Concerns About Esmya: Pregnancy Risk, Side Effects, and Alternatives

Alesse birth control pill issues?

Hello Dr.
Wu, I would like to ask you some questions regarding Alesse: (1) I started taking Alesse on the first day of my period on April 1st, and I have taken all 21 pills on time every evening.
If I had unprotected intercourse on April 18th, what is the likelihood of pregnancy? (2) Today, April 24th, I have stopped taking the pills for three days and have not experienced any withdrawal bleeding.
Should I take emergency contraception? (3) Additionally, I noticed unexplained swelling on the outer side of my thigh on April 23rd, which is painful when pressed and has no bruising.
Could this be a symptom of a blood clot (venous thrombosis)? Should I stop taking the medication immediately? I have also experienced chest tightness and rapid heartbeat in the past few days; does this indicate that Alesse may not be suitable for me? As a side note, this is my first time taking a combined oral contraceptive, and I experienced headaches and nausea during the first three days, but I have managed to continue taking it and have since adapted better.
This month, I have not had any breakouts, which used to be a significant issue for me before my period, and my skin has been less oily.
I would like to maintain this improvement, but is Alesse really not suitable for my current condition? If you believe Alesse is not appropriate, are there alternative contraceptive options or supplements that you would recommend? Thank you.

Ginny, 20~29 year old female. Ask Date: 2020/04/24

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
For pregnancy concerns, please take a home pregnancy test or consult a gynecologist for evaluation four weeks after sexual intercourse.
2.
The side effects of the aforementioned contraceptive pills can vary from person to person; you may try switching to a different brand.

Reply Date: 2020/04/24

More Info

When considering the use of hormonal contraceptives like Esmya (also known as ulipristal acetate), it is essential to understand both the potential risks and benefits associated with their use, especially in the context of pregnancy and side effects.

1. Pregnancy Risk with Esmya:
Esmya is primarily used for the treatment of uterine fibroids and is not a conventional contraceptive. If you have been taking Esmya as directed and engaged in unprotected intercourse, the risk of pregnancy is generally low, but not zero. The effectiveness of Esmya in preventing ovulation can vary based on individual hormonal responses. If you are concerned about the possibility of pregnancy after having unprotected sex while on Esmya, it is advisable to take a pregnancy test if your period is late or if you experience any unusual symptoms.

2. Withdrawal Bleeding:
The absence of withdrawal bleeding after stopping Esmya does not necessarily indicate pregnancy. Hormonal contraceptives can sometimes lead to irregular bleeding patterns, and it may take some time for your menstrual cycle to normalize after discontinuation. If you are concerned about the lack of bleeding, you may want to consult your healthcare provider for further evaluation.

3. Symptoms of Thrombosis:
The symptoms you describe, such as swelling in the thigh, pain upon pressure, chest discomfort, and rapid heartbeat, could potentially indicate a serious condition like venous thromboembolism (VTE). Hormonal contraceptives can increase the risk of blood clots, particularly in individuals with certain risk factors (e.g., obesity, smoking, personal or family history of clotting disorders). It is crucial to seek immediate medical attention if you experience these symptoms, as they may require urgent evaluation and management.

4. Side Effects and Suitability:
Your experience of headaches and nausea during the initial days of taking Esmya is not uncommon, as many individuals may experience side effects when starting hormonal contraceptives. However, if these symptoms persist or if you develop new symptoms, it may indicate that Esmya is not the right fit for you. The improvement in your skin condition is a positive effect that some users experience, but it is essential to weigh this against any adverse effects you may be experiencing.

5. Alternatives to Esmya:
If you and your healthcare provider determine that Esmya is not suitable for you, there are several alternative contraceptive methods available. These include:
- Non-hormonal options: Such as copper intrauterine devices (IUDs) or barrier methods (condoms, diaphragms).

- Other hormonal contraceptives: Such as different formulations of birth control pills, patches, or hormonal IUDs that may have a different side effect profile.

- Natural family planning: Monitoring your menstrual cycle and fertility signs to avoid pregnancy.

In conclusion, it is essential to have an open dialogue with your healthcare provider about your concerns regarding Esmya, including the risk of pregnancy, side effects, and any symptoms that may indicate a more serious condition. They can provide personalized advice and help you explore alternative contraceptive options that align with your health needs and lifestyle. Always prioritize your health and safety when making decisions about contraceptive methods.

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