Severe Abdominal Pain After Emergency Contraceptive: What to Know

Severe abdominal pain

In mid-November, I had unprotected intercourse without ejaculation, and four days later, I took the emergency contraceptive pill (Ella).
Since this past Monday, I have been experiencing mild discomfort and bleeding, and starting Tuesday, the discomfort has worsened significantly, with extreme abdominal pain.
I have taken pain relief medication for menstrual cramps, but it has not alleviated the pain.
In the past, I have not experienced such severe pain, and the pain relief medication usually helps.
This time, the bleeding is darker in color (brownish) and lighter in volume than usual, accompanied by a sensation of something being stuck.
What could be the problem? I am also concerned about the possibility of pregnancy-related bleeding.

Qian, 10~19 year old female. Ask Date: 2023/12/07

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, emergency contraceptive pills are generally more effective when taken within 48 hours.
If you still experience discomfort, it is advisable to consult a gynecologist.
Wishing you good health.

Reply Date: 2023/12/07

More Info

Severe abdominal pain after taking emergency contraception, such as Ella, can be concerning and may arise from several factors. It's essential to understand the potential causes and what steps to take next.

Firstly, emergency contraceptive pills (ECPs) like Ella contain ulipristal acetate, which works primarily by delaying ovulation. While generally safe, they can cause side effects, including abdominal pain, nausea, fatigue, and changes in menstrual bleeding patterns. The abdominal pain you are experiencing could be a result of the hormonal changes induced by the medication.
The bleeding you mentioned, especially if it is darker in color and less than usual, could indicate a few possibilities. It might be a side effect of the emergency contraceptive, as hormonal fluctuations can lead to lighter or irregular menstrual bleeding. However, if the pain is severe and persistent, it could also suggest other underlying issues that need to be ruled out.

One potential concern is the risk of an ectopic pregnancy, especially if you had unprotected intercourse. Although the likelihood of pregnancy is reduced after taking emergency contraception, it is not 100% effective. An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in a fallopian tube, and can lead to severe abdominal pain and bleeding. Symptoms of an ectopic pregnancy may include sharp or stabbing pain in the abdomen or pelvis, shoulder pain, and dizziness or fainting due to internal bleeding.

Another possibility is that the abdominal pain could be related to other gynecological issues, such as ovarian cysts, pelvic inflammatory disease (PID), or endometriosis. These conditions can also cause significant discomfort and may require medical evaluation.

Given the severity of your symptoms and the ineffectiveness of over-the-counter pain relief, it is crucial to seek medical attention promptly. A healthcare provider can perform a physical examination, possibly including a pelvic exam, and may recommend imaging studies such as an ultrasound to assess for any complications, including an ectopic pregnancy or other abnormalities.

In summary, while some abdominal discomfort can be a normal side effect of taking emergency contraception, severe and persistent pain warrants further investigation. It is essential to consult with a healthcare professional to ensure that any serious conditions are ruled out and to receive appropriate care. If you experience symptoms such as heavy bleeding, fainting, or severe dizziness, seek emergency medical attention immediately. Your health and safety are paramount, and timely intervention can prevent potential complications.

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Hello, it seems that the contraception was successful. If you still experience discomfort, it is advisable to see a doctor. Wishing you good health.