Post-Pill Bleeding: Is It Menstruation or Early Pregnancy?

Can I get pregnant? What about emergency contraception?

Hello Doctor, first of all, thank you for your response.
I would like to continue the discussion regarding question #131483.
My girlfriend took the emergency contraceptive pill on the night of December 16, and this morning, December 22, she experienced some bleeding (six days after taking the pill).
This morning, the blood was bright red and only a few drops, but by the evening, it resembled the amount typically seen a few days into her period (dark red color, less than the usual first day).
I found information online about early pregnancy bleeding, which can easily be confused with menstrual bleeding, so I would like to ask the following questions:
1.
Is the bleeding my girlfriend is experiencing considered a menstrual period?
2.
Does this bleeding rule out the possibility of pregnancy?
3.
Since she is bleeding today, is it still necessary to buy a pregnancy test two weeks after sexual intercourse?
4.
Should the start date for her next period be calculated from the originally estimated date or from today’s bleeding?
P.S.
My girlfriend's last menstrual period was from December 8 to December 12, and the sexual encounter occurred on December 15, with the next period estimated to start on January 5.

ian, 10~19 year old female. Ask Date: 2017/12/22

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Your girlfriend took the emergency contraceptive pill on the night of December 16th.
This morning, December 22nd, she experienced bleeding (six days after taking the pill).
In the morning, the blood was bright red and only a few drops, but by the evening, it resembled the amount typically seen in the later days of her period (dark red color, less than the usual first day).
I found information online about early pregnancy bleeding, which can easily be confused with menstrual bleeding, so I would like to ask the following questions:
1.
Does this bleeding count as her period?
Answer: It should be considered as such.
2.
Does this bleeding rule out the possibility of pregnancy?
Answer: It likely does.
3.
Since she is bleeding today, is it still necessary to buy a pregnancy test two weeks after sexual intercourse?
Answer: It would be advisable to buy a pregnancy test to check.
4.
Should the start date for her next period be calculated from the originally estimated time or from today’s bleeding?
Answer: It should be calculated from today’s bleeding.
P.S.
Her last period was from December 8th to December 12th, and the sexual encounter was on December 15th, with the next period estimated to start on January 5th.

Reply Date: 2017/12/22

More Info

Understanding post-pill bleeding can be a bit complex, especially when trying to differentiate between menstruation and potential early pregnancy. Let's break down your questions one by one.

1. Is the bleeding considered menstruation?
The bleeding your girlfriend is experiencing after taking the emergency contraceptive pill (commonly known as the "morning-after pill") can be classified as withdrawal bleeding rather than a true menstrual period. Emergency contraceptive pills work primarily by delaying ovulation and altering the uterine lining, which can lead to bleeding that resembles a period. This bleeding can occur within a week or so after taking the pill, and it can vary in color and flow. In your girlfriend's case, the bleeding started six days after taking the pill, which is consistent with the expected response.

2. Does this bleeding rule out the possibility of pregnancy?
Not necessarily. While the occurrence of bleeding after taking the emergency contraceptive pill suggests that the pill was effective in preventing ovulation, it does not completely eliminate the possibility of pregnancy. If ovulation had already occurred before taking the pill, there is still a chance that fertilization could have happened. Therefore, while the bleeding is a good sign, it is not a definitive indicator that pregnancy has been ruled out.

3. Should a pregnancy test still be taken?
Yes, it is advisable to take a pregnancy test if there is any uncertainty about the possibility of pregnancy. Since your girlfriend had unprotected intercourse on December 15 and took the emergency contraceptive pill shortly after, it would be prudent to wait at least two weeks after the intercourse to take a home pregnancy test for the most accurate result. This timing allows enough time for the hormone hCG (human chorionic gonadotropin) to build up in the body if pregnancy has occurred.

4. How should the next menstrual cycle be calculated?
The start of the next menstrual cycle is typically calculated from the first day of bleeding, regardless of whether it is considered a true period or withdrawal bleeding from the pill. Therefore, if the bleeding started on December 22, that date would be considered the first day of her new cycle. However, it is important to note that the cycle may be irregular following the use of emergency contraception, and it may take some time for her menstrual cycle to return to its normal pattern.

In summary, the bleeding your girlfriend is experiencing is likely withdrawal bleeding from the emergency contraceptive pill, but it does not completely rule out the possibility of pregnancy. Taking a pregnancy test after two weeks is a sensible approach to confirm her status. Additionally, the next menstrual cycle should be calculated from the first day of this bleeding. If there are any further concerns or unusual symptoms, it is always best to consult with a healthcare provider for personalized advice and guidance.

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