Can I Rule Out Pregnancy After Emergency Contraceptive Use?

Can this rule out pregnancy?

Hello doctor, my girlfriend took the emergency contraceptive pill on April 11.
She experienced some bleeding from April 17 to 20.
We had unprotected intercourse on May 2 (only for 2 minutes of withdrawal), but at that time, the app indicated it was a fertile window.
We took a pregnancy test 19 days after the intercourse (on May 21), which showed negative, and another test 29 days later (on May 31), which also showed negative.
However, the app indicates that her period was due on May 17, and it is now 21 days late.
I am really anxious.
Can you help me understand if there is still a possibility of pregnancy? What are the chances? What can I do? Could the delay in her period be caused by the emergency contraceptive pill? If we don't see a doctor, will her period come on its own? Thank you, doctor, for your help.

Mr. Chen, 10~19 year old female. Ask Date: 2021/06/10

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the factors that can affect the menstrual cycle or cause intermenstrual bleeding are numerous, including age, environment, lifestyle, stress, emotional instability, weight changes, medications, emergency contraceptive pills, diet, polycystic ovary syndrome, uterine or cervical lesions, infections, ovulation, pregnancy, and breastfeeding, among others.
The effect of emergency contraceptive pills on menstruation may not necessarily result in an earlier or delayed period, and their contraceptive effectiveness is not 100%.
It is advisable to consult a gynecologist if symptoms persist or worsen to check for hormonal imbalances or other underlying causes.
Thank you! Wishing you peace and health, Dr.
Zhang.

Reply Date: 2021/06/10

More Info

When it comes to the use of emergency contraceptive pills (ECPs) and their effects on menstrual cycles, it's important to understand how these medications work and what factors can influence pregnancy and menstrual irregularities.

Emergency contraceptive pills, such as Plan B or Ella, are designed to prevent pregnancy after unprotected intercourse. They work primarily by delaying ovulation, which means that if taken before ovulation occurs, they can effectively prevent the sperm from fertilizing the egg. However, if ovulation has already occurred, ECPs may not be effective.
In your case, your girlfriend took an emergency contraceptive pill on April 11, and then experienced some bleeding between April 17 and 20. This bleeding could be a side effect of the ECP, often referred to as "withdrawal bleeding," which can occur as a result of the hormonal changes induced by the medication. It is not a true menstrual period but rather a response to the sudden hormonal shift.

You mentioned that you had unprotected intercourse again on May 2, during a time that your app indicated was a "dangerous period" for pregnancy. However, since you took the emergency contraceptive pill earlier, it is possible that it had already affected her ovulation cycle. The negative pregnancy tests you conducted on May 21 and May 31 are encouraging signs, as they suggest that pregnancy is unlikely. Generally, if a pregnancy test is negative and taken correctly, it is a reliable indicator that pregnancy has not occurred.

Regarding the delay in her menstrual cycle, it is not uncommon for ECPs to cause temporary disruptions in the menstrual cycle. The hormones in these pills can lead to changes in the timing of ovulation and menstruation, which may result in a delayed period. It is also worth noting that stress and anxiety about the situation can further impact menstrual regularity.

As for whether her period will return without medical intervention, many women find that their menstrual cycles normalize after a few cycles following the use of emergency contraception. However, if her period is significantly delayed (more than a week or two beyond the expected date) and she continues to have negative pregnancy tests, it may be advisable for her to consult a healthcare provider. A doctor can provide further evaluation and reassurance, and rule out any other potential issues that could be causing the delay.

In summary, based on the information provided, the likelihood of pregnancy seems low given the negative pregnancy tests and the timing of events. The delay in her period could be attributed to the use of emergency contraception, and it is possible that her cycle will return to normal soon. However, if there are ongoing concerns or if her period does not arrive soon, seeking medical advice would be a prudent step.

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