Ectopic pregnancy pain: location, shoulder symptoms and next steps

October 2, 2023

Ectopic pregnancy pain often starts low in the abdomen or pelvis and may be worse on one side. Shoulder-tip pain, marked dizziness or fainting can signal internal bleeding. Sudden severe pain or collapse needs emergency care; call 911 rather than waiting for an office appointment.

If pregnancy is possible and you have pain or bleeding, seek prompt medical assessment even without a positive home test. Symptoms alone cannot locate a pregnancy. Evaluation may include transvaginal ultrasound and repeated pregnancy-hormone blood tests.

Pregnancy, ideally, is a joyous and exciting time. But reality and what’s ideal don’t always match. Sometimes a fertilized egg doesn’t travel down your fallopian tubes and into the uterus, where it implants itself in the blood-rich lining that nourishes its growth.

Instead, the fertilized egg stays in the fallopian tube or implants elsewhere outside the uterus. Although the pregnancy could lodge in scar tissue, the area where the fallopian tubes join the uterus, or even the bowels, in more than 90% of cases, an ectopic pregnancy takes place in the fallopian tubes.

A fallopian tube can’t expand sufficiently to accommodate embryonic growth. Neither fallopian tubes nor other non-uterine tissues have the resources to nourish a baby, either. Without treatment, the embryo could rupture your tubes or cause other types of hemorrhaging that put your life at risk.

At Elite Gynecology in New York City, our caring and knowledgeable gynecologists, including Tamara Guichard, MD, want you to enjoy your pregnancy. But they also advise you to stay alert to problems, particularly signs of an ectopic pregnancy, to safeguard your life.

Only about 2% of pregnancies in the United States are ectopic pregnancies. Your risk is higher if you’ve had a previous ectopic pregnancy, tubal or pelvic surgery, pelvic inflammatory disease or certain STIs, if you smoke, or if you conceived with fertility treatment. However, if you experience any of the symptoms of ectopic pregnancy — whether you think you’re pregnant or not — you should contact us immediately.

How do you know if you have an unsustainable, life-threatening ectopic pregnancy, and what should you do about it? The answers are here.

You experience pelvic pain

Pelvic pain is associated with a variety of conditions that could occur during pregnancy, including ectopic pregnancy. In fact, other than the normal symptoms of pregnancy — such as tender breasts and a positive pregnancy test — slight pelvic pain could be the first indication of an ectopic pregnancy.

Any pelvic pain should be evaluated by your OB/GYN. Warning signs for ectopic pregnancy include:

• Mild, one-sided pelvic pain
• Mild abdominal or pelvic pain
• Sudden, severe abdominal or pelvic pain

If you have sudden, severe pain, you could be hemorrhaging and should go straight to the emergency room.

Your shoulder hurts

Shoulder pain could be another indication that you could have life-threatening internal bleeding, and you should go to the emergency room right away. An ectopic pregnancy usually causes pain in the very tip of the shoulder — where your arm starts and your shoulder ends.

You probably never experienced this type of shoulder pain before. It’s different from the pain of sleeping awkwardly on your shoulder or that caused by stress. It also tends to be sharp and sudden.

You’re bleeding abnormally

Light spotting can happen in early pregnancy, but you should always tell your OB/GYN about it, especially if you also have pain. If you’re bleeding continuously after a positive pregnancy test, or if the blood is either brown, black, or watery, you should call us right away.

Even if you don’t know that you’re pregnant, spotting and unusual vaginal bleeding could be a sign of an ectopic pregnancy. It commonly occurs before you even think of taking a pregnancy test. Always see a gynecologist if you have abnormal bleeding or bleeding outside of your period.

You have bladder or bowel problems

Both menstruation and pregnancy may cause alterations in your bowel patterns. However, symptoms that can also occur with an ectopic pregnancy include:

• Diarrhea
• Pain when defecating
• Pain when urinating
• Sharp or shooting vaginal pain

Even if you’re not aware that you’re pregnant, we give you a pregnancy test when evaluating pain or bowel problems, due to their association with ectopic pregnancy.

You feel dizzy or faint

Feeling dizzy, faint, or confused is always a warning sign that should be taken seriously. If you actually do faint, see a doctor to find out why.

If you faint, feel very dizzy or have severe pain with possible pregnancy, call 911 for emergency assessment. Do not drive yourself or wait for an online appointment response.

• Fainting
• Feeling lightheaded
• Feeling sick
• Looking pale
• Very slow or rapid pulse

Deaths from ectopic pregnancy in the United States have fallen sharply, but a ruptured ectopic pregnancy remains a leading cause of pregnancy-related deaths from bleeding. Early diagnosis and treatment, with medication (methotrexate) or surgery, are what have lowered the death rate in ectopic pregnancies.

For nonurgent follow-up after assessment, contact the office about the appropriate location and timing. Use emergency services for severe symptoms, not the routine appointment form.

Sources

1. Tubal Ectopic Pregnancy. American College of Obstetricians and Gynecologists (Practice Bulletin No. 193; reaffirmed 2025), 2018.
2. Tubal Ectopic Pregnancy. N Engl J Med, 2025.
3. Does this woman have an ectopic pregnancy?: the rational clinical examination systematic review. JAMA, 2013.
4. Sites of ectopic pregnancy: a 10 year population-based study of 1800 cases. Hum Reprod, 2002.
5. Trends in ectopic pregnancy mortality in the United States: 1980-2007. Obstet Gynecol, 2011.
6. Ectopic Pregnancy. American College of Obstetricians and Gynecologists, 2026.

Further reading: NHS ectopic pregnancy symptoms and assessment.