Post-Pill Bleeding: Is It Menstruation or Pregnancy?

Postcoital bleeding after taking emergency contraceptive pills?

The menstrual cycle is typically around 26-28 days.
My last period was from January 28 to February 12.
After having intercourse, I took Levonorgestrel (1.5 mg) four hours later.
On February 22, I experienced bleeding (which was around the expected time of my period), the amount was similar to my usual menstruation, but by the third night, it suddenly decreased.
On the fourth and fifth days, the bleeding returned to normal levels.
Could this be considered as withdrawal bleeding from the emergency contraceptive pill, or can it be regarded as a normal period? I am concerned it might be a false period or early pregnancy bleeding.
Recently, on March 9, I have been feeling some bloating, increased discharge, and frequent diarrhea.
Could this indicate pregnancy? However, I did have bleeding last month...
I would appreciate your clarification on this matter.
Thank you.

SR, 10~19 year old female. Ask Date: 2018/03/09

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The menstrual cycle is typically around 26-28 days.
The last menstrual period was from January 28 to February 1.
After having intercourse, the emergency contraceptive pill (1.5g) was taken 4 hours later.
On February 22, there was bleeding (which is around the expected time for menstruation), and the amount was similar to a regular period.
However, by the third night, the bleeding suddenly decreased, and by the fourth and fifth days, it returned to a normal amount.
Is this considered withdrawal bleeding from the emergency contraceptive pill, or can it be regarded as a normal menstrual period?
Answer: The menstrual cycle is typically around 26-28 days.
The last menstrual period was from January 28 to February 1.
The bleeding on February 22 (which is around the expected time for menstruation) was similar in amount to a normal period, so it can be considered a normal menstrual period.
There is concern about the possibility of false menstruation or early pregnancy bleeding.
Recently, on March 9, there has been some abdominal bloating, increased discharge, and frequent diarrhea.
Could this indicate pregnancy? However, there was bleeding last month...

Answer: It is unlikely to be pregnancy.

Reply Date: 2018/03/09

More Info

Understanding post-pill bleeding can be quite complex, especially when considering the timing of your menstrual cycle, the use of emergency contraception, and the potential for early pregnancy. Based on the information you've provided, let's break down your situation.

1. Post-Pill Bleeding vs. Menstruation: After taking emergency contraception like the Levonorgestrel pill (often referred to as "Plan B" or "morning-after pill"), it is common to experience some form of bleeding. This bleeding can occur within a few days to a few weeks after taking the pill and may resemble a menstrual period. The timing of your bleeding on February 22, which aligns with your typical menstrual cycle, suggests that it could be a withdrawal bleed caused by the hormonal changes induced by the pill. The fluctuation in the amount of bleeding you experienced—starting heavy, then decreasing, and returning to normal—can also be typical of post-pill bleeding.
2. Pregnancy Considerations: The concern about whether this bleeding could indicate early pregnancy is valid, especially since you mentioned symptoms like abdominal bloating and increased discharge. However, if you had a significant bleed that resembled your normal menstrual flow, it is less likely that you are pregnant. Early pregnancy bleeding can occur, but it is usually lighter and may be accompanied by other symptoms such as cramping or spotting. Given that you had a full bleed after taking the emergency contraception, the likelihood of pregnancy is reduced, but not entirely eliminated.

3. Symptoms of Early Pregnancy: The symptoms you are experiencing, such as bloating and increased discharge, can be associated with both early pregnancy and hormonal fluctuations due to the emergency contraceptive. If you suspect pregnancy, the best course of action is to take a home pregnancy test about a week after your expected period. This will provide a more definitive answer.

4. Follow-Up: If you continue to experience unusual symptoms, such as persistent abdominal pain, significant changes in your discharge, or if you miss your next period, it would be wise to consult with a healthcare provider. They can perform a blood test to check for pregnancy and evaluate any other potential issues.

5. Understanding Your Cycle: Your menstrual cycle, which typically ranges from 26 to 28 days, is important to consider. If your cycle is regular, any significant deviation from it, such as a missed period or unusual bleeding patterns, should prompt further investigation.
In conclusion, the bleeding you experienced after taking the emergency contraceptive is likely a withdrawal bleed rather than a sign of pregnancy, especially given the timing and nature of the bleeding. However, if you have concerns about your symptoms or if your next period does not arrive as expected, it is advisable to seek medical advice for further evaluation. Always trust your instincts about your body, and don’t hesitate to reach out to a healthcare professional for reassurance and guidance.

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