Negative Pregnancy Tests: Cysts and Delayed Menstruation

Pregnancy tests have all been negative, there are cysts in the uterus, but menstruation still hasn't arrived?

Hello Doctor, I had sexual intercourse with my girlfriend on August 6th.
We did not ejaculate inside, but we did not use a condom for a few minutes.
69 hours later, I took an emergency contraceptive pill (Ella).
Nine days after the intercourse, I visited a gynecologist for a pregnancy test, which came back negative.
Twenty-one days after the intercourse, I returned for another check-up, where a 4 cm cyst was observed, and I took another pregnancy test, which was also negative.
The doctor prescribed medication to induce menstruation, but even after a week, my period still hasn't arrived.
My period is now over 20 days late.
Given that I have tested negative for pregnancy twice, is it more likely that the emergency contraceptive has caused a disruption in my menstrual cycle, or is there still a possibility of pregnancy?

Mr. Huang, 10~19 year old female. Ask Date: 2021/09/06

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you are unlikely to be pregnant.
Wait for another week, and if your period still hasn't arrived, it is advisable to see a gynecologist.
Wishing you good health.

Reply Date: 2021/09/06

More Info

In your situation, it seems that you have taken the necessary steps to determine whether or not your girlfriend is pregnant, including using emergency contraception (Ella), undergoing pregnancy tests, and consulting with a healthcare provider. However, the absence of menstruation for over 20 days after taking the emergency contraceptive pill raises several important considerations.

Firstly, it is essential to understand how emergency contraceptive pills (ECPs) like Ella work. They primarily function by delaying ovulation, which means that if taken before ovulation, they can prevent the egg from being released. If ovulation has already occurred, ECPs may not be effective. Additionally, ECPs can cause temporary hormonal changes that may lead to irregular menstrual cycles. It is not uncommon for women to experience delayed menstruation or changes in their cycle after taking ECPs. This could explain the absence of your girlfriend's period for over three weeks.

Regarding the cyst you mentioned, it is important to note that functional ovarian cysts are common and often form during the menstrual cycle. These cysts can sometimes cause hormonal imbalances, which may also contribute to menstrual irregularities. The presence of a 4 cm cyst, while noteworthy, does not necessarily indicate pregnancy, especially if pregnancy tests have returned negative results. However, it is essential to monitor the cyst, as larger cysts can sometimes lead to complications, such as pain or rupture.

Given that both pregnancy tests returned negative results, the likelihood of pregnancy is low, especially considering the timing of the tests and the use of emergency contraception. However, it is crucial to follow up with a healthcare provider if menstruation does not resume soon. They may recommend further evaluation, including blood tests to measure hormone levels, which can provide more definitive answers regarding pregnancy and assess the status of the ovarian cyst.

In summary, the combination of taking emergency contraception, the presence of a functional cyst, and the hormonal fluctuations that can occur as a result of these factors likely explains the delayed menstruation. It is advisable for your girlfriend to continue monitoring her symptoms and to consult her healthcare provider for further evaluation if her period does not return within the next few weeks. Regular follow-ups are essential to ensure that any underlying issues are addressed and to provide peace of mind regarding her reproductive health.

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