Is This Menstruation? Irregular Cycles and Emergency Contraception

Is this considered a menstrual period?

Hello, Doctor.
My menstrual cycle has been irregular.
In the past three months, my periods were as follows: October 27 to November 2, December 11 to December 17, and January 16 to January 22.
I had sexual intercourse on January 24 (the second day after my period ended) and I am unsure if the condom was used properly (there was no ejaculation).
The next day, around 12-1 PM, I took emergency contraception.
However, I had sexual intercourse again on January 26 (four days after my period ended), and this time I checked the condom for any breakage, and it was intact!
On the sixth day after taking the emergency contraception (January 31), I experienced bleeding that was similar in volume to my usual menstrual flow, lasting about four days.
On the fifth day, the blood was a dark brown color, and on the sixth and seventh days (today), there was no bleeding at all.
I later asked the pharmacist who sold me the emergency contraception, and she said that the bleeding indicates that it was my period.
I also took pregnancy tests on the 12th day after the first intercourse, the 10th day after the second intercourse, and the 18th day, all of which showed one line, which relieved my concerns.
On February 24, I noticed some bleeding when I wiped after using the restroom, and the bleeding started that day, with a volume similar to my usual menstrual flow (even with some small clots).
I would like to ask the doctor:
1.
Is the bleeding on February 24 considered my period? Was the bleeding on January 31 a withdrawal bleed from the emergency contraception?
2.
Does having two menstrual periods in one month indicate that the emergency contraception was effective? I understand that taking emergency contraception can disrupt the menstrual cycle (I have taken it before but have never experienced two periods in one month).
3.
If I want to start taking a regular contraceptive pill (Yaz), should I begin taking it on the fifth day of my next period?
4.
Does Yaz have fewer side effects? I have a history of water retention, and I am concerned that it might worsen or lead to weight gain.
I have consulted an obstetrician about this brand, but I have not started taking it yet.
I would appreciate your answers to these questions, as they have been troubling me.
Thank you, Doctor, and I apologize for the lengthy message.
😅

Jiang Jiang, 20~29 year old female. Ask Date: 2023/02/27

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the effects of emergency contraceptive pills on menstruation can vary; they may cause your period to come earlier or later.
Additionally, their contraceptive effectiveness is not 100%, with a failure rate of about 3%.
If you are unsure whether the bleeding is a true menstrual period or if you might be pregnant, it is advisable to consult a physician for evaluation.
It is best to start taking contraceptive pills after confirming that you are not pregnant.
The side effects can vary based on individual physiology, and you will only know how your body reacts after trying them.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2023/02/27

More Info

When it comes to understanding irregular menstrual cycles and the implications of emergency contraception, it’s essential to consider several factors, including the timing of sexual activity, the use of contraception, and the effects of emergency contraceptive pills (ECPs) on your menstrual cycle.

1. Understanding Your Bleeding: Based on your description, the bleeding you experienced on January 31 after taking the emergency contraceptive pill (ECP) is likely a withdrawal bleed, which is a common side effect of ECPs. This type of bleeding can mimic a menstrual period but is not considered a true menstrual cycle. The bleeding you experienced on February 24, which was heavier and lasted longer, is more likely to be your actual menstrual period. It’s common for ECPs to cause changes in your menstrual cycle, including timing and flow.

2. Evaluating Contraceptive Success: Since you engaged in sexual activity after your last menstrual period and used ECPs, it seems you took appropriate steps to prevent pregnancy. The negative pregnancy tests you took after both instances of sexual activity suggest that you did not conceive. Therefore, you can consider the use of ECPs as successful in preventing pregnancy, even though your menstrual cycle has been irregular.

3. Starting Regular Contraceptive Pills: If you are considering starting a regular contraceptive pill (like "悦己"), it is generally recommended to begin taking it at the start of your next menstrual cycle. However, some pills can be started at any time, but it’s best to consult with your healthcare provider for personalized advice. Starting the pill on the fifth day of your cycle is a common practice, as it allows for effective contraception while minimizing the risk of ovulation.

4. Side Effects of Contraceptive Pills: Regarding concerns about side effects, including weight gain or water retention, it’s important to note that individual responses to contraceptive pills can vary. Some women may experience side effects such as bloating or weight gain, while others may not notice any significant changes. If you have a history of water retention, it’s crucial to discuss this with your healthcare provider, who can help you choose a contraceptive method that aligns with your health needs and lifestyle.

5. Monitoring Your Cycle: Since you have a history of irregular cycles, it may be beneficial to keep track of your menstrual patterns, including the timing and flow of your periods. This information can be helpful for your healthcare provider in managing your reproductive health and addressing any concerns you may have.

In summary, the bleeding on January 31 is likely a withdrawal bleed from the ECP, while the bleeding starting on February 24 is likely your menstrual period. Your use of ECPs appears to have been effective, and starting a regular contraceptive method can help regulate your cycle moving forward. Always consult with your healthcare provider for tailored advice and to address any ongoing concerns regarding your menstrual health and contraceptive options.

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