Emergency Contraceptive Pills: Timing and Effectiveness - Obstetrics and Gynecology

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The timing for taking emergency contraceptive pills?


Hello Doctor, I had my last menstrual period on December 9, and I haven't gotten my period since November 14, so I went to see a doctor and received medication to induce menstruation (I started taking 8 doses from the evening of January 14 until the morning of January 18).
On January 16, I had sexual intercourse (with my partner using their hands) and experienced slight bleeding that was only visible when wiping, not enough to stain my underwear.
On January 19, I had sexual intercourse again (with my partner using their hands) and noticed slight bleeding that did stain my underwear.
On January 20, I had a normal flow, which is the first day of my period.
I usually experience menstrual cramps, but this time I did not have any bleeding until January 24.

I would like to ask:
1.
Should I consider January 16 as the first day of my menstrual cycle or January 20?
2.
If January 20 is considered the first day of my normal flow, what was the bleeding on January 16?
3.
This month, I started taking the contraceptive pill (Aivy, 28 pills).
The pharmacist said to start taking it on the fifth day.
I began taking it on January 23 (considering January 19 as the first day of my period).
Will it be effective for contraception?
4.
On January 29 (the seventh day of taking the pill, which would be the 11th day of my cycle if counting from January 19), I had unprotected intercourse.
What is the likelihood of pregnancy, and should I take emergency contraception? Thank you, Doctor.

Fung, 10~19 year old female. Ask Date: 2021/01/29

Dr. Cao Guotao reply Obstetrics and Gynecology


Hello, it should be around the 20th day of your menstrual cycle.
Taking it this way can also provide contraceptive effects, so please rest assured.
Wishing you good health.

Reply Date: 2021/01/29

More Info


Understanding emergency contraceptive pills (ECPs) is crucial for anyone who is sexually active and wants to prevent unintended pregnancies. ECPs are designed to be taken after unprotected intercourse or contraceptive failure, and their effectiveness largely depends on the timing of administration relative to the menstrual cycle.

1. Timing of Menstrual Cycle: In your case, the first day of your menstrual cycle is typically counted from the first day of your period. Since you mentioned that you had a normal menstrual flow starting on January 20, that date would be considered the first day of your cycle. Therefore, January 16 would not be counted as the first day of your cycle, even if you experienced some spotting.

2. Understanding Spotting: The spotting you experienced on January 16 could be due to several factors, including hormonal fluctuations from the medication you took to induce menstruation. It is not uncommon for hormonal treatments to cause irregular bleeding or spotting, which may not necessarily indicate the start of a menstrual period. Given that your actual menstrual flow began on January 20, it is safe to conclude that the bleeding on January 16 was likely not a true menstrual period.

3. Effectiveness of Contraceptive Pills: You mentioned starting the contraceptive pill (Aivee 28) on January 23, which is a few days after your period began. The effectiveness of the pill typically requires consistent use for at least seven days before it provides reliable contraception. Since you started taking the pill after your period, it is important to continue taking it as directed. If you take the pill consistently, it will provide contraceptive protection against pregnancy.

4. Risk of Pregnancy: Regarding your concern about unprotected intercourse on January 29, if you have been taking your contraceptive pills correctly since January 23, the risk of pregnancy is significantly reduced. However, if you missed any doses or did not take the pills as prescribed, the risk of pregnancy could increase. If you are unsure about your contraceptive coverage or if you had unprotected intercourse during a time when you were not fully protected, it may be prudent to consider taking emergency contraception (ECP) as a precaution.

In summary, your menstrual cycle should be counted from January 20, the spotting on January 16 was likely not a period, and starting the contraceptive pill on January 23 should provide you with effective contraception after seven days of consistent use. If you have concerns about potential pregnancy after unprotected intercourse, consulting with your healthcare provider about the possibility of taking emergency contraception would be advisable. Always remember that consistent use of contraceptives is key to preventing unintended pregnancies, and if you have any doubts or questions about your contraceptive methods, don't hesitate to reach out to a healthcare professional for personalized advice.

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