Irregular Bleeding After Emergency Contraceptive Use

After taking emergency contraception, menstruation occurred, but there was abnormal bleeding three weeks later?

Hello, doctor.
I had sexual intercourse on August 29 with a condom, but I'm not sure if there was any contact.
I took emergency contraception one hour later.
After taking it, I experienced light bleeding on September 2, which lasted for about two days, followed by heavy bleeding that was more than my usual menstrual flow and included blood clots.
This heavy bleeding stopped around September 11.
Between September 2 and September 11, I consulted both traditional Chinese medicine and Western medicine, and both confirmed that I was not pregnant.
However, on September 14 and 15, I manually stimulated my vagina and noticed a small amount of brownish discharge that looked like ovulation bleeding.
This stopped after those two days.

Starting on September 22, I experienced light bleeding again, which is a dark red-brown color, unlike the bright red of my menstrual blood.
As of today, the 25th, this has continued for four days without stopping.
The amount is small and does not resemble my regular menstrual flow.

Could you please advise if there is a possibility of pregnancy from the sexual encounter on August 29 or from the manual stimulation on September 14 and 15? Additionally, what could be the reason for the abnormal bleeding starting on September 22, which has now persisted for four days? What does this situation indicate?

a a, 10~19 year old female. Ask Date: 2018/09/25

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On August 29, I had sexual intercourse with a condom, but I'm not sure if it was compromised, so I took emergency contraception one hour later.
After taking it, I experienced light bleeding on September 2, which lasted for about two days, followed by heavy bleeding that was more than my usual menstrual flow and included blood clots.
This heavy bleeding stopped around September 11.
Between September 2 and September 11, I consulted both traditional Chinese medicine and Western medicine, and both confirmed that I was not pregnant.
However, on September 14 and 15, I manually stimulated my vagina and noticed a small amount of brownish discharge that looked like ovulation bleeding.
This stopped after two days.
Starting on September 22, I experienced light bleeding again, which was a dark red-brown color, unlike the bright red of menstrual blood.
As of now, September 25, this has continued for four days without stopping, and the amount is low and not like my usual menstrual flow.

Doctor, could you tell me if there is a possibility of pregnancy from the sexual encounter on August 29 or from the manual stimulation on September 14 and 15?
Answer: Since you used a condom during the sexual encounter on August 29 and took emergency contraception one hour later, as well as the manual stimulation on September 14 and 15, there is no risk of pregnancy.
However, the irregular bleeding starting on September 22 could be a side effect of the emergency contraception, which can cause changes in menstrual patterns.

Reply Date: 2018/09/25

More Info

Irregular bleeding after the use of emergency contraception can be concerning, and it's important to understand the potential causes and implications. In your case, you took emergency contraception (EC) after a potential contraceptive failure, which is a common practice to prevent unintended pregnancy. The bleeding you experienced following the use of EC can be attributed to several factors.

Firstly, emergency contraceptive pills (ECPs) can cause hormonal fluctuations in the body, leading to changes in your menstrual cycle. It is not uncommon for women to experience irregular bleeding, spotting, or changes in the timing and flow of their next period after taking ECPs. The initial light bleeding you experienced around September 2 could be a side effect of the ECP, while the heavier bleeding that followed may represent a withdrawal bleed, which is similar to a menstrual period triggered by the hormonal changes induced by the ECP.

Regarding the bleeding you experienced from September 22 onward, it is essential to consider that hormonal contraceptives can cause various types of bleeding, including breakthrough bleeding or spotting. The dark red or brownish color of the blood you described could indicate older blood, which is common in cases of irregular bleeding. This type of bleeding can occur due to hormonal imbalances, stress, or other factors affecting your menstrual cycle.

As for the possibility of pregnancy, the fact that you took ECPs shortly after the sexual encounter significantly reduces the likelihood of pregnancy. Additionally, since you have consulted both Western and traditional Chinese medicine practitioners and received negative pregnancy tests, it is unlikely that you are pregnant. The manual stimulation of the vagina you mentioned is also not a method that would lead to pregnancy, especially if there was no direct ejaculation or sperm transfer involved.

It is essential to monitor your bleeding patterns and any accompanying symptoms. If the irregular bleeding persists or worsens, or if you experience severe pain, it would be advisable to consult a healthcare provider for further evaluation. They may recommend a pelvic examination or ultrasound to rule out any underlying conditions, such as fibroids, polyps, or other hormonal issues.

In summary, the irregular bleeding you are experiencing is likely a result of the hormonal changes induced by the emergency contraceptive pill. While the likelihood of pregnancy is low, it is crucial to keep track of your symptoms and seek medical advice if the situation does not improve. Regular follow-ups with your healthcare provider can help ensure that any potential issues are addressed promptly.

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