Post-Pill Bleeding: Is It Early Menstruation or Something Else?

Bleeding after taking contraceptive pills?

Around March 20, I had my menstrual period and I expect it to come again between April 18-21.
My cycle is quite regular, approximately every 28-30 days.
On April 15, I had sexual intercourse, and the condom broke.
However, within an hour and a half, I took one dose of Ella, an emergency contraceptive pill.
On the evening of April 16, I noticed some brownish blood, and I'm unsure if it was menstrual blood.
On April 17 and 18, the bleeding was quite heavy, similar to the second or third day of my period.
I have read that taking the pill close to your period can cause it to come early.
On April 19, the bleeding gradually decreased, resembling my usual menstrual pattern, and it did not present as spotting or light bleeding as many others describe.
The flow was consistent with my menstrual period, just slightly heavier.
What is the likelihood of pregnancy in this situation? Unlike many others who report bleeding three to five days after taking the pill, I experienced some brownish-red blood the next day, followed by a flow similar to the second day of my period, with no other discomfort.
It feels like the first day of my period with some cramping.
If this is indeed my period, will it come again, or do I need to recalculate my cycle?

ch, 20~29 year old female. Ask Date: 2018/04/19

Dr. Huang Jianzhong reply Obstetrics and Gynecology

Around March 20, menstruation began, and it is expected to occur between April 18-21.
The cycle is quite regular, approximately every 28-30 days.
On April 15, early in the morning, I had sexual intercourse, and the condom broke.
However, within an hour and a half, I took one dose of Ella, an emergency contraceptive pill.
On the evening of April 16, I noticed some brownish blood, and I am unsure if it is menstrual blood.
On April 17 and 18, the bleeding was quite heavy, similar to the second or third day of my usual period.
I have read that taking the pill close to the expected period may cause it to arrive earlier.
On April 19, the bleeding gradually decreased, resembling my typical menstrual pattern, without the spotting or light bleeding that many experience; it was consistent with my menstrual flow, just slightly heavier.
1.
What is the likelihood of pregnancy in this situation?
Answer: The likelihood of pregnancy is low.
Unlike many who inquire about menstruation occurring three to five days after taking the pill, I experienced some brownish-red spotting the next day, followed by bleeding similar to the second day of my period, with no other discomfort.
It feels like the first day of menstruation, which typically includes abdominal cramps.
2.
If this is menstruation, will it come again, or should the cycle be recalculated?
Answer: The cycle should be recalculated.

Reply Date: 2018/04/19

More Info

Understanding post-pill bleeding can be quite complex, especially when considering the timing of your menstrual cycle and the effects of emergency contraception. In your case, you experienced a regular menstrual cycle, with your last period starting around March 20 and expected to arrive again between April 18 and 21. After a condom failure on April 15, you took the emergency contraceptive pill (ella) shortly thereafter.
Emergency contraceptive pills can cause changes in your menstrual cycle. They work primarily by delaying ovulation, but they can also alter the timing and flow of your next period. It is not uncommon for women to experience bleeding that resembles a menstrual period after taking the pill, which can lead to confusion about whether it is an early period or a side effect of the medication.

From your description, the bleeding you experienced on April 16, which was a small amount of coffee-colored blood, could be considered spotting, which is a common side effect of taking emergency contraception. The heavier bleeding you experienced on April 17 and 18, resembling a typical menstrual flow, suggests that your body may have responded to the emergency contraceptive by inducing a withdrawal bleed. This is similar to what happens when women take hormonal birth control and then stop it; the body sheds the uterine lining, resulting in bleeding.

Regarding your concern about the possibility of pregnancy, the likelihood is relatively low if you took the emergency contraceptive pill within the recommended time frame (ideally within 72 hours, but ella can be effective up to 120 hours after unprotected intercourse). However, no contraceptive method is 100% effective, and if you continue to have concerns about pregnancy, it may be advisable to take a pregnancy test about a week after your expected period date.

As for your question about whether this bleeding means your menstrual cycle will reset, it is important to note that the bleeding you experienced after taking the emergency contraceptive pill may not be a true period. Instead, it could be a withdrawal bleed. If this bleeding resembles your typical menstrual flow, you may consider it as the start of a new cycle. However, it is also possible for your next period to be delayed or altered due to the hormonal changes induced by the emergency contraceptive.

In summary, the bleeding you experienced after taking the emergency contraceptive pill is likely a withdrawal bleed rather than an early period. It is essential to monitor your cycle in the following months, as it may take some time for your menstrual cycle to return to its regular pattern after taking hormonal medications. If you have any further concerns or if your cycle does not normalize, it would be wise to consult with a healthcare professional for personalized advice and guidance.

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