This information is about pain and bleeding in early pregnancy clinics. Not all of the problems discussed will apply to you as causes of bleeding and pain are varied.

Our aim is continuity of care, however this is not always possible, and when you are in hospital you will be looked after by a team of doctors and nurses.

Is it normal to have bleeding/spotting in pregnancy before 18 weeks?

Spotting or bleeding in early pregnancy can be common. It can occur in about 20 in 100 people, and may also come with lower abdominal (tummy) pain and back pain. These symptoms do not mean there is a problem with the pregnancy.

Why am I bleeding?

There are many causes of bleeding in early pregnancy. If you have been scanned, this may help us understand why. 

If the scan is normal we will discuss with you possible causes of bleeding but may never be sure of the exact reason. The main aim of scanning is to assess whether the pregnancy is normal.

The bleeding may be coming from the neck of the womb. Some changes on the cervix related to hormones (ectropian) are common in pregnancy, which can cause bleeding. 

In an ectropian, cells that line the inside of the canal (behind the cervix) change position. These cells are more fragile and are prone to bleeding. This is not a sinister or worrying problem, and it is commonly seen. However, in pregnancy, it can make you anxious. Bleeding can be light, pink, dark, or red, and can sometimes be a heavy ‘gush’. The pregnancy is rarely affected by this.

In other cases, an area of bleeding outside of the pregnancy sac (commonly related to the placenta) has occurred. This usually resolves without any prolems. This is called a subchorionic bleed and occurs in about 1% of pregnancies. 

Sometimes on a scan, we can measure this and look at the size of the sac/pregnancy in comparison to the size of the area of bleeding. We may scan again if the bleed is the same size or larger than the the sac. 

In cases where the subchorionic bleed continues to be present on future scans and remains equal to or larger than the size of the sac, further scans may be needed including a dating scan.

If large subchorionic bleeds do not resolve the placenta can struggle to function as well as it should. This is not common.
Although bleeding in pregnancy is not uncommon, we appreciate having bleeding in pregnancy remains an anxious time for many women. 

What if the bleeding continues?

It is normal following a bleed in pregnancy to have some brown pink or vaginal bleeding/discharge for a week or so. If the bleeding becomes heavy, or you pass any blood clots, along with pain, you should contact the clinic via a self-referral form. If you are very concerned you can contact 111. You maybe advised to return to EPC for review.

Our usual advice is to allow the bleeding to settle over about 10 to 14 days. If you are having persistent slight bleeding past this time, we may consider a re-referral for advice .

Many women experience bleeding and/or pain in pregnancy and carry on to have a normal pregnancy. Some of these women have more than one bleeding episodes in the pregnancy.

This does not mean a miscarriage will happen, but if the bleeding does not settle over a number of weeks, or heavy bleeding starts, a further scan will be needed.

Sometimes bleeding is a sign of a problem with the pregnancy. If your scan is normal then this is reassuring.

Can I still have intercourse?

Sexual intercourse is perfectly safe in pregnancy. However if you have had bleeding or spotting, wait until this completely settles or any discharge stops before resuming sex.

Should I rest in bed?

There is no reason to rest in bed – you may carry on normal activities, just be sensible and rest when you are tired.

Should I go to work?

There is no reason to stay at home, however if you have a strenuous job you may wish to remain off work until the bleeding settles off. See the GP if you need to be signed off.

Can I use tampons?

Sanitary pads are safer, and better. Make sure you change pads or liners regularly.

Can I have a bath?

Personal hygiene is important. Showers are more hygienic if you are bleeding, but it is ok to have a bath.

Pain in pregnancy

Why do I have pain?

If you have unexpected abdominal or back pain during pregnancy it is easy to worry. Some pain may need medical attention, but often pain is relatively harmless. 

We do not always find a cause for pain but we know that episodes of discomfort are common during early pregnancy.

Will the pain affect the pregnancy?

In most cases the baby will be absolutely fine, and the pain will not harm the pregnancy in the future.

Most common reasons for pain in pregnancy 

• One of the first times when you may experience pain is around the time of your first missed period. For a day or two, some women have a pain that is low down in the abdomen (tummy) and feels a bit like a dull period pain. It is thought that the embryo is beginning to implant itself in the lining of your womb at this time.
• At any time during pregnancy, constipation, bloating and wind can cause aches, pains and abdominal discomfort. Constipation is common, and pregnancy hormones slow down the way the gut works.
• As the pregnancy progresses, women often have discomfort or pain on and off as the womb begins to change more. The ligaments or muscles around your uterus stretch and thicken as they support a growing baby, and can cause of discomfort.
• In later pregnancy, Braxton-Hicks contractions may cause some pain. These contractions, (which are irregular tightenings of the uterus), can occur from early pregnancy, but most women don’t notice them until the second half of a pregnancy. This is a normal but can feel uncomfortable. 

If you are concerned, or the contractions become more frequent, do talk to your doctor or midwife, or send a new referral in to the early pregnancy clinic and we will triage you by phone.

Causes of pain

Common gynaecological causes of pain include:

• Pelvic infection. Thrush occurs in about 25 in 100 pregnant women. Chlamydia/pelvic infection in up to 5 in 100 women.
• Ovarian cysts occur in 1 to 2 in 100 women (many cysts resolve without any treatment, and are usually nothing to worry about).
• Fibroids (can occur in 1 in 1000 to 1 in 1500 women.
• Irritable bowel syndrome – can get worse in pregnancy if you already have this.
• Musculoskeletal pain for example low back pain is common in pregnancy.

Renal causes

• Urinary tract infection (water/kidney infection) are common in pregnancy and can affect 1 in 25 women.
• Renal stones (kidney stones). (Rare in pregnancy)

Other causes include:

• Appendicitis - this is rare in pregnancy.
• Gallstones (which can enlarge during pregnancy and may present for the first time) - also rare in pregnancy.

What will happen to work out why I have pain?

If you have mild pain and are well, with a normal scan, you will be discharged back to their GP. 

If you fell less well or have a lot of pain you may need to be seen by a nurse or doctor. 

What does this include?

• Asking you about your symptoms: pain history, vaginal bleeding, urinary symptoms.
• Last period date, and what your periods are usually like.
• Previous operations or medical problems.
• Examination.
• General examination - to see how you are feeling and look for signs of infection. This may include blood pressure, pulse, temperature, breathing rate, and a urine dipstick.
• Abdominal examination - to see where you are tender, and also to assess the pregnancy and uterus.
• Possibly, vaginal examination.
• The neck of the womb can be examined and bleeding assessed.

Other possible investigations

• MSU (urine testing) to look for a water infection.
• Vaginal swabs - to look for infection.
• Full blood count to look for infection and to make sure your iron count is normal.

How we look after you

We look after you by trying to find the cause of the pain and treating you once we are sure we know what the problem is. 

If we have taken any blood tests or swabs or water samples, we will let you know if there are any problems.

We will not contact you if everything is normal. 

Please note that swabs and urine samples take 1 to 2 days to come back. Some specialist swabs can take longer.

If needed we may refer you to a different specialist.

Basic painkillers (paracetamol) are used to control pain.

Summary

There are many reasons for pain in pregnancy, but the majority of women we see have nothing seriously wrong.

The main aim of assessing you is to exclude any worrying cause for pain, and to ensure the pregnancy itself is doing well.

If in the next week the pain gets worse, or does not go away, speak your GP.

References and sources of further information

• Antenatal care NG201. 19 August 2021. 
• Bleeding and pain in pregnancy RCOG (2016) 
• Ectopic pregnancy and miscarriage NICE guidance NG126  2019 (Reviewed August 2023). 
• Tommys: www.tommys.org

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002073 

We are sorry that you have had a miscarriage

We are aware that this a distressing time and want to make sure you are well supported. Everybody deals with miscarriage differently, and there is no ‘right way’ to be. 

This is a guide to help you so that: 

• you are aware of what will happen
• you can make decisions
• you can work out when to seek advice/help

Understanding the terms used for miscarriage

Complete miscarriage: the scan shows your womb is empty after a miscarriage. No further treatment is needed.

Incomplete miscarriage: your scan shows that there is some tissue remaining in the womb.

Missed miscarriage: your scan shows that the baby is not developing or has not developed and there is no heartbeat, or where a sac has developed with nothing inside it. 

Expectant management of miscarriage (waiting for a natural miscarriage to happen)

Medical management of miscarriage

Surgical management of miscarriage

Frequently asked questions

How long will I bleed after the miscarriage?

Can we be told the sex of our lost baby?

What happens to the pregnancy, or pregnancy tissue after a miscarriage has happened?

When will my periods come back?

Why did I miscarry?

Will it happen again?

How soon can I resume my normal life?

When can we start having sex again?

Is there anything we can do to remember our baby?

If and when you feel ready to decide to plan another pregnancy you may wish to refer to the information below.

How soon can we try again?

Diet

Folic acid

Smoking

Medication

Pregnancy loss

Information and Support Services for patients and their families 

Grief and sadness can be hard for you, your family, and other carers. Support can help you manage more easily. The list of support agencies at the end of this leaflet does not include everything. They are options but we do not formally endorse them. You can also speak to your GP for things like counselling.  
 

Further help and advice

References

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002479
 

This page aims to explain how we diagnose an ectopic pregnancy. 

Sadly, an ectopic pregnancy cannot survive and losing a pregnancy in this way affects everybody differently. The diagnosis of an ectopic is often unexpected, and can be a stressful and distressing time. We want to ensure you are well supported whilst in hospital or under the care of the early pregnancy clinic (EPC).

You will be looked after by a team of doctors and nurses, and although we try hard to ensure continuity this is not always possible. Please let us know if you need additional information or support during this time.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that develops outside the cavity of the womb. Most ectopic pregnancies occur in the fallopian tube (95%), however they can occur in other places (such as the ovary, the cervix, and inside the tummy). Since the fallopian tubes are not large enough for the growing pregnancy so it cannot continue normally. 

What are the causes of ectopic pregnancy?

Most ectopic pregnancies occur because the fertilized egg cannot pass through the fallopian tubes, this occurs for many reasons:

• an infection or inflammation of the tube may have partially or entirely blocked it
• Pelvic inflammatory disease (PID) is a common infection
• damage due to a previous ectopic pregnancy
• endometriosis or scar tissue (adhesions) from previous abdominal surgery or previous operations on the tubes including reversal of sterilisation

However, in many patients a cause cannot be found.

What are the symptoms of an ectopic pregnancy?

Symptoms of an ectopic pregnancy can often be vague, and difficult to diagnose because they mirror those of a normal early pregnancy. These can include:

• missed or late periods.
• irregular vaginal bleeding.
• abdominal pain.
• sharp pain in the abdomen (tummy) or pelvis which may be intermittent or constant (often one-sided).
• shoulder pain.
• dizziness or fainting.
• loose stools (poo) or diarrhoea

How is an ectopic pregnancy diagnosed?

If you come to the hospital with symptoms that suggest an ectopic pregnancy we may do the following tests: 

• If pregnancy has not already been confirmed, a pregnancy test will be done.
• A pelvic examination (feeling your tummy) by a nurse/ doctor may locate the areas causing pain.
• An ultrasound scan and often a vaginal scan (which may give better images) will be done to find out if there is a pregnancy inside the womb. 
• If we cannot see anything in the womb on scan and the pregnancy test is positive, an ectopic pregnancy has to be considered.
• It may just be that the pregnancy is too early to see on a scan or that a miscarriage might have already occurred, but the diagnosis of ectopic pregnancy cannot be ruled out. 
• Even with the best equipment, it is hard to see a pregnancy less than 6 weeks or an ectopic pregnancy.
• Blood levels of a hormone produced by the pregnancy may need to be assessed by a blood test. In normal pregnancy, the level of hormone nearly doubles about every two to three days during the first 10 weeks of pregnancy. 
• In an ectopic pregnancy, the levels climb slowly or stay the same (this can vary and sometimes the levels can rise or fall). 
• We may need to carry out a series of blood tests over a period of days to check these levels. An abnormal pattern in the rise of this hormone can be due to an ectopic pregnancy or sometimes a miscarriage.

The most important information while we are looking after you are your symptoms (how you feel).

You must let us know if your pain increases or if you develop any worrying symptoms (see the symptoms of ectopic pregnancy above).

Can an ectopic pregnancy cause me to be very unwell?

It is rare, but yes it can. In some cases, the embryo grows until the fallopian tube stretches and ruptures (bursts). Rupture of the fallopian tube is a medical emergency because of internal bleeding, causing abdominal pain and the risk of a person collapsing (fainting and being unwell).

Please be reassured, most people are diagnosed early and managed very safely. But your symptoms are so important because there have been cases where people have been so severely unwell that they have died due to an ectopic pregnancy. 

How will an ectopic pregnancy be treated?

There are 3 ways of treating/managing an ectopic pregnancy:

Conservative management: this involves no active medical or surgical treatment; you are simply kept under observation and may be allowed to stay at home or offered a bed in hospital.

Medical management: this involves an injection of a drug called methotrexate to resolve your ectopic pregnancy (separate leaflet available).

Surgical management: this is usually done through keyhole surgery (laparoscopy) although occasionally abdominal surgery (laparotomy) is needed.

Conservative management – ‘watching and waiting’

Conservative management means we expect your ectopic pregnancy to end naturally without treatment. Instead of immediate medical or surgical care, we will monitor you closely with regular blood tests to check that your pregnancy hormone levels are falling back to normal. This approach is commonly used, and more than half of ectopic pregnancies resolve on their own. While we take a “wait and see” approach, you will have 24-hour access to advice and support, so you can get help at any time if you have concerns.

Research has shown that in patients who are properly assessed, where their pregnancy hormone level (hCG) is dropping, up to 50% of these pregnancies will end naturally - so there will be no need for an operation or drugs.

Conservative management is the best treatment when:

• the hormone beta hCG (produced by a pregnancy) is low
• general health appears to be stable
• pain levels are considered to be acceptable
• an ultrasound scan shows a small ectopic pregnancy with no worrying bleeding into the tummy

What are the advantages of conservative management?

• You do not have to stay in hospital.
• It avoids medication/surgery with a general anaesthetic and the possible associated risks and side effects.

What are the disadvantages of conservative management?

• Further visits to the hospital are required which may include blood tests or scans.
• Medical or surgical management may be required if the pregnancy continues to develop.
• If the pregnancy continues to develop the tube may rupture and you will need emergency surgery.

Whilst at home it is important to tell Cotswold Ward or Early Pregnancy Clinic if: 

• you experience any increase in pain
• you experience pain somewhere you have not previously had it, for example, shoulder tip pain or rectal pain.
• you feel faint or dizzy

Medical management of ectopic pregnancy

Medical treatment of ectopic pregnancy is also used commonly and may avoid the need for surgery.

Methotrexate is a drug normally used in cancer treatment but the amount used is very small. It works because it kills the rapidly growing cells of an ectopic.  It has a good success rate for treating small ectopic pregnancies (more than 90 in 100) and avoids surgery. We have a separate leaflet that explains Methotrexate more fully.

Methotrexate cannot be used in all circumstances, and we will advise you as to the best treatment for you.

Side effects of the drug are: nausea/vomiting, diarrhoea, headaches, abdominal pains and bleeding. Repeated visits to the hospital are essential (with blood tests) and you may require a second dose of the drug. You will be advised to wait a minimum of 3 months before trying for a future pregnancy. 

How will I know if there is a problem and I need a different treatment?

We will do blood tests and scans. If the pregnancy is not resolving, they will suggest other forms of treatment for you. 

Will I experience any pain?

Yes, you might have some lower pelvic pain or backache at any time during the course of the management. If required you can take paracetamol, ibuprofen, and sometimes codeine. (Always read the label/instructions before taking them and do not take more than the maximum daily dose). 

If your pain is getting worse, or are taking pain relief and it is not helping, it is important to ring us.

Will I experience any vaginal bleeding?

Yes, this can vary from dark brown spotting to heavier bright red loss. Use sanitary towels rather than tampons to reduce the risk of infection. If you are concerned that the bleeding is excessive (changing pads every half an hour) please contact us.

Surgical management of ectopic pregnancy

What will surgery involve?

It involves an operation to remove the ectopic pregnancy and will be done under a general anaesthetic. Surgery to remove the ectopic pregnancy is the most well-established form of treatment (the one that has been done for the longest time). It may also be performed if conservative or medical management have failed. 

It is usually done through keyhole surgery (called a laparoscopy), which involves inserting a camera through the umbilicus (belly button) and inserting instruments through two small cuts in the lower abdomen (tummy).  A small amount of gas is put into your abdomen to inflate it to help the surgeon get a better view. There are times when a bigger cut in the tummy at the bikini line is needed (although not common).

The most common surgery is called ‘salpingectomy’ which is removal of the damaged fallopian tube. (In some cases where there are risk factors for infertility, the doctors may make different decisions about your care/management). 

If you are rhesus D negative blood group you will need an anti-D injection (we have a separate leaflet about this). 

You are often advised to take a home pregnancy test 3 weeks after your operation. If the test is positive, you should return for further checks. 

There may be occasions where the doctor requests a blood test 48 hours or 1 week after surgery. This is usually done in the Early Pregnancy Clinic.

How does surgery affect future pregnancies?

• Having an ectopic pregnancy whatever the treatment means there may be some damage to the tube and this will slightly reduce the chance of getting pregnant in the future.
• If you have had surgical treatment the chance of getting pregnant is about 70%, but it does depend on other factors such as the health of your remaining tube.
• Once you have had an ectopic pregnancy, although more likely to have a normal pregnancy - your chances of having another ectopic pregnancy are increased. 

Should I be off work during/after treatment?

This is a very individual decision. You will need to recover physically, and it will depend on how you are feeling emotionally. Please consider some time off work, especially in the first week when frequent visits to hospital may be required. You can self-certify for the first 5 days, or the staff in the hospital can issue you with a sick note (fit note).

Emotions

It is completely normal to feel a variety of emotions during this time. You may experience days when you feel completely ‘back to normal’, but you may also have days when you feel vulnerable and tearful. 

Pregnancy loss is not straightforward, and people all react and recover in different ways - there is no right or wrong way. It is important to give yourself time to recover on a physical and emotional level. 

If you wish to talk to someone about your feelings and are unable to do so with a partner, close friend or family member, a list of counselling services and support are included at the end of this leaflet.

What about future pregnancies?

• Studies have shown that there is a 7 in 10 (70%) chance of a normal pregnancy in the future irrespective of which way the ectopic pregnancy has been managed. 
• It is perfectly safe to start trying for another pregnancy once you and your partner feel ready. 
• If you have had methotrexate treatment then you will need to wait 3 months before trying for another pregnancy. If however, you have needed 2 doses of methotrexate you would need to wait for 6 months (see methotrexate leaflet).

In the future, If you think you are pregnant:

• do a urinary pregnancy test at home
• use the self referral form to refer yourself to EPC
• if you are very early in pregnancy (below 6 weeks) but have pain, please call the clinic for advice – or  self refer to the clinic and explain that you have had an ectopic pregnancy previously
• you have ‘open access’ to attend early pregnancy clinic when you are at least 6-7 weeks pregnant so we can perform a scan, there is an open access letter at the end of this leaflet

To be as healthy as possible when you are thinking of getting pregnant again, being healthy will really help. It is best to:

• take folic acid
• reduce/stop your alcohol and caffeine intake
• stop smoking

The list of support agencies below not exhaustive and inclusion does not imply endorsement. It is also worth remembering that many GPs have counselling services at their practices.

Further help and advice

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002434

Introduction

The aim of this page is to help you by: 

• explaining the treatment advised for you by medical staff
• providing sources of further information and support

An ectopic pregnancy is naturally an emotional time, and we wish to support you as much as we can. This leaflet helps to explain treatment and includes additional places for you to access information and support.

Whilst we are treating you, it is very important to let us know if your symptoms change. Some women develop worsening pain; shoulder pain; diarrhoea, heavy bleeding or dizziness. An ectopic pregnancy whilst being closely monitored can increase in size and cause you to be unwell, so we may need to reassess you – this is why it is important to let us know of any change in your health. 

Medical management (methotrexate)

Medical management of ectopic pregnancies is widely used and avoids the need for surgery, but it has specific guidance for use, and is not always the correct treatment for you. It cannot be used:

• in ruptured ectopic pregancies
• in larger ectopic pregnancies
• where hormones are above the suggested limit for using medical treatment
• where your liver and kidney function are not normal
• where your blood count / blood results are not normal (e.g. where you are anaemic)
• in any cases where you would be unable to attend for the necessary follow up after treatment

What is methotrexate?

It is from the family of cytotoxic (chemotherapy) drugs and is used for a number of conditions e.g. arthritis, cancer etc.

Please do not be frightened by this as although it is a chemotherapy drug, in early pregnancy it is used in very small doses. The injection works by destroying cells that grow quickly (in your case - stopping the cells of the pregnancy) leading to the pregnancy being absorbed. We assess this by your clinical symptoms (how you feel physically) and watching hormone results drop after treatment. In some instances where we cannot be clear that the ectopic is resolving, you may require a second dose of medication.

What are the advantages of methotrexate?

• It has a good success rate for treating small ectopic pregnancies (more than 90 in 100).
• Avoids surgery & the associated risks of having a general anaesthetic.
• It offers the best chance of maintaining fertility after treatment.
• You do not have to stay in hospital.

What are the disadvantages of methotrexate?

• It can take several weeks to complete the treatment.
• Side effects of the drug itself can occur (though rarely), such as:
  • nausea
  • vomiting
  • diarrhoea
• Abdominal cramps 3 to 7 days after treatment, and some vaginal bleeding are common side effects after having methotrexate.
• There may be some mild, temporary, abnormalities in liver function blood tests which you are unlikely to be aware of.
• Repeated visits to the hospital are essential (for blood tests).
• You may require a second dose of the drug.
• You are advised to wait a minimum of 3 months before trying for a future pregnancy. If you have 2 doses of treatment you are advised to wait 6 months. 
• You are sometimes more vulnerable to infection (if you come into contact with someone with the flu/common cold etc).

Why have I been offered this treatment?

On the basis of your tests we think that your problem is unlikely to resolve without further treatment. We do, however, think it is likely that you will respond to this particular form of treatment.

How is the drug given?

It is administered by a suitably trained doctor or nurse into the large muscle of the buttock or thigh.

After the drug has been given

Provided you are feeling well, you will be allowed home shortly after having the drug.

A small number of women require a further dose of the drug, and this would be given in the same way.

After you go home it is important to notify us with any changes in how you feel; especially if you have:

• any increase in pain
• pain somewhere you have not previously had it, or paracetamol does not help your pain
• you feel faint or dizzy, or develop shoulder tip pain

Is there anything I must avoid for the duration of my treatment?

Yes. It is important you avoid the following:

• unprotected sexual intercourse (sex)
• alcohol
• folic acid and vitamins, as they may interfere with treatment
• exposure to the sun/sunlamps
• herbal remedies should be discussed with your doctor

If methotrexate is not successful, or if you become more unwell, then surgery may be required.

Why should I avoid alcohol?

The liver metabolises (sorts out) toxic (strong) drugs, which includes alcohol. The liver will already be working hard, and it is important to make its job as easy as possible, especially as the drug you are being given needs the liver to work well.

It is important to avoid alcohol for a minimum of 7 days, at which point your liver function will be checked. However, as methotrexate has been found in the liver for up to 100 days after treatment, some research suggests that it is sensible to avoid alcohol until you are discharged after treatment.

Why must I avoid the sun exposure/sun lamps?

Use of methotrexate can cause dermatitis - a skin condition, and this would be worse if exposed to the sun or sun lamps. These should be avoided for about 4 weeks, by which time the drug should be minimally active with minimal risk to skin reactions.

Follow up:

You will need close observation for several weeks, including blood tests on days 4 and 7.

At this point we will know if the medicine has helped. There may be times when a second injection is needed. As soon as your blood tests show that the hormone (HCG) is dropping well, a weekly blood test is needed until the hormones return to normal. Follow up does vary in number of visits required as the blood tests can go back to normal quickly, or more slowly. 

We understand that sometimes it can be frightening being at home. Please do not hesitate to contact us on the numbers at the end of this leaflet if you are unwell or have any questions.

Frequently asked questions

Will I have any vaginal bleeding?

Yes. This can vary from dark brown spotting to heavier bright red loss. Use sanitary towels rather than tampons whilst you are bleeding, to reduce the risk of any infection. 

If you are concerned that the bleeding is excessive (requiring you to change a sanitary pad every half an hour) please telephone the ward for advice.

Can I have a bath/shower during my treatment?

Avoid hot baths if you are bleeding heavily, as you may feel dizzy. Otherwise it is safe for you to have a warm bath or shower.

Should I be off work during the treatment?

This is a very individual thing. However it is stressful having treatment, and you are recovering from the difficult news that this pregnancy will not continue. Many women feel that at least a few days off work may be necessary, and some take a lot of time off as they adjust to a change in circumstances (with the loss of the pregnancy). You can self-certificate for the first week off work, alternatively the staff in early pregnancy clinic or the doctor on the ward will provide you with a sick certificate (fit note).

When can I expect a period?

Every woman is different, and this will depend on the length of follow up you have needed. Within four weeks of your bloods returning to normal is usual, and your period may be different  (heavier or lighter); again this is nothing to be concerned about, unless the bleeding is very heavy, in which case consult your GP.

How long must I wait before trying to become pregnant again?

At least three months. If you have had more than one dose of Methotrexate this will be extended to six months. This ensures that all of the Methotrexate has left your body with no effect on future pregnancies.

During this time it is advisable to use condoms or alternative contraception.

What happens when I do become pregnant again?

If you suspect you may be pregnant:

• do an early urine pregnancy test at home
• you will be given an open access referral for the clinic, and can attend once you are 6-7 weeks pregnant in the future for an early scan
• you can self refer to the early pregnancy clinic if you have pain before 6 weeks or need a scan after 6 weeks (having had a previous ectopic we will scan you early in a future pregnancy)
• if you have abdominal pain in early pregnancy before this time, please call us in early pregnancy clinic as we will see you sooner

The future

Any preconception care you have been following should continue, once it is safe for you to try and become pregnant again such as:

• taking folic acid
• reducing your alcohol and caffeine intake
• ceasing smoking
• healthy eating

If you are unsure whether you wish to try for a future pregnancy, it is advisable to consider your contraceptive needs during this time.

We hope this information leaflet has been helpful.

If you have any further concerns, please contact the staff on Cotswold Ward, or the staff in Early Pregnancy Clinic, at Southmead Hospital.

Further help and advice

Date published: 16 June 2026 Review due: 30 June 2029 PI number: BFT002435
 

Skin care advice following radiology procedures

You have had a specialised X-ray procedure. During this a small patch of your skin may have been exposed to radiation for a long period of time; this can cause changes to the skin. 

The changes depend on which area of the body the X-rays were pointing at (for example the head or the back), and the length of the procedure.

Skin reddening (also known as erythema)

This is the first sign that the small patch of exposed skin has been affected. This looks like sunburn and can feel warm, sensitive, and tight. This can happen anything from the first 24 hours up to 2 weeks later.

Temporary hair loss

This may also start up to three weeks following your procedure, depending on the exposed area of skin.

If you have any of these symptoms, please contact the Imaging department and your referring consultant to let us know. We may need to arrange a follow up appointment.

Further recommendations

• Apply a creamy moisturiser (for example Epimax) sparingly to the affected skin. You can buy this or something similar from your pharmacist. Do not apply the cream to broken skin. Wash skin with lukewarm water and pat gently dry.
• Whilst you still have symptoms, wear loose cotton clothing (if skin damage is to the body) and try to let air circulate around the affected area. 
• Protect any affected skin from direct sunlight. 
• If you contact your GP about this issue, please itell them about your radiology procedure. 
• If you are required to have any further X-ray procedures within 14 days, please let the hospital staff know.

We will write down a contact name, phone number, and details about your procedure for you to take away. 

References

Date published: 25 February 2026 Review due: 28 February 2029 PI number: BFT002791

Your doctor has requested that you have a myelogram. We hope that the following information will answer some of the questions you may have about this examination.

What is a myelogram?

A myelogram is an X-ray examination of the spinal cord and the space surrounding it. It provides a very detailed picture of the spinal cord and spinal column and of any abnormalities that may be present such as herniated or ruptured intervertebral disc.

Contrast medium (or ‘X-ray dye’) is injected via a small needle into the lower part of the spine. This is done by a radiologist (a doctor who specialises in X-rays used for diagnosis) into the fluid filled space around the spine called the subarachnoid space. This is called a lumbar puncture or LP.

The table used for a myelogram can be tilted so that contrast medium will run up and down within this space and surround the nerve roots that enter and exit the spinal cord.

Images are then taken as the contrast medium flows into the various areas of the spine. Far more information can be obtained from a myelogram than from plain spine X-rays.

Why do I need to have a myelogram?

A myelogram is performed when other tests such as Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) have not provided enough information, or when patients cannot have an MRI for any reason.

How do I prepare for the examination?

It is important that you drink plenty of fluids before your myelogram to help remove the contrast medium from your body and to prevent headache. You may also eat light meals prior to the procedure.

If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, apixaban, dabigatran) we ask you to call the Imaging department on the number on your appointment letter as we may need to adjust your medication before undergoing this procedure. 

These may need to be adjusted to keep the risk of bleeding to a minimum.

On the day of the procedure

You will arrive at the Imaging Department (Gate 19) and be accompanied to our day case area.

Please inform us if you have any allergies or if you think there is a chance you may be pregnant. 

You will then be asked to change into a hospital gown.

Once all the checks have been performed, you will be taken to the X-ray room on the trolley. There will be a doctor, radiographer and imaging support worker with you throughout the procedure. 

What will happen during the procedure?

• Before the examination begins, the radiologist will explain what they are going to do. You will be given the opportunity to ask any questions you may have.
• If you are happy to proceed you will be asked to sign a consent form.
• You will then be asked to lie on your front on the X-ray couch.
• The skin on your back will be cleaned and a small amount of local anaesthetic will be injected under the skin. This stings for a few seconds and the area then goes numb.
• A very fine spinal needle will be guided into the correct place using the X-ray machine. If needed, a small amount of cerebral spinal fluid can be withdrawn for laboratory studies.
• When the contrast medium is injected, you may feel slight pressure. It is common to experience heavy legs and a momentary increase in symptoms. Headache, flushing or nausea are other symptoms you may experience following the contrast injection.
• The X-ray table is slowly tilted to different angles and X-ray pictures are taken. Rests and straps (or supports) will keep you from sliding out of position.
• A CT scan is often performed after the myelogam while contrast is still present in the spinal canal. You will be brought to the CT scanner on the trolley.

Are there any risks associated with a myelogram?

Generally it is a very safe procedure. Potential complications are uncommon and include:

• Bleeding or haematoma (a bruise under the skin) around the injection site. (This should settle down by itself).
• Infection. Contact your GP if you experience any redness or tenderness at the injection site.
• An allergic reaction to the contrast medium. (RCR 2015). Please inform the radiologist performing the myelogram if you have any allergies.
• Headache (see information about this below).

X-rays are used in this procedure but with modern equipment the risk is low (NRPB 2014).

It is important that patients inform the Imaging Department if there is any possibility of pregnancy before attending for the examination.

Will I experience any serious side effects?

Serious side effects are rare but you should notify your GP if you experience:

• A high fever
• Excessive nausea and vomiting
• Severe headache for more than 24 hours
• Neck stiffness
• Numbness in your legs
• Trouble urinating or passing a stool.

Who interprets the results and how do I get them?

The results will not be available at the time of your myelogram.

The radiologist, who performed your myelogram, will examine your images in detail and forward a report to the doctor who referred you for the myelogram. You will be able to get the results from this doctor.

We hope this information is helpful. If you have any questions either before, during or after the procedure, the staff will be happy to answer them.

References

© North Bristol NHS Trust. This edition published July 2023. Review due July 2026. NBT002598

What is a varicocele embolisation?

A varicocele is an abnormality of the veins that take blood away from the testicle. The veins become bigger and more obvious, rather like varicose veins in the leg.

Embolisation is a way of blocking these veins. This makes them less obvious and causes the varicocele to disappear without an operation.

Who has made the decision?

The consultant in charge of your care and the radiologist carrying out the varicocele embolisation will have discussed your symptoms. They feel that this is the best treatment option. You will also have the opportunity for your opinion to be taken into account and if, after discussion with your doctors, you do not want the procedure carried out then you can decide against it.

Who will be performing the varicocele embolisation?

A specially trained doctor called a radiologist. Radiologists have special expertise in using X-ray equipment and also in interpreting the images produced. They need to look at these images while carrying out the procedure.

Where will the procedure take place?

This will take place in the Imaging Department, Gate 19, as described in your appointment letter.

What happens before the procedure?

• You will need to have a blood test a few days before the procedure to check your kidney function, that you are not at increased risk of bleeding and that it will be safe to proceed. This may be arranged to take place at your GP surgery.  
• You can continue taking your normal medication.
• If you are on any medication which thins the blood (e.g. aspirin, clopidogrel, warfarin, rivaroxaban, dabigatran, apixaban) we ask you to call the Imaging Department using the number on your appointment letter as we may need to adjust your medication before undergoing this procedure.
• You will also need to make sure that you have somebody to bring and collect you from the hospital, as you will not be able to drive immediately after the procedure.
• You must also ensure that there is a responsible person to be with you after and during the first night following the procedure in case you have any difficulties.

On the day of the procedure

• You should not eat anything from 4 hours before your procedure but you may continue to drink water.
• You will arrive at the Imaging Department, Gate 19, and be accompanied into our day case area.
• You may take your normal medication unless instructed otherwise.
• Please inform us if you have any allergies.
• A radiologist will discuss the procedure with you. You will have an opportunity to ask questions about the procedure and your treatment. If you choose to have the procedure you will need to sign a consent form.
• You will be asked to change into a hospital gown and a small plastic tube (cannula) may be put into a vein in your arm to allow us to administer medications or intravenous fluids during the procedure.
• Once all the checks have been performed and consent signed, you will be taken to the angiography suite on the trolley. There will be a nurse, radiographer and a radiologist with you throughout the procedure.

During the procedure

• You will need to lie on your back on an X-ray table for the duration of the procedure.
• The skin near the neck or groin will be cleaned with an antiseptic solution and covered with sterile drapes.
• Using an ultrasound machine, the radiologist will then inject local anaesthetic into the skin and deeper tissues over the neck or groin. This will briefly sting and then go numb. Most people will feel a pushing sensation.
• A catheter (thin tube) is guided into the testicular vein with the help of the X-ray machine. Small, metal coils are then used to block off the abnormal testicular vein.
• Once the procedure is complete, the radiologist will remove the catheter and press gently on the entry site for a few minutes to prevent bleeding.
• The whole procedure will take around 40-60 minutes although treating both sides will take longer.

What to expect after the procedure

• You will be taken back to the day case unit, so that nursing staff may monitor you closely. They will let you know when you can eat, drink and mobilise.
• If you are feeling okay and your checks are normal, you may go home.

Are there any risks or complications?

Varicocele embolisation is a very safe procedure, but there are some risks and complications that can arise:

• There may occasionally be a small bruise around the site where the needle has been inserted. This is quite normal and should improve itself in a few days.
• It is possible that the site of injection may become infected. Contact your GP if you notice any redness
  at the injection site as this may need treatment with antibiotics.
• Some patients experience mild discomfort in the left flank (lower left part of your back) for a day or two, needing no more than simple painkillers, if anything.
• There is always the possibility that, although the varicocele seems to have been cured to start with, months or even years later, it may come back again. If this happens, then the procedure may need repeating or you may be advised to have an operation.

Despite these possible complications, the procedure is normally very safe and is performed with no significant side effects at all.

What about the metal coils?

The coils are made of platinum and look a bit like light bulb filaments. They will show up whenever you have an X-ray or CT scan but will not activate airport metal detectors. As they do not contain iron, it is safe should you ever need a Magnetic Resonance Scan (MRI).

Further information

We hope this information is helpful. If you have any questions, either before or after the procedure, the staff in the Imaging Department will be happy to answer them. The telephone number for the Imaging Department can be found on your appointment letter. 

Reference

British Society of Interventional Radiology (2011) “Varicocele embolisation Patient information”. BSIR - British Society of Interventional Radiology Accessed on 15/05/2020

© North Bristol NHS Trust. This edition published July 2023. Review due July 2026. NBT002077

HIV Medicine Service

The North Bristol NHS Trust HIV Service is based at Southmead Hospital, Bristol.

An HIV test can be done in many different healthcare settings, including at the GP or Bristol Sexual Health Centre. Early diagnosis and treatment has many health benefits. Where there are particular concerns around HIV testing, our team would be happy to discuss this.

Where patients are known to be HIV positive they should be referred to the HIV specialist nurses via email at brecon.nurses@nhs.net, which is also our preferred route for non-urgent HIV related queries.

If there are patient HIV related queries for the HIV team at North Bristol NHS Trust (Southmead) then we would prefer that patients email brecon.nurses@nhs.net, or alternatively phone 0117 414 6400 if they cannot email.

For confidential HIV testing and sexually transmitted infection (STI) screening visit https://yunosexualhealth.co.uk/. Patients may order free STI testing kits online for home use (if aged 16 or over and living in Bristol, North Somerset or South Gloucestershire). For some people it may be more appropriate to get an HIV test in a sexual health clinic.

Acutely ill HIV patients should be discussed with the HIV team or the hospital HIV on-call team for admission, contactable via switchboard at Southmead.

Conditions Treated:

•    Suspected acute HIV infection.
•    Post-Exposure Prophylaxis after Sexual Exposure to HIV (PEPSE) - referrals taken from other healthcare providers.
•    Chronic HIV infection.

Note this service is only for patients living with HIV and for those referred from other healthcare providers for continuation/discontinuation of PEPSE.

Appointment Clinic Times are

Monday 12.30 – 16:00
Tuesday 14:00 – 17:30
Wednesday 12.30 – 16:00
Thursday 08:00 – 11:30

HIV Medicine Team

Specialty Director

Dr Philip Bright - Lead Clinician
Telephone (secretary): 0117 414 6395

Consultants

Dr Megan Jenkins
Dr Ankur Gupta-Wright
Dr Alexander May
Dr Bret Palmer
Dr Sathish Thomas-William
Dr Adele Wolujewicz

Clinical Nurse Specialists/Health Advisors

Liz Williams
Lizzie Richards
Phoebe Byrne

Specialist Pharmacists

Joanna Latimer
Arianwen Denham

Research Nurses

Louise Jennings – Lead
Andrea Watts
Sally Tillett
Rebecca Croydon

Medical Secretaries

Tel: 0117 414 6394
Danielle Coombs
Sharon Hemming
Bozena Zelazowska

Database Manager 

Chloe Whitlock

Management Team

Christina Fletcher
Nia Jenkins-Welch
Laura Webb

HIV Medicine Service Useful Links

The team at NAM (National AIDS Manual) produce and distribute accurate, up-to-date and evidence-based resources (printed, electronic, audio and online), covering both the medical and social aspects of HIV, to people living with HIV and to those who work to treat, support and care for them. Visit Aids Map for more information.

A medicines interactions checker is available.

A charity called Brigstowe, based in Bristol, are dedicated to the help of patients living with HIV. As well as lots of information about HIV Brigstowe offer the following to patients living with HIV:

• A one-to-one advice and support service.
• A migrant and asylum service.
• Group peer support and a range of group workshops.
• One-to-one peer support.
• Clinic peer support.

Please contact Brigstowe on 0117 955 5038 or visit Brigstowe for further information, advice and support.

Peer support at clinic is provided by Brigstowe peer mentors to patients living with HIV. These are trained volunteers, also living with HIV, who will meet patients in a safe and confidential space at clinic. They can:

•    Check in with patients about appointments and any concerns patients may have.
•    Chat with patients about treatment and managing side effects.
•    Be a listening ear.
•    Let patients know how Brigstowe can help.
•    Share their own experiences and knowledge of living with HIV.
•    Share coping strategies.

Last updated 18/07/25

The Workforce Disability Equality Standard (WDES) is a set of ten specific measures (metrics) which enables NHS organisations to compare the workplace and career experiences of Disabled and non-disabled staff.  NHS trusts use the metrics data to develop and publish an action plan. It will enable us to demonstrate progress against the indicators of Disability equality.

Making a difference for Disabled staff

The WDES enables us to understand the experiences of our Disabled staff and support positive changes for all existing employees. NBT is committed to creating a more inclusive environment for Disabled people working and seeking employment in our Trust.

2023

2020/2021

"The actions plans are still in draft format as we are still working with our relevant staff networks and other stakeholders to finalise them in due course"

Video 1 - Sensing location

In sitting with your eyes closed ask a friend/ carer to touch your bare arms. Try to sense and point to which area was touched. Does the feeling vary between your arms and with different locations touched? Are you accurate in sensing the area touched? Repeat the process as often as able.