Ectopic pregnancy has been increasing in frequency over the past 2 decades. The sudden rupture of ectopic pregnancy can lead to haemorrhagic shock and death if not diagnosed and treated in a timely fashion. The first step in the diagnosis of ectopic pregnancy is demonstration of pregnancy by means of a rapidly performed and sensitive qualitative urine test for the beta-subunit of human chorionic gonadotropin (beta-hCG). This case report demonstrates the importance of further consideration of the diagnosis of ectopic pregnancy in the setting of an unusual presentation like per rectal bleed and amenorrhea for three years in the presence of Mirena.