexate injections to resolve. A transvaginal ultrasound was done afterwards to verify there was no need for further intervention. I was also told there didn't appear to be any complications or "damage" done to my fallopian tube or elsewhere. I was advised that there would likely be difficulty in getting pregnant in the future and a fairly concerning percent chance another pregnancy would end up also being ectopic.

I am still between cycles so I'm unsure if I am indeed pregnant, however there are some concerns for me. I experienced some extremely mild bleeding/spotting that lasted approximately 2 days, but only for an hour or so each day. The blood was pink and really only showed up on toilet paper, but again, it was extremely light (lighter than the last day of a normal period for me). Using the date of my last period and the dates that I had unprotected sex, it calculates implantation would have occurred on the same date I experienced this between cycle spotting. There was minor cramping but it only lasted 2 hours at most and only on the morning of the 2nd day. Since this happened, I have had no other odd symptoms come up.

I've reviewed a substantial amount of information about bleeding between cycles and found "implantation bleeding" was a recurring answer. I've eliminated other possibilities such as STIs or cervical trauma, I haven't had sex several days prior to and not at all after this bleeding, and I haven't been on birth control so that hasn't changed either. In addition, my cycles are regular. I didn't experience any bleeding or cramping with the first ectopic pregnancy. This bleeding/spotting has never happened to me before so I'm concerned, not necessarily about being pregnant, but about if I am pregnant, is this a sign of a problem considering my previous ectopic pregnancy.

Although I have yet to officially verify if I'm pregnant, I am still concerned that this is a repeat ectopic, which is making me worry beyond belief. I do have an appointment set up with my doctor, but I'd like an opinion in the interim. Does this sound like probable symptoms of implantation bleeding? Does my history regarding the ectopic play a part in what may potentially be going on?

Symptoms:  Very light, pink colored, bleeding/spotting between periods, mild cramping lasting only an hour or two during this spotting, some fatigue but not sure if that's related as I frequently am fatigued.
Doctor

A:   Hello,
Considering the description of bleeding in the mid-cycle for 2 days associated with cramps for few hours and light in colour does indicate an implantation bleed unless other causes are established. You have been having regular previous cycles and had unprotected sex during this cycle. Once cervical erosion and ectopy or local causes are ruled out, spotting in mid-cycle could be attributed to break through bleeding as well, due to progesterone deficiency but pregnancy has to be ruled out prior.

Keeping in view that you had an ectopic earlier, if this is a pregnancy then there are 10 per cent increased chances that it can be ectopic again , but that has to be confirmed by and ultrasound transvaginally and a blood serum beta hcg level test.
The pregnancy can be confirmed with a serum beta hcg test between day 22-26 of the cycle , way before the missed period. It is a more sensitive lab based test and can give reliable results. If the levels are higher for hcg in the blood, then pregnancy is confirmed, but if they are less than 1 then its likely to be a breakthrough bleeding.
It is suggested that you may visit your physician for a serum beta hcg test first before contemplating any chances of ectopic and if the test is positive then a follow up ultrasound can be planned the next week thereupon.
I hope i have answered your query in detail,
wishing you good health,
regards

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