Is Post-Pill Bleeding a Sign of Early Menstruation?

Is the bleeding that occurs about six days after taking the emergency contraceptive pill considered a menstrual period?

The menstrual cycle is 29-30 days, with a menstrual period lasting 6 days.
My recent menstrual cycles were from April 6-10, May 4-9, and June 1-6.
I had unprotected intercourse with my boyfriend on May 23 and June 9, both times with ejaculation inside, and I took emergency contraception within approximately 12 hours after each encounter.
For the first instance, I took the second-generation emergency contraceptive pill Ella; for the second instance, I took the first-generation low-dose progestin pill Plan B.
This morning (June 15), I noticed some bleeding, which seems to be similar in volume to the bleeding on the third or fourth day of my period.
I would like to ask: Is this phenomenon an early arrival of my period? If so, should I recalculate my menstrual cycle? If the bleeding lasts more than a week, should I see a doctor and take a pregnancy test? Is this phenomenon related to the disruption of my menstrual cycle caused by taking the low-dose progestin? Thank you!

jyu, 20~29 year old female. Ask Date: 2019/06/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The menstrual cycle is 29-30 days, with a duration of 6 days for menstruation.
My recent menstrual periods were from April 6-10, May 4-9, and June 1-6.
I had unprotected sexual intercourse with my boyfriend on May 23 and June 9, both times with ejaculation inside, and I took emergency contraception within approximately 12 hours after each encounter.
For the first instance, I took the second-generation emergency contraceptive pill Ella; for the second instance, I took the first-generation low-dose progestin pill Plan B.
This morning (June 15), I noticed some bleeding, which is similar in volume to the bleeding on the third or fourth day of my period.
I would like to ask: Is this phenomenon an early arrival of my menstrual period? If so, should I recalculate my menstrual cycle? Answer: It could be ovulation bleeding.
If the bleeding lasts more than a week, should I see a doctor and take a pregnancy test? Answer: You can consult a doctor to determine if this phenomenon is related to the low-dose progestin causing a disruption in your menstrual cycle.
Answer: It is unrelated.

Reply Date: 2019/06/15

More Info

Post-pill bleeding, often referred to as withdrawal bleeding, can indeed be a sign of early menstruation, especially after taking emergency contraceptive pills (ECPs) like Ella (ulipristal acetate) or Plan B (levonorgestrel). These medications work primarily by delaying ovulation, but they can also alter the menstrual cycle and cause unexpected bleeding.

In your case, the timeline of your menstrual cycle and the use of emergency contraception are crucial. You mentioned that your cycle typically lasts 29-30 days, with a duration of 6 days for menstruation. After having unprotected intercourse on May 23 and June 9, you took emergency contraceptive pills within 12 hours, which is within the recommended timeframe for these medications to be effective.
The bleeding you observed on June 15 could be attributed to the hormonal changes induced by the emergency contraceptive pills. ECPs can cause a variety of side effects, including changes in menstrual bleeding patterns. This can manifest as spotting, lighter or heavier periods, or even withdrawal bleeding that mimics a menstrual period.
If this bleeding resembles your typical menstrual flow, it could indeed be considered an early period. However, it is essential to note that the timing and characteristics of this bleeding may differ from your usual cycle due to the hormonal influence of the pills. If the bleeding lasts longer than a week or if you experience any unusual symptoms such as severe pain or heavy bleeding, it is advisable to consult a healthcare provider. They may recommend a pregnancy test to rule out pregnancy, especially since you had unprotected intercourse.

Regarding your question about recalculating your menstrual cycle, if this bleeding is indeed your period, you would start counting your next cycle from the first day of this bleeding. However, if the bleeding is irregular or significantly different from your normal cycle, it may take a few cycles for your body to readjust and establish a new pattern.

In summary, post-pill bleeding can be a sign of early menstruation, but it is essential to monitor the duration and characteristics of the bleeding. If it exceeds a week or if you have concerns about your menstrual cycle's regularity, seeking medical advice is prudent. Emergency contraceptive pills can cause temporary disruptions in your cycle, and it may take some time for your body to return to its regular rhythm. Always keep track of your menstrual cycle and any changes you experience, as this information can be valuable for your healthcare provider in assessing your reproductive health.

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