Delayed Menstruation After Emergency Contraceptive Use

Take the emergency contraceptive pill as directed?

Hello Doctor, I would like to ask about my girlfriend's situation.
Her last menstrual period was around February 14 to February 28.
We had unprotected intercourse during that time, and she took the emergency contraceptive pill (Ella) afterward.
We calculated that her period should have arrived on March 14, but on March 15, we had unprotected intercourse again and she took Ella once more.
However, her period has been delayed, and she is now experiencing abdominal pain.
She took a pregnancy test on March 27, which came back negative.
Could the pain be a side effect of the contraceptive? Is it normal for her period to be delayed for this long? Besides the abdominal discomfort, she has not noticed any light bleeding or anything unusual.

Panda, 30~39 year old female. Ask Date: 2023/03/28

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, if you are still experiencing discomfort, you can first consult a gynecologist, and they may consider inducing menstruation.
Wishing you good health.

Reply Date: 2023/03/28

More Info

Understanding delayed menstruation after the use of emergency contraceptives, such as Ella (ulipristal acetate), can be complex and involves several factors. Emergency contraceptive pills (ECPs) are designed to prevent pregnancy after unprotected intercourse or contraceptive failure, and they can affect the menstrual cycle in various ways.

Firstly, it's important to understand how ECPs work. Ella, for instance, primarily functions by delaying ovulation. If taken before ovulation, it can prevent the release of an egg, thereby reducing the chance of fertilization. However, if ovulation has already occurred, the effectiveness of Ella diminishes. After taking Ella, some women may experience changes in their menstrual cycle, including delayed menstruation, which can be a common side effect.

In your girlfriend's case, she took Ella after two instances of unprotected intercourse, which can lead to hormonal fluctuations. These fluctuations can cause her menstrual cycle to become irregular, resulting in a delayed period. It is not uncommon for women to experience a delay of a week or more after taking emergency contraception. The stress of the situation, hormonal changes, and the body's response to the medication can all contribute to this delay.

Regarding the abdominal pain your girlfriend is experiencing, it could be related to several factors. ECPs can cause side effects such as nausea, abdominal pain, and changes in menstrual bleeding patterns. The pain might also be a result of premenstrual symptoms, which can occur as the body prepares for menstruation. However, if the pain is severe or persistent, it is advisable for her to consult a healthcare provider to rule out other potential issues, such as ovarian cysts or ectopic pregnancy, especially since she had unprotected intercourse.

As for the pregnancy test taken on March 27, if it was negative, it is a good indication that she is not pregnant, especially considering the timing of the test in relation to her menstrual cycle. However, if her period does not arrive within a week or so, it would be prudent to repeat the pregnancy test or consult a healthcare professional for further evaluation.

In summary, delayed menstruation after taking emergency contraceptives like Ella is not unusual and can be attributed to hormonal changes caused by the medication. Abdominal discomfort may also be a side effect of the medication or related to premenstrual symptoms. If the delay continues or if there are any concerning symptoms, seeking medical advice is essential for proper assessment and peace of mind.

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