A positive hCG test after delayed menstruation, which was immersed in the joy of pregnancy, showed vaginal bleeding and lower abdominal pain, which made people nervous, is it a pre-miscarriage? Or is it an ectopic pregnancy? How to identify? Pre-eclampsia and ectopic pregnancy are both in the state of pregnancy and can manifest as vaginal bleeding and lower abdominal pain after menopause. Pre-eclampsia may be caused by some poor embryonic or maternal factors, and the pregnancy can continue and can be treated with fertility preservation for the specific case, but if the condition progresses further, it can develop into inevitable miscarriage and eventually complete or incomplete miscarriage. Ectopic pregnancy, on the other hand, is a wrong pregnancy in which the embryo goes to the wrong place and the site where it lays cannot provide the good nutritional support and growth space that the uterine cavity has, and it will eventually miscarry or rupture, which can cause intra-abdominal bleeding or even hemorrhagic shock and endanger life. Therefore, it must be actively treated once detected. In terms of symptoms, both may present vaginal bleeding after menopause. Early preterm miscarriage may present as vague pain in the middle of the lower abdomen or no abdominal pain, while ectopic pregnancy often presents as vague pain or distension in one side of the lower abdomen. The HCG value of ectopic pregnancy is usually lower than that of normal pregnancy. When β-HCG > 2000 IU/L or 5+ weeks of menopause, vaginal ultrasound is performed and no gestational sac is detected in the uterine cavity or a mass is detected in one of the adnexal areas, ectopic pregnancy is very likely. However, sometimes for asymptomatic early ectopic pregnancy, it is difficult to identify whether it is a miscarriage or an ectopic pregnancy based on symptoms, physician’s examination, hCG value and ultrasound examination alone. In clinical practice, the optimal treatment plan for such patients is often based on a combination of symptoms, signs and ancillary tests. In addition to pre-eclampsia and ectopic pregnancy, vaginal bleeding may also be caused by gravidity, endometrial polyps, cervical polyps, etc. Therefore, if you experience vaginal bleeding and lower abdominal pain after menopause, it is important to consult a doctor promptly and not to judge the condition on your own to avoid adverse consequences.