Is It Irregular Periods or Pregnancy? Your Symptoms

Is it irregular menstruation or pregnancy?

Hello Doctor: My husband and I had sexual intercourse on December 24 and December 25, 2017, during which the condom slipped off.
Due to our work commitments, we are not planning to conceive at this time, so I took the emergency contraceptive pill, Levonorgestrel, after the intercourse on December 25.
Subsequently, I experienced menstruation from December 29, 2017, to January 5, 2018, with a heavy flow that required the use of overnight sanitary pads during the day.
After the bleeding ended, I took a pregnancy test on January 6, which was negative.
However, from February 8 to February 26, my menstrual flow was lighter but lasted longer, starting with a pink color and then, after about seven days, dark red clots appeared.
In the following days, I also had intermittent light brown discharge, along with breast tenderness and occasional cramping in the lower abdomen.
Could this phenomenon be due to the emergency contraceptive pill causing irregular menstruation, or is there a possibility that I could be pregnant?

Zhuó, 20~29 year old female. Ask Date: 2018/02/26

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On December 24 and December 25, 2017, I had sexual intercourse with my husband, during which the condom slipped off.
Due to our work circumstances, we are not planning to conceive at this time, so after the sexual intercourse on December 25, I took the emergency contraceptive pill, Levonorgestrel.
Subsequently, I experienced menstruation from December 29, 2017, to January 5, 2018, with heavy bleeding that required the use of overnight sanitary pads during the day.
After the bleeding ended, I took a pregnancy test on January 6, which showed negative results.
However, from February 8 to February 26, 2018, my menstrual flow was lighter but lasted for a longer duration.
The bleeding started as pink and, after about seven days, dark red clots appeared.
In the following days, I also experienced intermittent light brown discharge, breast tenderness, and occasional cramping in the lower abdomen.
Could this phenomenon be due to the emergency contraceptive pill causing irregular menstruation, or is there a possibility of pregnancy?
Answer: The menstruation you experienced from December 29, 2017, to January 5, 2018, and the subsequent lighter but prolonged bleeding from February 8 to February 26, 2018, are likely due to the effects of the emergency contraceptive pill causing menstrual irregularities.
It is unlikely that you are pregnant, and a follow-up pregnancy test can further confirm that you are not pregnant.

Reply Date: 2018/02/26

More Info

When it comes to distinguishing between irregular periods and potential pregnancy, it can be quite complex, especially given the various factors that can influence menstrual cycles and the symptoms that may arise. In your case, there are several key points to consider based on your history and the symptoms you've described.

Firstly, the use of emergency contraception, such as the pill you took after the condom failure, can indeed affect your menstrual cycle. Emergency contraceptive pills (ECPs) are designed to prevent pregnancy after unprotected intercourse, and they can cause changes in your menstrual cycle. Common side effects include changes in the timing of your next period, the flow (which can be heavier or lighter than usual), and even spotting between periods. In your situation, the heavy bleeding you experienced from December 29 to January 5 could be a result of the ECP, as it can induce a withdrawal bleed similar to a menstrual period.

The subsequent menstrual cycle you described, which started on February 8 and was characterized by lighter bleeding and unusual colors (pink to dark red with small clots), could also be influenced by the hormonal changes caused by the emergency contraceptive. It’s not uncommon for women to experience irregularities in their cycles after taking ECPs, and this can include variations in flow, duration, and color of menstrual blood.

Now, regarding your symptoms of breast tenderness and abdominal cramping, these can be associated with both premenstrual syndrome (PMS) and early pregnancy. Breast tenderness is a common symptom experienced in both scenarios due to hormonal fluctuations. Similarly, cramping can occur with PMS as the body prepares for menstruation, but it can also be an early sign of pregnancy as the uterus begins to change.

Given that you had a negative pregnancy test on January 6, it is less likely that you are pregnant from the December intercourse, especially since the test was taken shortly after the potential conception window. However, if you suspect that you might be pregnant due to the irregularities in your cycle and the symptoms you are experiencing, it would be advisable to wait a few days and take another pregnancy test. Testing is most accurate when done after a missed period or at least a week after the expected date of menstruation.

In summary, the irregularities in your menstrual cycle following the use of emergency contraception are likely the cause of the symptoms you are experiencing. However, if you continue to have concerns about pregnancy or if your symptoms worsen, it would be prudent to consult with a healthcare provider. They can perform a thorough evaluation, including a physical examination and possibly additional testing, to provide clarity on your situation. Remember, it’s always better to seek professional advice when in doubt about your reproductive health.

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