The experience of menopausal symptoms for women varies widely


 Menopause is a natural phenomenon which occurs in all women when their finite number of eggs becomes depleted and their monthly flow ceases or pauses for at least 12 months. 


The eggs/ovaries are responsible for the production of estrogen and progesterone hormones and as the eggs declined the levels of these hormones fall, causing the monthly flow to first become erratic and eventually stop. Consequently, most menopausal complaints or symptoms are as a result of the decline of these two hormones on the woman’s body physically and mentally.

95 percent of women become menopausal between the ages of 45 to 55 years and factors which can affect the age at which women have their final period includes;

  • Age at first menses
  • Number of children
  • Previous use of oral contraceptives
  • BMI- Weight
  • Ethnicity and
  • Family history/Genetics

The experience of menopausal symptoms for women varies widely; some symptoms begin while still menstruating and others not until a year or more after their last period. Symptoms of the menopause last far longer than most women anticipate; for example, night sweats and hot flushes, persist in more than half of women for more than seven years.


Common menopausal symptoms

1.   Menstrual irregularities: The typical presentation of some women is to see the GP to rule out they are pregnant. Irregularities to the menstrual cycle may last for up to four years and the cycle may lengthen or shorten with a slight increase in the amount of menstrual blood. For few, the flow stops abruptly.

2.   Hot flushes and sweats: The face, head, neck and chest and body suddenly becomes hot. Some describe this as internal heat, and the symptoms may last for several minutes and feel like the chill of a fever. Many women think they are coming down with Malaria or Typhoid.

 3.  Genitourinary syndrome of menopause (GSM): Steroid hormones decreases can lead to changes in certain areas of her body, like the vagina, vulva, and bladder. For example, estrogen helps keep the vagina moist and flexible. But when estrogen levels decline, the vagina can become dry and tight.

GSM is thought to affect about half of postmenopausal women. Symptoms include:

• Dryness, burning sensations, and irritation in the genital area

• Poor vaginal lubrication during sex, discomfort or pain with intercourse, and impaired sexual function

• An urgent need to urinate, painful urination, or recurrent urinary tract infections (UTIs)

GSM is chronic and progressive. It does not get better over time. However, symptoms can be managed with treatment.


4. Sleep disturbance: The new and different feeling of menopause adds to other psychosocial factors like dissatisfaction, depression, irritability and this affects sleeping patterns and concentration.

5. Mood changes: Anxiety, nervousness, irritability, memory loss and difficulty concentrating.

6. Low back pain with generalized joint aches: Many women complain of this. Estrogen helps to maintain the strength of bones and the decline allows the bones to become more brittle.

Health Screens For menopausal women

Once a woman is 45, she must become aware of other diseases that can mimic menopausal symptoms as well as understand the diseases she’s also at risk of contracting.

  • Thyroid Function Tests – can help differentiate thyroid disease symptoms from menopausal symptoms.
  • Blood glucose (FBG and HbA1c)- as diabetes, especially associated with PCOS can cause similar symptoms, it is important to screen for type two diabetes as the age of onset begins from 30.
  • Blood cholesterol and triglycerides – Estrogen interestingly reduces the risk of hypertension in women. Cardiovascular risk factors such as being overweight or having a sedentary lifestyle must, therefore, be screened immediately a woman enters menopause.
  • Cervical screening (Pap smear) and mammograms
  • A pelvic scan – may be considered for those women with atypical symptoms.
  • Other screenings are selected by the physician based on the complaints. They may include renal function test with serum electrolytes including calcium, liver function tests, a Xray/MRI of the lower back or joints. 
  • Book to have a complete health screen in Lagos at                      


Healthy lifestyle

A healthy lifestyle; Stopping smoking, losing weight and limiting alcohol are beneficial. Also, regular aerobic exercise and adequate calcium intake (around 700 mg/day) help.


HRT is the most effective treatment to relieve the symptoms caused by the menopause completely. In addition to relieving hot flashes, it also helps;

Mood lability/depression – HRT, alone or in combination with an antidepressant

Joint aches and pains

Genitourinary symptoms of menopause (GSM) – The epithelial linings of the vagina and urethra are very sensitive to estrogen, and estrogen deficiency leads to thinning of the vaginal epithelium.

Osteoporosis – Bisphosphonates are best for this, however, in the occasional patient with persistent menopausal symptoms who cannot tolerate first and second-line therapies for osteoporosis, estrogen may be a reasonable option.

Register and consult with a GP online now, or book a gynecologist or urologist to find out more at

Psychological symptoms

  • Cognitive behavioral therapy (CBT) can also be beneficial.

Genitourinary syndrome of menopause (GSM)

Because genitourinary syndrome of menopause (GSM) refers to a number of different symptoms, treatment depends on a woman’s individual situation.

Pain during sex due to vaginal dryness can be alleviated with lubricants, moisturizers, or low-dose vaginal estrogen treatment. Or, if she has urinary problems, she might try pelvic floor physical therapy.

Women who suspect they’re having GSM-related should speak to their doctor. Many women don’t realize that treatments are available, but some symptoms can be easily managed.

Alternatives to HRT

Herbal or complementary treatments

  1. Phyto-oestrogens are naturally occurring compounds found in plant sources, that are structurally related to estradiol. Foods such as soybeans, as well as nuts, wholegrain cereals and, igbo-ora yam, are the foods most rich in phytoestrogens.
  2. Sex! Regular intercourse prior to the onset of symptoms may contribute a great deal to the alleviation of menopausal symptoms. Although no studies have been conducted to confirm this, several studies show that intravaginal steroids administration was able to rapidly and efficiently achieve correction of all the signs and symptoms of vaginal atrophy, improve sexual function and caused no or minimal changes in serum sex steroid levels, guess what? All these steroids are abundant in the male semen!


About 10% of pregnancies need to be induced in order to expedite vaginal delivery. This happens when the benefits of delivering the baby outweighs the risks  of continuing the pregnancy or awaiting spontaneous labour. 
*What are the indications for induction of labour? 
-Placenta insufficiency : when the placenta is diseased and no longer capable of supporting the foetus
-‎Prolonged pregnancy : beyond 41 weeks of gestation 
-Intrauterine growth restriction (IUGR) : when the foetus fails to gain weight, or loses weight due to constitutional, maternal or placental disease
– Premature rupture of membranes : when the “bag of water” breaks without any sign of labour after 24 hours (to avoid infection to the baby) 
– Intrauterine fetal death – to prevent the risk of toxicity or infection to the mother 
– Intrauterine infection (Chorioamnionitis) 
– Unexplained antepartum hemorrhage 
– Potential or presumed fetal macrosomia : increasing growth beyond 4kg, especially in diabetic mothers
– Medical diseases in the mother : such as severe hypertension, uncontrolled diabetes, cardiac or renal diseases, cancers, etc. 
*What are the methods for inducing labour? 
Before induction of labour, it is important to assess the cervix to determine its “ripeness”, ie. to predict whether induction is likely to succeed or fail. Predictors of a successful induction includes advanced gestational age (above 37weeks) and multiparity (having delivered by vagina in the past). 
The cervix can be ripened through medical and non-medical methods. There is limited evidence to support the efficacy of non-medical methods (eg. Sexual intercourse, nipple stimulation, herbal mixtures, dates, castor oil, etc.) 
The medical methods of ripening are :

1. Mechanical methods –  this includes using the finger to “stretch and sweep” the cervix and/or insertion of a catheter into the cervical canal. 
2. Pharmacological methods – use of chemical agents (prostaglandins and oxytocin) 
Certain parameters are used by the midwives/physicians to “score” the ripeness of the cervix. After satisfactory ripening, induction of labour proper begins. This can be done in one of two ways – 
~Artificial rupture of membranes – Deliberately breaking the “bag of water”, which stimulates the process of active labour through the release of prostaglandins.
~Induction/Augmentation of labour using oxytocin infusion – Oxytocin is released normally by the brain at the time of labour. This process can be augmented by infusion of controlled amount of oxytocin (Syntocinon®) through dedicated intravenous infusion pumps. 
*Note that induction of labour MUST be done in a hospital where adequate feto-maternal monitoring and standard obstetric care are available. This will ensure that any complication in the course of induction can be identified promptly and treated appropriately. 
It is also better to have standby facilities for Caeserean section in case of complications during, or failure of induction of labour. 
Wishing all expectant mothers safe delivery! 

Monkeypox Outbreak

Monkeypox is a viral disease similar to smallpox and chickenpox transmitted majorly by rodents. The virus can spread both from animal to human and from human to human.

On the 22nd of September, 2017, the Nigeria Centre for Disease Control (NCDC) was notified of a case of suspected Monkeypox.

The case was identified in an 11-year-old male patient who was presented to the Niger Delta University Teaching Hospital (NDUTH) in Yenagoa, Bayelsa State in Nigeria.

Subsequently, 11 other cases were identified. All the cases are currently receiving appropriate medical care. All the patients are improving clinically and there have been no deaths.

A medical doctor and 10 persons who came down with the monkeypox had been quarantined in an isolation centre at the Niger Delta University Teaching Hospital, Okolobiri, in Yenagoa Local Government Area of the state.

As at 1st October 2017, 32 close contacts of the cases have been identified, advised appropriately and are being monitored.

Infection from animal to human can occur via an animal bite or by direct contact with an infected animal’s bodily fluids. The virus can spread from human to human by both respiratory (airborne) contact and contact with infected person’s bodily fluids.

Risk factors for transmission

  • close contact with infected persons eg- sharing a bed, room
  • using the same utensils as an infected person
  • Eating inadequately cooked meat of infected animals
  • Anything that favors the introduction of the virus to the oral mucosa.

Incubation period

It takes about 5-21 days but ideally it is 10–14 days. symptoms of monkeypox are similar to smallpox, although it is often milder.


Signs and symptoms

A distinctive feature of monkeypox compared to other similar diseases is that some patients develop severe lymphadenopathy (swollen lymph nodes) before the appearance of the rash.

The infection can be divided into two periods:

  • The invasion period (0-5 days) characterized by fever, intense headache, lymphadenopathy (swelling of the lymph node), back pain, myalgia (muscle ache) and an intense asthenia (lack of energy);
  • The skin eruption period (within 1-3 days after the appearance of fever) where the various stages of the rash appear.

Rash often begins

  • on the face and then spreading elsewhere on the body.
  • The face (in 95% of cases), and palms of the hands and soles of the feet (75%) are most affected.
  • Evolution of the rash begins with lesions with a flat base to vesicles (small fluid-filled blisters), pustules, followed by crusts occurs in approximately 10 days. Three weeks might be necessary before the complete disappearance of the crusts.
  • Rash can also affect oral mucous membranes (in 70% of cases), genitalia (30%), and conjunctivae (eyelid) (20%)

Severe cases occur more commonly among children and are related to the extent of virus exposure, patient health status and severity of complications.


The differential diagnoses that must be considered include other rash illnesses, such as, smallpox, chickenpox, measles, bacterial skin infections, scabies, syphilis, and medication-associated allergies. Lymphadenopathy during the prodromal stage of illness can be a clinical feature to distinguish it from smallpox.

Monkeypox can only be diagnosed definitively in the laboratory where the virus can be identified by a number of different tests:

  • enzyme-linked immunosorbent assay (ELISA)
  • antigen detection tests
  • polymerase chain reaction (PCR) assay
  • virus isolation by cell culture

Treatment and vaccine

There are no specific treatments or vaccines available for monkeypox infection, but outbreaks can be controlled.


Vaccination against smallpox is assumed to provide protection against human monkeypox infection however routine smallpox vaccination was discontinued following the apparent eradication of smallpox.


Any human that might have come into contact with an infected animal/human should be quarantined, handled with standard precautions and observed for monkeypox symptoms for 30 days.

Reducing the risk of infection in people

During human monkeypox outbreaks, close contact with other patients is the most significant risk factor for monkeypox virus infection. In the absence of specific treatment or vaccine, the only way to reduce infection in people is by raising awareness of the risk factors and educating people about the measures they can take to reduce exposure to the virus. Surveillance measures and rapid identification of new cases is critical for outbreak containment.

  •  Gloves and protective equipment should be worn when taking care of ill people. Regular hand washing should be carried out after caring for or visiting sick people.
  • Reducing the risk of animal-to-human transmission. Efforts to prevent transmission in endemic regions should focus on thoroughly cooking all animal products (blood, meat) before eating. Gloves and other appropriate protective clothing should be worn while handling sick animals or their infected tissues, and during slaughtering procedures.
  • hand-washing-250px
  • Health-care workers caring for patients with suspected or confirmed monkeypox virus infection, or handling specimens from them, should implement standard infection control precautions.
  • Healthcare workers and those treating or exposed to patients with monkeypox or their samples should consider being immunized against smallpox via their national health authorities. Older smallpox vaccines should not be administered to people with comprised immune systems.
  • Samples taken from people and animals with suspected monkeypox virus infection should be handled by trained staff working in suitably equipped laboratories.
"Mad cow, deer tick, monkey pox, what's next?"
“Mad cow, deer tick, monkey pox, what’s next?”

Continue reading “Monkeypox Outbreak”



Vaginal delivery remains the better option than C-section; unless there’s a medical indication for the latter. But nothing comes without its own downside. One of the downsides of vaginal birth is the higher risk of genital tract injuries: ranging from slight bruising to various degrees of tear.

Episiotomy is the surgical cut made in the vaginal wall and peri-anal (perineal) muscles which is sometimes necessary to widen the space for the passage of the baby and to prevent irregular lacerations during delivery (which are more difficult to treat).

When a woman is given an episiotomy or she sustained genital laceration during childbirth, a proper repair must be done by a trained personnel (midwife or doctor). Failure to repair promptly and skillfully can result in immediate and longterm complications.

The steps involved in repairing perineal tear and episiotomy are essentially similar:
*The doctor will examine your vagina and anus to visualize the extent of injury, check if the anus is involved and decide whether the repair should be done in the labour room or operating theater.

*You will be given an injection at the site of the wound to numb the pain. You shouldn’t feel anything during the stitching and a few hours thereafter.

*The cut will be stitched layer-by-layer, ie. Vaginal wall, muscles, then skin. Absorbable sutures are widely used nowadays, so need to go back for removal of stitches.

*If the deep anal sphincters (special muscles controlling the anus) are involved, the procedure should be done in an operating theater, by a specialist doctor, under anesthesia.

After the repair, care must be taken to ensure proper healing of the wound. Painkillers, antibiotics and stool softening medications must be taken for at least 2 weeks. Sitz bath (immersing the perineum in lukewarm water) should be done twice daily until full healing. Long-term contraception is advised to reduce the risk of wound breakdown during the next delivery. Next pregnancy and childbirth should be hospital-supervised, taking into consideration the past events.

If perineal tears are left unattended for a long time after delivery, severe bleeding can occur; necessitating blood transfusion. Other complications include:


*poor wound healing


*chronic pain

*faecal incontinence (inability to control flow of stool)

*flatulence (uncontrollable farting)

*fecal fistulae (abnormal connection between anus and vagina – soiling the vagina with feaces)

*sexual dissatisfaction and other sexual dysfunctions

*difficulty in subsequent deliveries

*low self esteem

Genital tract injuries can be prevented by allowing the baby to descend gradually, with controlled pushing, guarding of the perineum by the midwives, doing episiotomy when needed or planned caesarean section when the fetal weight is estimated to be above 4kg.


Blood Cancer: The Leukemias

Just like any other cancer which is basically an abnormal, uncontrolled cell growth, the human blood is not left out of this inferno. Blood cancer is literarily a condition whereby blood cells continue to proliferate uncontrollably.

Leukemia Symptoms, Types, Causes, Diagnosis, Treatments, Prevention, Nutritions, Cure (1)

What is Leukemia?

Leukemias are a heterogeneous group of malignant disorders which is characterized by uncontrolled clonal (single cell) proliferation of blast cells in the bone marrow and body tissues. To put it simply, imagine a pregnant woman delivering 100 premature babies every year whenever she gets pregnant!

Blast cells are immature blood cells. Blood cells go through about 5 stages before they become mature and are able to perform their functions. In leukemia, immature cells accumulate and are unable to reach their full matured state.


Blood cells produced in the bone marrow (the soft spongy center of long bones of the arms and legs) include; The Red Cells, White Cells, and Platelets.

While the red cells are responsible for carrying oxygen, providing nutrients to body cells and tissues to ensure their survivals as well as transporting waste products away from those same cells,

The white cells act as defense mechanisms of the body to fight and guard against infections. They are basically the B (The Myeloid cell line) and T cells (The Lymphoid cell line).

Platelets are responsible for the formation of blood clots at sites of injury.

Stages of Blood Cells Production.

Leukemia can be Acute- (of short, quick and fatal onset) or Chronic- (continues over an extended period of time) while it is being managed.




Characterized by 20% or more of blast cells in the bone marrow. It is of abrupt onset and is rapidly fatal. The survival rate is <6 months without treatment. The more recent WHO classification of acute leukemia relates it with other Chromosomal Abnormalities E.g. Down Syndrome.

Acute Lymphoblastic Leukemia (ALL) is the most common Leukemia in children falling off by 10 years with a secondary rise after the age of 40 years. Its incidence is highest at 3 to 7 years while Acute Myeloid Leukemia is most common in adults.

Causes of Leukemias

There is no exact known cause but several risk factors of leukemia just like every other cancer, however, for Acute Leukemias;

  • The first event is thought to occur in the fetus in utero due to environmental exposure during pregnancy.
  • It may arise as a postnatal (after birth) mutation in early lymphoid cells in the bone marrow.
  • The secondary event is precipitated by infection in childhood due to the mechanism of abnormal response of the child’s immune system to infection.

It is of utmost importance to exclusively breastfeed babies for the first six months of life this boosts the child’s immune system and the introduction of a balanced diet in complementary feeding.

Furthermore, children with high level of social activity like those attending day care have reduced incidence of ALL because of exposure to common infections boosting their immune system

Symptoms and Features of Acute Leukemia include:

  • Fever
  • features of mouth, throat, skin and respiratory infections
  • Marked cervical lymphadenopathy
  • Testicular swelling
  • Spontaneous bruises, purpura and bleeding gums.


 Laboratory Diagnosis

1. Bone marrow infiltration checked with bone marrow biopsy

  • Anemia (Reduced Blood hemoglobin concentration)
  • Leucopenia (Reduced white cells count)
  • Thrombocytopenia (Reduced platelet count)
  • Hypercellular bone marrow with >20% blast cells.
  • Infiltration of organs Liver, Spleen and lymph nodes.

2. Cerebrospinal fluid examination contains blast cells (CSF is meant to be a clear colorless fluid which cushions the brain)

3. Increase uric acid as a result of bone degradation with deranges Liver and renal function tests

4. Radiography may include lytic bone lesions

5. Other tests like a CT scan which may be needed for staging as well as other investigations depending on the salient signs


Supportive Therapy: Prompt treatment of any episode of fever, blood and blood products support.

Specific Therapy: Chemotherapy, Radiotherapy, Short and intensive courses of drugs.


The physician (Hemato-Oncologist) decides which is the best approach to treatment according to severity.


An unfortunate complication of acute leukemia is DIC Disseminated Intravascular Coagulation

  • DIC is a disorder characterized by excessive inappropriate activation of coagulation and formation of small clots in the blood vessels. These clots block the flow of blood and are a leading cause of death in acute Leukemia.
  • The activation of clot formation is caused by road- like clumps of granular materials in leukemic cells called Auer Rods. This can as well lead to bleeding from the digestive and respiratory tracts as all platelets are used up in the formation of these clots.


Could be chronic myeloid or chronic lymphoid leukemia according to the cell line affected. It is characterized by rapid proliferation and growth of MATURED blood cells within the bone marrow.


Hypercellularity (increased amount of cells) of any of the different blood cells (eg White Blood Cell or Red Blood Cell) is a diagnostic feature. It is mostly asymptomatic and detected mostly in routine blood checks. It is nominated according to the predominantly increasing cell;

  • White cells increasing predominantly- Chronic Myeloid Leukemia or Chronic Lymphocytic Leukemia
  • Red cells increasing predominantly- Polycythemia Rubra Vera
  • If it’s the platelets increasing predominantly then we refer to as Essential Thrombocythemia

The Chronic leukemias account for about 15% of Leukemias and can occur at any stage.

Chronic Leukemia is managed appropriately at this hypercellular stage. It is stable indolent and slow progressing. All efforts by medical personnel managing the condition are aimed at not progressing from this stage into the accelerated phase where symptoms begin to manifest and ultimately to blastic transformation. (Transformation to the acute phase)

General Prevention of Leukemias

Prevention is aimed at reducing your risks of leukemia since there is no known cause for leukemia as well as other various types of cancers.


Risk factors include;

  • Occupational exposures to certain chemicals such as benzene
  • Smoking and other uses of tobacco products
  • Exposure to large amounts of radiation
  • Down Syndrome or other types of genetic abnormalities
  • Smoking, other uses or exposure in pregnancy and in childhood to tobacco smoke (passive smoking).


The treatment for cancers are quite expensive and drain resources. This is even more so when the five-year survival rates aren’t encouraging, however, new treatments are emerging that can change the outcomes into a better prognosis.

Presentación de PowerPoint

Immunotherapy is the “treatment of disease by inducing, enhancing, or suppressing an immune response”. Immunotherapies designed to elicit or amplify an immune response are classified as activation immunotherapies, while immunotherapies that reduce or suppress are classified as suppression immunotherapies.

What holds true for most blood cancers is that the earlier you detect it, the better you can reign it in.



Mariam Mojisola Solate-Eshinlokun is a Medical Laboratory Scientist (B.MLS, AMLSCN) in Hematology and Immunohematology. She also has an M.Sc in view. She’s from Ogun state, a wife, mother and currently practice at the National blood bank, Khartoum Sudan.





Most women have, at least, a rough idea of when to expect their monthly visitors – the menses. But some are not so lucky. The visitor can just decide to barge in at any time. Irregular menses can be very embarrassing, frustrating and distressing. 
I have discussed normal menstrual cycle on this blog before, read it here…

Let’s look at some of the definitions of abnormal menses. 
*Menorrhagia – heavy menstrual flow, which can be described subjectively as the need to change pads more frequently than before. 
*Metrorrhagia – prolonged menses lasting for more than 9 days. 
*Menometrorrhagia – combination of heavy and prolonged menses. 
*Hypermenorrhea – cycle length shorter than 24 days. 
*Hypomenorrhea – cycle length greater than 38 days. 
*Amenorrhoea – absence of menses for 3 or more consecutive months. 
*Inter-menstrual bleeding – bleeding or spotting in between the menstrual cycles. 
*Post-coital bleeding – bleeding or spotting after sexual intercourse. 
*Post menopausal bleeding – bleeding or spotting after menopause (after at least one year of confirmed menopause) 
*Irregular menstrual cycle – more than 7-9 days of disparity in lengths of cycles. 
What are the causes of irregular menses? 

Irregular menses are commoner in pubertal girls (11-14years) and older women who are approaching menopause. Other than these, irregular or abnormal menses can be due to any of the following – 
*Psychological stress, physical exertion, or sudden change in diet, environment, etc. 

*Problems with ovulation 

*Uterine fibroids

*Adenomyosis (a condition in which the uterine lining – endometrium – grows into the wall of the uterus) 

*Use of contraceptive pills and devices 


*Ectopic pregnancy 

*Bleeding disorders

*Hormonal imbalance 

*Infections of the genital tract including the uterus 

*Cancers of the genital tract

*Co-morbid medical conditions such as diabetes, obesity, etc. 

*Some drugs, alcohol, tobacco smoking, etc. 
Management of abnormal menstrual bleeding depends on the cause. You need to visit a doctor who will take a detailed history and carry out some tests to determine the cause. 
Some of the tests you have to do are:

*Pregnancy test

*Ultrasound scan

*Endometrial biopsy 


*CT scan or MRI, if indicated 

*Full blood workup

*Hormonal profile 
Of course, treatment depends on the cause or definitive diagnosis. This can be medical or surgical. Certain general measures can be used to restore normal menses; such as weight loss and stress management. 
In conclusion, menstrual disorders and irregularities are quite common. It is important to understand the mechanism of normal menses, so as to be able to detect any anomaly and seek professional advice for prompt investigation and treatment. 



a rebellious embryo may decide to implant itself outside the uterus!


After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.


However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!

Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.


Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.

Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.

What are the risk factors for EP?

  • Previous history of EP
  • Previous history of infertility and its treatment (assisted reproductive techniques)
  • Pelvic inflammatory disease (PID)
  • Intrauterine contraceptive device use at the time of conception
  • Endometriosis (presence of the uterine lining outside of the uterus)
  • Pelvic or tubal surgery
  • Smoking

The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.


The symptoms are variable and non-specific but there is a classical triad reported by many patients:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. Mild vaginal bleeding or brownish discharge. 

 Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP),  Sudden collapse (due to severe blood loss)


    A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.



    *Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient. 

    *Medical management – using methotrexate, in clinically stable patients who are compliant 

    *Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.

    Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.