Could She Be Pregnant? Early Signs and Contraceptive Effectiveness

Pregnancy issues

On February 25, I had my first sexual experience with my girlfriend, which included finger and oral sex.
We used a condom throughout the attempt to penetrate, but I only went in a little bit, and it seems that her hymen did not break.
I did not ejaculate because my girlfriend was in too much pain, so we stopped.
Afterward, she decided to take an emergency contraceptive pill.
Later, on March 8, she experienced bleeding that was consistent with her expected menstrual cycle, and there was still a little bleeding until March 12.
However, she felt nauseous yesterday and sometimes has lower back pain, which makes me anxious.
Doctor, is there a possibility of pregnancy in this situation? Is this bleeding her menstrual period or early pregnancy bleeding? She has started taking Ella (ulipristal acetate).
When does it start to have contraceptive effects?

Jones, 10~19 year old female. Ask Date: 2017/03/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On February 25, I had my first experience with my girlfriend, which included finger and oral sex.
We used a condom throughout the attempt to penetrate, but it only went in a little bit, and it seems her hymen did not break.
I did not ejaculate because my girlfriend was in too much pain, so we stopped.
Afterward, she decided to take an emergency contraceptive pill.
Later, on March 8, she started bleeding, which was consistent with her expected menstrual cycle, and there was still a little bleeding until March 12.
However, she felt nauseous yesterday and had some lower back pain, which made me anxious.

1.
Doctor, is it possible for her to be pregnant?
Answer: It is unlikely that she is pregnant.

2.
Is this bleeding her period or early pregnancy bleeding?
Answer: It is her period.

3.
She has started taking the contraceptive pill, when does it start to be effective?
Answer: It becomes effective after 14 days.

P.S.
It is recommended to refer to the National Health Administration's "Sexual Health e-Learning" or the Society of Obstetrics and Gynecology's "Adolescent Contraceptive Guidance" at http://goo.gl/dc6PfW.

Reply Date: 2017/03/13

More Info

When it comes to understanding the possibility of pregnancy, especially after a recent sexual encounter, there are several factors to consider. Based on the scenario you provided, it seems that you and your girlfriend took precautions by using a condom and that you did not ejaculate inside her. Additionally, she took emergency contraception (the "morning-after pill") shortly after the encounter.
1. Effectiveness of Emergency Contraception: Emergency contraceptive pills (ECPs) are designed to prevent pregnancy after unprotected intercourse or contraceptive failure. They are most effective when taken as soon as possible after the incident, ideally within 72 hours. However, they can be taken up to 5 days after intercourse, with decreasing effectiveness over time. Since your girlfriend took the ECP, this significantly reduces the likelihood of pregnancy, especially since you did not ejaculate.

2. Menstrual Cycle and Withdrawal Bleeding: The bleeding your girlfriend experienced from March 8 to March 12 could be a result of the emergency contraception. This is often referred to as "withdrawal bleeding," which can occur due to the hormonal changes induced by the ECP. This bleeding can mimic a regular menstrual period, and it is not uncommon for it to occur within a week or two after taking the pill.

3. Early Pregnancy Symptoms: The symptoms your girlfriend is experiencing, such as nausea and lower back pain, can be associated with early pregnancy, but they can also be side effects of the emergency contraceptive pill. Hormonal fluctuations can lead to symptoms similar to those of early pregnancy, including breast tenderness, mood swings, and gastrointestinal discomfort.

4. Timing of Pregnancy Tests: If there is still concern about the possibility of pregnancy, it is advisable to wait until at least a week after the expected date of her next period to take a home pregnancy test. This allows enough time for the hormone hCG (human chorionic gonadotropin), which is produced during pregnancy, to build up to detectable levels in her urine.

5. Contraceptive Effectiveness of Birth Control Pills: You mentioned that your girlfriend has started taking "Yaz" (or a similar birth control pill). Birth control pills generally take about 7 days to become effective if started at the right time in her cycle. If she starts taking the pill during the first five days of her menstrual cycle, she is protected from pregnancy immediately. If she starts at another time, she should use additional contraception (like condoms) for the first week.

In conclusion, while the possibility of pregnancy cannot be completely ruled out, the combination of using a condom, not ejaculating, and taking emergency contraception significantly lowers that risk. The bleeding she experienced is likely a response to the emergency contraception rather than a sign of pregnancy. If her symptoms persist or if there are any concerns, it would be wise for her to consult a healthcare provider for further evaluation and guidance.

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