Does Emergency Contraceptive Cause Increased Menstrual Pain and Issues?

Does emergency contraception cause increased menstrual pain and other menstrual-related issues?

Hello: My girlfriend's last menstrual cycle was from November 8 to November 15.
We had sexual intercourse on November 18 and 19, both times starting without a condom and then using one.
To be safe, she took the emergency contraceptive pill (Ella) on November 22.
We then had intercourse again on November 30 and December 2, both times using a condom throughout.
On the evening of December 4, she started feeling dizzy and somewhat unwell.
On December 5, she reported that her period had started and that she felt very uncomfortable.
The level of discomfort was much worse than her previous menstrual periods, and pain relievers did not help.
I have the following questions: (1) Is this bleeding a normal menstrual period, or could it be early pregnancy bleeding? (2) Could taking the emergency contraceptive pill cause her next or future periods to be particularly uncomfortable?

Zheng Qian, 20~29 year old female. Ask Date: 2023/12/06

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, it should be menstruation; just observe it.
Wishing you good health.

Reply Date: 2023/12/06

More Info

Emergency contraceptive pills (ECPs), such as Ella (ulipristal acetate), are designed to prevent pregnancy after unprotected intercourse. While they are generally safe and effective, some women may experience side effects, including changes in their menstrual cycle and increased menstrual pain.

1. Understanding Menstrual Changes After Taking ECPs
After taking an emergency contraceptive, it is common for women to experience changes in their menstrual cycle. This can include:
- Timing of Menstruation: ECPs can cause your next period to come earlier or later than expected. In your girlfriend's case, since her last menstrual period was from November 8 to November 15, and she took the emergency contraceptive on November 22, the bleeding she experienced on December 5 could be her regular period, but it may also be influenced by the hormonal changes induced by the ECP.

- Flow and Symptoms: Some women report heavier or lighter bleeding after taking ECPs, as well as increased menstrual cramps or discomfort. This is likely due to the hormonal fluctuations caused by the emergency contraceptive. The discomfort your girlfriend is experiencing could be a result of these hormonal changes, which can lead to more intense menstrual cramps than usual.

2. Is the Bleeding Normal Menstrual Bleeding or Early Pregnancy Bleeding?
Given that your girlfriend had unprotected intercourse followed by the use of an emergency contraceptive, it is essential to differentiate between normal menstrual bleeding and potential implantation bleeding, which can occur in early pregnancy. However, since she took the emergency contraceptive shortly after the unprotected intercourse, the likelihood of pregnancy is significantly reduced.
If the bleeding is consistent with her typical menstrual cycle and is accompanied by the usual symptoms of menstruation (such as cramping), it is likely her period. However, if the bleeding is unusually light or different in character, it may warrant further investigation. If there is any doubt or if she experiences other symptoms such as severe pain, it would be advisable for her to take a pregnancy test and consult a healthcare provider.

3. Can ECPs Cause Increased Discomfort in Future Menstrual Cycles?
Yes, it is possible for ECPs to cause increased discomfort during subsequent menstrual cycles. The hormonal changes induced by ECPs can lead to:
- Increased Cramps: Some women may experience more intense menstrual cramps after taking ECPs. This can be due to the way the hormones in the pill affect the uterine lining and muscle contractions.

- Changes in Flow: ECPs can also alter the flow of menstruation, leading to heavier or lighter periods, which can be accompanied by more discomfort.

Conclusion
In summary, the bleeding your girlfriend experienced after taking the emergency contraceptive is likely her regular menstrual period, though it may be influenced by the hormonal changes from the ECP. Increased menstrual pain can occur as a side effect of taking emergency contraceptives, and it is not uncommon for women to experience more discomfort during their next few menstrual cycles after using these medications. If her symptoms persist or worsen, or if there is any concern about pregnancy, it is advisable for her to consult a healthcare professional for further evaluation and guidance.

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