Abnormal Bleeding: Causes and Concerns After Unprotected Sex

Intermenstrual bleeding, I hope to receive a prompt response?

Hello Doctor: My period ended on August 31 (Tuesday), and I had unprotected intercourse on September 1 (Wednesday).
I took emergency contraception on the same day.
On September 6 (Monday), I had unprotected intercourse again and took emergency contraception three hours afterward.
On September 12 (Sunday), I experienced light bleeding that required a panty liner.
On September 13 (Monday), I woke up to find a lot of blood on my underwear, and a few hours later, there was brown discharge with an unusual odor on my pad.
On September 14 (Tuesday), the bleeding gradually decreased, but I continued to notice blood on my underwear until September 17 and 18 (Friday and Saturday), when the bleeding finally stopped.
I would like to ask the doctor: 1.
Is this ovulation bleeding, implantation bleeding, or retained menstrual blood? 2.
Since I took emergency contraception on the same day after intercourse, is there still a chance of pregnancy? Thank you!

Ms. K, 10~19 year old female. Ask Date: 2021/09/19

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it may be related to taking emergency contraceptive pills.
It is recommended to take regular contraceptive pills instead.
Wishing you good health.

Reply Date: 2021/09/19

More Info

Abnormal bleeding can be a concerning symptom for many individuals, especially after unprotected sexual intercourse. Based on your description, it appears that you have experienced a series of events following unprotected sex, including the use of emergency contraception (the "morning-after pill") and subsequent abnormal bleeding. Let's break down your situation and address your concerns.

1. Understanding the Types of Bleeding:
- Ovulation Bleeding: This type of bleeding can occur around the time of ovulation, which typically happens about 14 days before your next expected period. It is usually light and may be accompanied by mild cramping. However, given the timeline of your events, it seems less likely that this is the cause of your bleeding.

- Implantation Bleeding: If fertilization occurs, implantation bleeding can happen when the fertilized egg attaches to the uterine lining. This bleeding is usually light and can be mistaken for a light period. However, given that you have taken emergency contraception, the likelihood of implantation bleeding is reduced.

- Menstrual Bleeding: If your body is preparing for a menstrual cycle, you may experience irregular bleeding, especially after taking emergency contraception, which can disrupt your hormonal balance and lead to unexpected bleeding.

2. Emergency Contraception and Its Effects:
- Emergency contraception is designed to prevent pregnancy after unprotected sex. It works primarily by delaying ovulation. However, it can also cause changes in your menstrual cycle, including irregular bleeding or spotting. The bleeding you experienced after taking the emergency contraceptive could be a side effect of the medication.

3. Possible Causes of Your Symptoms:
- The bleeding you described, especially the transition from light spotting to heavier bleeding and then to brown discharge with an odor, may indicate a few possibilities:
- Hormonal Imbalance: The emergency contraceptive can cause hormonal fluctuations that may lead to irregular bleeding.

- Infection: The presence of an unusual odor with the discharge could suggest a possible infection, such as bacterial vaginosis or a sexually transmitted infection (STI). It is essential to consult a healthcare provider for appropriate testing and diagnosis.

- Retained Products of Conception: If there was a very early pregnancy that did not progress, retained tissue could cause bleeding. However, this is less likely given your use of emergency contraception.

4. Should You Be Concerned About Pregnancy?:
- While emergency contraception is effective, it is not 100% guaranteed. If you have concerns about potential pregnancy, taking a home pregnancy test after a missed period or consulting with a healthcare provider for a blood test can provide clarity.

5. Next Steps:
- It is crucial to follow up with a healthcare provider to discuss your symptoms, especially the abnormal bleeding and any associated discomfort. They may recommend a pelvic exam, ultrasound, or laboratory tests to rule out infections or other underlying conditions.

- Be honest with your healthcare provider about your sexual history and any contraceptive methods used. This information is vital for accurate diagnosis and treatment.

In summary, while your symptoms may be related to hormonal changes from emergency contraception, the presence of an unusual odor and the nature of the bleeding warrant further evaluation. It's essential to seek medical advice to ensure your reproductive health is managed appropriately.

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