Pregnancy Tests and Irregular Periods After Birth Control

Questions about pregnancy testing and stopping birth control pills?

Hello Dr.
Chang: My girlfriend started using oral contraceptives over two years ago and did not stop until about six months ago.
However, her menstrual cycle has been very irregular since then, with periods arriving nearly two months late.
Now, her cycles are spaced about 40 to 50 days apart, and this pattern has persisted for three cycles.
The first two cycles had lighter bleeding than usual, but the third cycle had a significantly heavier flow.
I would like to know if this is normal.

Additionally, during the past six months, we have consistently used condoms during sexual intercourse.
However, her most recent period has not yet arrived (it has not been more than 50 days since the last one).
Our last sexual encounter was about 10 days ago (or possibly 13 to 14 days ago), but three days ago, she started to notice a small amount of brown discharge that resembles spotting.

Yesterday, out of concern, I purchased two different brands of pregnancy tests.
The first one (made in the USA - QuickVue) showed one dark line and one very faint line, which was visible to the naked eye.
My girlfriend mentioned that she might have accidentally splashed urine onto the test window; could this affect the result? The second test (from Unified Pharmaceuticals) was taken around 11 PM and only showed one dark line, with no indication appearing on the other side even after a long wait.

Could you please explain what this situation might indicate and if there are any specific conditions that could lead to these test results? Thank you.

Mr. Chen, 20~29 year old female. Ask Date: 2012/08/23

Dr. Zhang Yongxuan reply Obstetrics and Gynecology

It is abnormal, but let's observe for now.
As long as the amount is not enough to cause dizziness or anemia, it should gradually return to normal after a few menstrual cycles.
If it does not normalize, you may consider using oral contraceptives to regulate your menstrual cycle, which would likely be a fixed-dose combination.
One of its mechanisms is to suppress ovulation, particularly by inhibiting the mid-cycle surge of gonadotropins.
When taking contraceptives, this suppression does not occur, which subsequently affects other hormones, such as progesterone and GnRH from the hypothalamus, ultimately leading to irregular shedding (or bleeding) of the endometrium.
Please retest, as errors in the pregnancy testing procedure or using an expired pregnancy test kit (quality issues) can also lead to such results.

Reply Date: 2012/08/23

More Info

Understanding pregnancy tests and the effects of birth control on menstrual cycles can be quite complex, especially after discontinuing hormonal contraceptives. In your case, it seems that your girlfriend has experienced significant changes in her menstrual cycle after stopping the birth control pills, which is not uncommon.
When a woman stops taking hormonal contraceptives, it can take some time for her body to readjust and for her natural menstrual cycle to return to its previous rhythm. This adjustment period can vary widely among individuals. Some women may experience irregular periods, delayed menstruation, or changes in flow for several months after discontinuation. In your girlfriend's case, having menstrual cycles that are spaced 40 to 50 days apart, along with variations in flow, can be a normal response to the cessation of hormonal birth control.
Regarding the recent changes in her menstrual cycle, the presence of brown discharge can often indicate old blood, which may occur at the beginning or end of a menstrual period. However, if this brown discharge is accompanied by a missed period, it could also be an early sign of pregnancy.
You mentioned that you have been using condoms consistently during sexual intercourse, which is a reliable method of contraception when used correctly. However, no contraceptive method is 100% effective, and there is always a small chance of pregnancy with any sexual activity.
As for the pregnancy tests, the results can be influenced by several factors. The first test you conducted showed one dark line and one faint line, which suggests a possible positive result, but the faintness of the second line could indicate that the level of hCG (human chorionic gonadotropin) in her urine is low. This can happen if the test is taken too early after conception. The second test showing only one line indicates a negative result, which could be due to testing at a time when hCG levels were not high enough to detect pregnancy.

It's important to note that if urine is splashed onto the test window, it can potentially affect the results, especially if it interferes with the test's ability to read the control line properly. Therefore, it is advisable to follow the instructions carefully when conducting a pregnancy test.

Given the irregularities in her menstrual cycle and the mixed results from the pregnancy tests, I recommend waiting a few days and then taking another pregnancy test, preferably with the first morning urine, which is typically more concentrated and may provide a clearer result. If the tests continue to show mixed results or if her period does not arrive, it would be wise for her to consult a healthcare provider for further evaluation. They may recommend a blood test to measure hCG levels, which can provide a more definitive answer regarding pregnancy.

In summary, while irregular periods after stopping birth control can be normal, the presence of brown discharge and missed periods warrants further investigation. Consistent use of condoms reduces the likelihood of pregnancy, but if there are concerns, a follow-up with a healthcare professional is the best course of action.

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