When Ectopic Pregnancy Symptoms Start & Early Signs

In a healthy pregnancy, a fertilized egg implants itself inside the uterus (also known as the womb), which is the organ that will effectively house and grow the baby until birth. 

In rare cases, a fertilized egg can implant itself outside of the uterus, most commonly in the fallopian tubes.

This condition is known as an ectopic pregnancy.

The fallopian tubes cannot stretch like the uterus, so a tubal pregnancy can lead to a life-threatening rupture and severe internal bleeding in the mother.

An ectopic pregnancy is a medical emergency that has to be treated by a healthcare professional as soon as possible. 

This guide from Pharmacists.org goes over the early signs and symptoms of an ectopic pregnancy, including exactly when ectopic pregnancy symptoms often start, so you know when to seek emergency medical treatment. 

What Is an Ectopic Pregnancy?

Every pregnancy begins when a sperm fertilizes an egg. In normal cases, the fertilized egg attaches itself inside the uterus.

In rare cases, the egg can attach itself outside the uterus and begin to grow. 

An ectopic pregnancy most often happens in the fallopian tubes, which carry eggs from the ovaries to the uterus.

In rarer cases, an ectopic pregnancy can affect other areas of the body, such as the ovaries, the abdominal cavity, or the cervix. 

Regardless of where the fertilized egg attaches, if it’s outside the uterus, the pregnancy can’t continue. If the egg continues to grow, it can cause life-threatening complications for the mother. 

An ectopic pregnancy can be treated with medications early on. In the later stages, surgery may be necessary. 

Ectopic pregnancy can affect 1-2% of those who get pregnant. The risk can go up to 5% for those who use assisted reproductive technology. 

What Causes an Ectopic Pregnancy?

The causes of an ectopic pregnancy depend on which type of ectopic pregnancy it is.

For instance, a tubal pregnancy (when the fertilized egg attaches to the fallopian tubes) is caused by damage to the fallopian tubes.

In other cases, an ectopic pregnancy is caused by a hormonal imbalance or abnormal development of the fertilized egg. 

Some risk factors can increase your chances of an ectopic pregnancy. These include: 

  • Previous ectopic pregnancy: Women with a previous ectopic pregnancy may continue to have the same risk factors that increase their chances of another ectopic pregnancy (e.g. imbalances in hormone levels or pelvic inflammatory disease ). Women with a previous ectopic pregnancy are 10 times as likely to get an ectopic pregnancy in future pregnancies compared to women without a history of ectopic pregnancy. 
  • Previous infections: A sexually transmitted infection, like chlamydia or gonorrhea, or pelvic inflammatory disease (PID) and the subsequent scar tissue it causes, can cause inflammation in the reproductive organs (such as the fallopian tubes) and lead to structural abnormalities that can increase the chances of an ectopic pregnancy. (Speaking to the importance of getting tested for STIs and STDs regularly, especially as you begin pregnancy or start planning for pregnancy.)
  • History of fertility treatments: Research shows that some fertility treatments, such as in vitro fertilization (IVF), increase the risk of an ectopic pregnancy. For instance, women who undergo IVF have a 1 in 100 risk of getting an ectopic pregnancy. 
  • Older age: The risk of fallopian tube damage increases with age, making older women more likely to have an ectopic pregnancy. 
  • Smoking: Studies show that smoking causes permanent changes in the fallopian tubes. This puts former and current smokers at a higher risk for an ectopic pregnancy. If you currently smoke, you have many options to help you quit — you can also speak to your healthcare provider for additional help and resources. 

When Do Ectopic Pregnancy Symptoms Start?

An ectopic pregnancy begins almost immediately after conception. However, many women may not notice any symptoms, and some may not even know that they’re pregnant

If you’ve missed your menstrual period, a pregnancy can be confirmed with an at-home pregnancy test.

If you are not using contraception like condoms, birth control, or an intrauterine device (IUD), it may be helpful to regularly test for pregnancy.

For other women, symptoms may show in early pregnancy. The early signs may be similar to those of a normal pregnancy, and can include breast tenderness, nausea, a little cramping, and fatigue.

About six to eight weeks following the first missed period, women can begin to experience the first ectopic pregnancy symptoms. These are typically not considered “normal” pregnancy symptoms and can be a warning sign that something is wrong. 

In the following section, we’ll go over these early signs of an ectopic pregnancy

What Are the Early Signs of an Ectopic Pregnancy?

Abdominal Pain or Discomfort 

Abdominal pain is one of the most common symptoms of an ectopic pregnancy. It’s typically felt only on one side and can be persistent or sporadic.

Combined with other symptoms, this can indicate an ectopic pregnancy. 

That said, many women with an ectopic pregnancy do not feel any abdominal pain at all until there’s a life-threatening rupture. 

Vaginal Bleeding

Although it may get confused with a regular period, the bleeding that occurs during an ectopic pregnancy will generally look very different. 

It can last only a day or two, or it can occur every several days in an irregular pattern. In addition, the color of the blood may be darker than normal. 

Of course, vaginal bleeding during pregnancy is fairly common and is not necessarily a sign of an ectopic pregnancy. 

Nausea, Vomiting, or Diarrhea

An ectopic pregnancy can affect the gastrointestinal (GI) tract, leading to classic GI symptoms like nausea, vomiting, or diarrhea.

If there’s no other reason to feel stomach upset, then GI upset combined with the above symptoms may be a sign of an ectopic pregnancy

Shoulder Pain

If the ectopic pregnancy has led to internal bleeding, it can cause shoulder pain. This is because the bleeding can irritate the phrenic nerve, which is found in the diaphragm and connect to the shoulder.

This muscle can cause pain to be felt in the shoulder. This symptom is a sign that the condition has gotten to a more serious stage and warrants emergency medical attention. 

When To See a Doctor 

In the later stages, an ectopic pregnancy can cause the fallopian tubes to split open, which is known as a rupture.

This is a serious condition that requires emergency medical treatment, which will most likely involve surgery. 

If you experience any of the following symptoms, it can be a sign of a rupture:

  • Sharp, sudden, and intense pain in the abdomen
  • Heavy vaginal bleeding
  • Extreme dizziness or vertigo
  • Light-headedness 
  • Physical fatigue
  • Fainting

It’s important to seek emergency medical advice if you experience any of the above symptoms. 


An ectopic pregnancy happens when a fertilized egg attaches itself outside the uterus. This type of pregnancy can’t continue, and if left untreated, can cause serious risk to the mother’s health. 

If you are pregnant and experience symptoms such as abdominal pain, vaginal bleeding, and an upset stomach, it’s important to see a doctor right away.

You may need diagnostic tests, including blood tests and urine tests to check your pregnancy hormone levels, such as human chorionic gonadotropin (hCG level).

While these symptoms aren’t always side effects of an ectopic pregnancy, it’s better to be safe than risk potential complications during your pregnancy. 

If you have dealt with the pregnancy loss of an ectopic pregnancy, there are support groups available for these and other women’s health matters.

References and Sources: 

Ectopic Pregnancy | NCBI Bookshelf 

Incidence, Diagnosis and Management of Tubal and Nontubal Ectopic Pregnancies: A Review | NCBI 

The Association Between Smoking and Ectopic Pregnancy: Why Nicotine Is BAD for Your Fallopian Tube | PMC 

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