Delayed Menstruation: Is It Pregnancy or a Side Effect?

Delayed menstruation?

Hello, doctor.
I had unprotected sexual intercourse with my girlfriend on the morning of February 13.
Since it was our first time, the penis only penetrated about 3-5 centimeters for friction.
I withdrew before ejaculation.
However, I still bought emergency contraception (Ella) to take.
My girlfriend's period was expected around February 27, but as of now, March 17, it still hasn't arrived.
I would like to know if there is a possibility of pregnancy or if this could be a side effect of the medication.
Thank you for your response.

S, 10~19 year old female. Ask Date: 2023/03/17

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, you should not be pregnant, but you can take a pregnancy test to confirm.
Wishing you good health.

Reply Date: 2023/03/17

More Info

When it comes to delayed menstruation, it can be challenging to determine whether it is due to pregnancy or a side effect of medication, especially in the context of emergency contraception and unprotected intercourse. In your case, you mentioned having unprotected sexual intercourse on February 13 and subsequently taking emergency contraception (Ella, or ulipristal acetate) to prevent pregnancy. Your girlfriend's expected menstrual period was around February 27, but as of March 17, she has not yet menstruated.

Firstly, it is important to understand how emergency contraception works. Ella is a selective progesterone receptor modulator that can delay ovulation. If taken before ovulation, it can effectively prevent pregnancy. However, if ovulation has already occurred, the effectiveness of the medication diminishes. The timing of the menstrual cycle can also be influenced by various factors, including stress, hormonal fluctuations, and the use of emergency contraception itself.

Emergency contraception can sometimes lead to changes in the menstrual cycle. Some women may experience a delay in their period after taking Ella, while others may have an earlier or heavier period. This variability is due to the hormonal changes induced by the medication. Therefore, it is possible that the delay in menstruation could be a side effect of taking Ella rather than an indication of pregnancy.

To assess the likelihood of pregnancy, consider the following points:
1. Timing of Intercourse and Medication: You had unprotected intercourse on February 13, and if your girlfriend's cycle is regular, ovulation likely occurred around mid-cycle (approximately 14 days before her expected period). If Ella was taken shortly after intercourse, it may have prevented ovulation, reducing the chance of pregnancy.

2. Pregnancy Testing: If menstruation does not occur, it is advisable for your girlfriend to take a home pregnancy test. These tests are most accurate when taken after a missed period. If the test is positive, it would confirm pregnancy; if negative, it may indicate that the delay is due to other factors.

3. Consulting a Healthcare Provider: If the period remains absent and pregnancy tests are negative, it is essential to consult a healthcare provider. They can perform further evaluations, including a blood test for pregnancy and an assessment of any underlying issues that may be causing the delay.

4. Understanding Side Effects: As mentioned, Ella can cause menstrual irregularities. It is not uncommon for women to experience changes in their cycle after taking emergency contraception. This can include delayed periods, which may lead to confusion regarding pregnancy status.

In conclusion, while there is a possibility of pregnancy, the delay in menstruation could also be a side effect of the emergency contraception taken. It is crucial to conduct a pregnancy test and consult with a healthcare provider for a definitive answer and to discuss any concerns regarding menstrual irregularities. Monitoring the situation and seeking professional advice will provide clarity and ensure appropriate care moving forward.

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