Emergency Contraception: Risks and Effects on Pregnancy

Emergency contraceptive pill

My last menstrual period ended on September 25 and started again on September 29.
On September 30, I had unprotected intercourse.
Is it safe to say that the 14 days after my period are considered a safe period? Is there a possibility of pregnancy? On September 29, I took the emergency contraceptive pill, Ella (ulipristal acetate), within 10 hours.
On September 30, I had unprotected intercourse again within 48 hours but did not take the pill again.
Should I take another dose of the medication within the effective period? Would that reduce the effectiveness of the medication?
In the past few days, I've been experiencing some cramping in my uterus.
On October 4, I had some light bleeding that was brownish with a bit of bright red.
Is this bleeding a side effect of the medication or could it be my period? After this bleeding, what is the likelihood of pregnancy? I've also heard that some women experience bleeding in early pregnancy.
Is it possible that I could be pregnant? Thank you, doctor, for your help!

Cǎoméi, 10~19 year old female. Ask Date: 2019/10/04

Dr. Huang Jianzhong reply Obstetrics and Gynecology

The last menstrual period ended on September 25 and started again on September 29.
There was unprotected intercourse with ejaculation on September 30.
The 14 days after the end of menstruation are considered a safe period, so is there a possibility of pregnancy? Answer: There is a possibility of pregnancy.
The emergency contraceptive pill, Ella (Ulipristal Acetate), was taken within 10 hours after the intercourse on September 29.
On September 30, there was another instance of unprotected intercourse with ejaculation within 48 hours, but no additional medication was taken.
Should another dose of the medication be taken within the effective period? Answer: No, it is not necessary.
Will this reduce the effectiveness of the medication? Answer: No.
Recently, there has been some cramping in the uterus.
On October 4, there was light bleeding that was brownish with some bright red.
Is this bleeding due to the medication or is it menstruation? Answer: This is likely bleeding due to the medication.
Is the chance of pregnancy high after this bleeding? Answer: The chance of pregnancy is not high, but some say that early pregnancy can cause bleeding.
Is it possible that pregnancy has occurred? Answer: Currently, it is not considered early pregnancy bleeding.

Reply Date: 2019/10/04

More Info

Understanding emergency contraception and its effects on pregnancy is crucial for anyone who is sexually active and concerned about unintended pregnancies. In your case, you have taken emergency contraception (Levonorgestrel, commonly known as Plan B or "Lijieting") after unprotected intercourse, and you are experiencing some symptoms that raise questions about your current situation.

First, let's clarify the timing of your menstrual cycle and the concept of the "safe period." The menstrual cycle typically lasts about 28 days, but it can vary from person to person. Ovulation usually occurs around 14 days before the start of your next period. If your last menstrual period ended on September 25, and you had unprotected intercourse on September 30, you were likely within your fertile window, as sperm can survive in the female reproductive tract for up to five days. Therefore, there is a possibility of pregnancy if ovulation occurred shortly after your unprotected intercourse.

You mentioned taking the emergency contraceptive pill within 10 hours of the unprotected intercourse. This is a good decision, as emergency contraception is most effective when taken as soon as possible after unprotected sex. The effectiveness of Levonorgestrel decreases the longer you wait, but it can still be effective up to 72 hours after intercourse. Since you took it within this timeframe, you have maximized your chances of preventing pregnancy.

Regarding your question about whether you need to take another dose of the emergency contraceptive pill after having unprotected intercourse again on September 30, it is generally not necessary to take a second dose if you have already taken the pill within the recommended time frame. Taking additional doses of emergency contraception within a short period does not necessarily enhance its effectiveness and may lead to increased side effects, such as nausea or changes in your menstrual cycle.

Now, concerning the symptoms you are experiencing, such as the slight abdominal pain and the brownish-red spotting on October 4, these could be attributed to several factors. Spotting can occur after taking emergency contraception due to hormonal changes, and it is not uncommon for women to experience some irregular bleeding or spotting after taking the pill. This bleeding is often referred to as "withdrawal bleeding" and can be mistaken for a period.

However, it is also important to note that early pregnancy can sometimes present with light spotting or bleeding, known as implantation bleeding, which occurs when a fertilized egg attaches to the uterine lining. If you suspect that you might be pregnant, it is advisable to take a home pregnancy test about a week after your expected period or consult with a healthcare provider for a blood test.

In summary, based on the information provided, your use of emergency contraception was timely, and while you may experience some side effects such as spotting, it does not necessarily indicate pregnancy. If your symptoms persist or if you have concerns about potential pregnancy, it is best to consult with a healthcare professional for further evaluation and guidance. They can provide you with the most accurate information and support based on your individual circumstances.

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