Ectopic Pregnancy: Signs, Treatment & What Florence Welch's Story Teaches Us

On 28 September 2025, Florence Welch, the powerhouse voice behind Florence and the Machine, revealed a harrowing experience from 2023. During a performance, she was unknowingly bleeding internally from a ruptured ectopic pregnancy. Doctors later told her there was "a Coke can's worth of blood" in her abdomen, and she needed emergency surgery within the hour to remove her fallopian tube.

Her story highlights a critical truth: ectopic pregnancy is a medical emergency that affects approximately 1 in 90 pregnancies, yet many people don't recognize the warning signs until it's too late.

If you’d like to read a real-life experience, I’ve shared my personal story of ectopic pregnancy — from diagnosis to recovery and hope.

This guide will help you understand what an ectopic pregnancy is, how to spot the symptoms, and what treatment options are available.

Quick Reference: Emergency Warning Signs

Call 999 or go to A&E immediately if you experience:

• Severe abdominal pain, especially on one side
• Pain at the tip of your shoulder (indicates internal bleeding)
• Sudden dizziness, fainting, or feeling very unwell
• Severe vaginal bleeding combined with abdominal pain

What is an Ectopic Pregnancy?

An ectopic pregnancy (also called a tubal pregnancy) occurs when a fertilised egg implants and begins to grow outside the uterus. In over 90% of cases, this happens in a fallopian tube.

Because fallopian tubes are only about 10cm long and too narrow to accommodate a growing embryo, the pregnancy cannot continue safely. The tube can stretch and eventually rupture, causing life-threatening internal bleeding.

Key fact: The uterus is the only organ in the body designed to safely expand and support a developing baby. An ectopic pregnancy is never viable and always requires medical intervention.

Warning Signs and Symptoms

Symptoms typically appear between weeks 4 and 12 of pregnancy, but some women, like Florence, don't experience clear warning signs until the situation becomes critical.

Common Early Symptoms

Abdominal pain: Often sharp and persistent, usually concentrated on one side of your lower abdomen. The pain may come and go or be constant.

Abnormal vaginal bleeding: This bleeding looks different from a normal period. It may be watery, dark brown, or stop and start irregularly. Some women describe it as "prune juice" in appearance.

Pregnancy symptoms: You may have typical early pregnancy signs like missed periods, breast tenderness, nausea, or a positive pregnancy test.

Emergency Symptoms (Seek Immediate Help)

Shoulder tip pain: A sharp, unusual pain where your shoulder ends and your arm begins. This is caused by internal bleeding irritating the diaphragm and is a medical emergency.

Severe sudden pain: Intense abdominal pain that makes it difficult to stand upright or move.

Collapse or fainting: Feeling extremely dizzy, lightheaded, or losing consciousness can indicate significant internal bleeding.

Important: Some women have no symptoms until a rupture occurs, which is why early pregnancy scans are crucial if you have risk factors.

What Causes an Ectopic Pregnancy?

Ectopic pregnancies occur when something prevents or slows the fertilised egg's journey through the fallopian tube to the uterus. Common causes include:

Pelvic Inflammatory Disease (PID): The most common cause. This infection (often from untreated chlamydia or gonorrhea) can scar and damage the fallopian tubes.

Previous ectopic pregnancy: Having one ectopic pregnancy increases your risk of another because the underlying cause may still be present.

Endometriosis: This condition causes tissue similar to the uterine lining to grow outside the uterus, potentially affecting the fallopian tubes.

Previous surgery: Operations on the fallopian tubes, including tubal ligation reversal, can create scar tissue that blocks the passage.

Fertility treatments: IVF and other assisted reproductive technologies slightly increase ectopic pregnancy risk.

Smoking: Damages the fallopian tubes and affects their ability to move the egg along.

In many cases, no clear cause is identified, and ectopic pregnancies can happen to anyone.

Who is at Higher Risk?

While any woman can experience an ectopic pregnancy, certain factors increase the likelihood:

• History of PID or sexually transmitted infections
• Previous ectopic pregnancy (10-15% recurrence rate)
• Age over 35
• Smoking
• Previous fallopian tube surgery or damage
• Endometriosis
• Conception while using an IUD (intrauterine device)
• Undergoing fertility treatments

If you have any of these risk factors and discover you're pregnant, contact your GP or early pregnancy unit for an early scan.

How is it Diagnosed?

Diagnosing an ectopic pregnancy can be challenging because early symptoms often mimic normal pregnancy or other conditions like ovarian cysts or appendicitis.

Diagnostic Steps

1. Initial Assessment

Your GP will perform a physical examination and pregnancy test. If positive with concerning symptoms, you'll be referred to an Early Pregnancy Assessment Unit (EPAU).

2. Transvaginal Ultrasound Scan

A small probe is gently inserted into the vagina to create detailed images of your reproductive organs. This can show:

• Whether the pregnancy is in the uterus
• The location of an ectopic pregnancy (though very early pregnancies may not be visible yet)
• Any free fluid in the abdomen (potential bleeding)

3. Blood Tests (hCG Monitoring)

Doctors measure the pregnancy hormone hCG (human chorionic gonadotropin) through blood tests taken 48 hours apart.

In a healthy uterine pregnancy, hCG levels typically double every 48-72 hours. In an ectopic pregnancy, levels rise more slowly or plateau, providing crucial diagnostic information.

4. Laparoscopy (Diagnostic Surgery)

If the diagnosis remains unclear and symptoms are concerning, doctors may perform keyhole surgery under general anaesthetic. A tiny camera inserted through a small abdominal incision allows direct visualization of the fallopian tubes and can treat the ectopic pregnancy during the same procedure if confirmed.

Treatment Options

Sadly, an ectopic pregnancy cannot continue, and the embryo cannot be saved or relocated to the uterus. Treatment focuses on protecting your health and, when possible, preserving fertility.

Expectant Management (Watch and Wait)

When it's used: If you have minimal symptoms, the ectopic pregnancy is very small, and hCG levels are low and falling.

What happens: You'll have regular blood tests and scans to ensure the pregnancy is resolving naturally without intervention.

Success rate: Approximately 50% of very early ectopic pregnancies resolve without treatment.

Medical Treatment (Methotrexate)

When it's used: For unruptured ectopic pregnancies under 35mm with no heartbeat detected and hCG levels below 3,000.

What happens: You receive an injection of methotrexate (usually in your bottom or thigh), which stops the pregnancy from growing. Your body then absorbs the tissue over several weeks.

Follow-up: Regular blood tests monitor hCG levels until they return to zero. This can take 4-6 weeks.

Side effects: Stomach pain, nausea, dizziness, or diarrhoea.

Important restrictions:

• No alcohol for at least one week (it interferes with the medication)
• Avoid trying to conceive for 3-6 months afterward
• No folic acid supplements during treatment
• Avoid prolonged sun exposure

Success rate: 85-95% when used appropriately.

Surgical Treatment

When it's used: For larger ectopic pregnancies, when there's internal bleeding, if methotrexate isn't suitable, or if the fallopian tube has ruptured.

Types of surgery:

Salpingectomy: The affected fallopian tube is removed along with the ectopic pregnancy. This is necessary if the tube is severely damaged or ruptured.

Salpingotomy: The ectopic pregnancy is removed through an incision in the fallopian tube, which is then repaired. This preserves the tube but carries a small risk that some pregnancy tissue remains.

Method: Usually performed via laparoscopy (keyhole surgery) using small incisions. In emergencies, open surgery (laparotomy) may be necessary.

Recovery: Most women go home the same day or after one night in hospital. Full recovery takes 2-4 weeks.

Your doctor will recommend the best treatment based on your symptoms, the size and location of the pregnancy, your hCG levels, and whether you want to preserve fertility.

Why Immediate Treatment Matters: The Danger of Rupture

Florence Welch's experience demonstrates why ectopic pregnancies are medical emergencies. When left untreated, the growing pregnancy stretches the fallopian tube until it ruptures.

What Happens During a Rupture

A ruptured ectopic pregnancy causes severe internal bleeding into the abdomen. Without immediate surgery, this can lead to:

• Hemorrhagic shock (dangerously low blood pressure from blood loss)
• Organ damage from lack of oxygen
• Death (though rare in countries with accessible healthcare)

The timeline can be rapid. Some women feel relatively fine one moment and collapse the next as internal bleeding accelerates.

In Florence's case, she performed on stage while unknowingly bleeding internally, with a "Coke can's worth of blood" in her abdomen. Emergency surgery saved her life.

This is why recognizing symptoms early and seeking immediate medical attention is crucial.

Future Pregnancy and Fertility

Experiencing an ectopic pregnancy understandably raises concerns about future fertility. However, the outlook is generally positive.

The Good News

Research shows that up to 85% of women who have had an ectopic pregnancy go on to have a successful pregnancy within two years.

Even if one fallopian tube was removed, you can still conceive naturally with the remaining tube and ovary. Each ovary releases eggs on alternate months, and eggs can travel across the pelvic cavity to reach the functioning tube.

Understanding Your Risk

Your risk of another ectopic pregnancy does increase (to about 10-15%) because:

• The underlying cause may still be present
• The remaining tube may have similar damage
• Scar tissue from surgery can affect tubal function

Trying Again

Most doctors recommend waiting until:

• You've completed one normal menstrual cycle after methotrexate (or 3-6 months if specified)
• You've physically healed from surgery (usually 1-3 cycles)
• You feel emotionally ready

Future Pregnancy Care

When you do conceive again, contact your GP or EPAU immediately. They'll arrange an early scan (typically around 6-7 weeks) to confirm the pregnancy is in the correct location, providing reassurance and early intervention if needed.

If you're struggling to conceive after an ectopic pregnancy, speak with your GP about fertility testing and referral options.

🌸 A Personal Note:
If you’d like to hear a real story of what going through an ectopic pregnancy feels like — from the first signs to recovery and hope — you can read my personal experience here.
I wrote it in the hope that it brings comfort to anyone facing this difficult journey.

This article is for informational purposes only and does not replace professional medical advice. Always consult your healthcare provider with questions about your health.