Should You Seek Medical Attention for Prolonged Bleeding After Emergency Contraceptive?

If you have been experiencing bleeding for 17 days after taking emergency contraception while abroad, it is advisable to seek medical attention?

Hello, doctor.
Since I am currently in Italy and it is inconvenient for me to seek medical care, I would like to ask if my condition warrants a visit to a local healthcare provider.
I do not have insurance, so the costs would be quite high, and I would like to consult whether it is necessary.
My last menstrual period started on August 10, lasting about seven days, with a cycle of approximately 28 days.
I had sexual intercourse with my boyfriend on August 18, and the condom broke.
Since it was close to my ovulation period, I decided to take emergency contraception, specifically Ezinelle (Each tablet contains 1.5 mg of levonorgestrel).
About four days later, on August 23, I started bleeding.
Initially, the bleeding was similar to the brown discharge seen on days four or five of my period, but after two days of continuous bleeding, on August 25, I experienced heavy bleeding that resembled bright red blood on the third day of my period.
This heavy bleeding lasted for two days, and from August 27 until yesterday, September 6, I had intermittent brown discharge, sometimes accompanied by blood clots.
On September 6, I felt that it was almost stopping as the amount of blood decreased significantly.
However, today, September 7, I suddenly started heavy bleeding again, with bright red blood similar to the third day of my period, accompanied by discomfort akin to menstrual cramps.
I am unsure if this is normal.
If I had not taken the emergency contraception, today would indeed be the day my period is due, but I have already been bleeding for over two weeks, and the sudden heavy bleeding is causing me great concern.
I wonder if there could be a uterine infection or other complications.
I hope you can provide me with some advice.
If medical attention is necessary, I need to make an appointment quickly.
Thank you very much!

Anna, 30~39 year old female. Ask Date: 2019/09/08

Dr. Huang Jianzhong reply Obstetrics and Gynecology

In Italy, it is inconvenient to seek medical care, so I would like to ask if my condition requires local medical attention.
Since I do not have insurance, the costs will be quite high, and I would like to consult whether it is necessary.
My last menstrual period started on August 10, lasting about seven days, with a cycle of approximately 28 days.
I had sexual intercourse with my boyfriend on August 18, and the condom broke.
Since it was close to ovulation, I decided to take the emergency contraceptive pill, Ezinelle (each tablet contains 1.5 mg of levonorgestrel).
About four days later, on August 23, I began to bleed.
Initially, the bleeding was similar to the brown discharge seen on days four or five of my period, but after two days of continuous bleeding, on August 25, I experienced heavy bleeding that resembled bright red blood on the third day of my period.
This continued for two days, and from August 27 to yesterday, September 6, I had intermittent brown discharge, sometimes accompanied by blood clots.
On September 6, I felt like it was about to stop as the bleeding decreased significantly.
However, today, September 7, I suddenly started heavy bleeding again, bright red and abundant, similar to the third day of my period, accompanied by discomfort akin to menstrual cramps.
I am unsure if this is normal.
If I had not taken the emergency contraceptive, today would indeed be the day my period is due.
However, I have already been bleeding for over two weeks, and the sudden heavy bleeding is very concerning.
I wonder if there could be a uterine infection or complications.
I hope you can provide some advice.
If medical attention is needed, I must make an appointment quickly.
Answer: Yes, you need to seek medical attention.

Reply Date: 2019/09/08

More Info

It sounds like you are experiencing a concerning situation following the use of emergency contraception, specifically Ezinelle, which contains levonorgestrel. Your symptoms of prolonged bleeding, especially the transition from light brown discharge to heavy red bleeding accompanied by cramps, warrant careful consideration.

Firstly, it is important to understand that emergency contraceptive pills (ECPs) can cause various side effects, including changes in menstrual bleeding patterns. Some women may experience irregular bleeding or spotting after taking ECPs, which can sometimes be heavier than a typical menstrual period. This is due to the hormonal changes induced by the medication, which can disrupt the normal menstrual cycle.

However, the duration and nature of your bleeding raise some concerns. The fact that you have been bleeding for over two weeks, with a sudden increase in flow, could indicate a few possibilities:
1. Hormonal Effects: As mentioned, ECPs can lead to prolonged bleeding or spotting. This is often not a cause for alarm, but it is essential to monitor the situation.

2. Menstrual Cycle Variation: Since you mentioned that today would have been the start of your regular menstrual cycle, it is possible that your body is reacting to the hormonal changes and trying to establish a new cycle. However, the heavy bleeding and cramps could also indicate that your body is experiencing a more significant response.

3. Potential Complications: While less common, prolonged bleeding can sometimes indicate complications such as an infection, retained products of conception (if there was a pregnancy), or other underlying conditions. Symptoms such as fever, severe pain, or foul-smelling discharge would be particularly concerning.

Given your situation, it is advisable to seek medical attention, especially since you are experiencing heavy bleeding and discomfort. While I understand that you are in Italy without insurance, your health should be the priority. Many clinics and hospitals may offer payment plans or reduced fees for those without insurance. It is crucial to have a healthcare professional evaluate your condition to rule out any serious complications.

In summary, while some irregular bleeding can be a normal side effect of emergency contraception, the extent and duration of your bleeding, particularly the recent increase in flow, suggest that you should seek medical attention. A healthcare provider can perform the necessary examinations, such as a pelvic exam or ultrasound, to determine the cause of your symptoms and provide appropriate treatment. Please prioritize your health and seek care as soon as possible.

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