Emergency Contraception and Abnormal Bleeding Patterns

Regarding emergency contraceptive pills and menstrual flow?

Hello.
I had sexual intercourse with my girlfriend on January 10th, and the condom slipped off inside her vagina.
I manually removed it and suspected that some semen may have leaked out.
To be safe, I took emergency contraception (Postinor, or Ella).
She started bleeding on January 20th, and she mentioned that the flow was similar to her menstrual period but the color was brighter red.
I have the following questions:
1.
The bleeding lasted until around January 24th.
Does this mean that pregnancy can be ruled out?
2.
After her last period, she took herbal medicine on the 25th and 26th, but she started bleeding again on January 28th, and the color was a darker brown.
As of today, January 31st, she is still bleeding, and she says the amount is similar to her menstrual flow.
Is brown blood normal? Does she need to see a gynecologist?
Thank you for your help.

Mr. Chen, 20~29 year old female. Ask Date: 2016/01/31

Dr. Tian Yiwen reply Obstetrics and Gynecology

The effectiveness of emergency contraception is not 100%.
If there are concerns about pregnancy, a pregnancy test can be purchased and taken 2-3 weeks after sexual intercourse.
Emergency contraception contains high doses of hormones, and some individuals may experience menstrual irregularities after taking it.
If abnormal bleeding persists, it is advisable to consult a gynecologist.
Additionally, it is recommended that individuals who frequently engage in sexual activity consider long-term use of regular contraceptive pills (which provide the best contraceptive effect) combined with the use of condoms by their partner (to prevent sexually transmitted infections), thus protecting both themselves and their partner.
Methods such as tracking the safe period, withdrawal, or relying solely on condoms are not appropriate contraceptive measures.
Frequent use of emergency contraception can lead to menstrual irregularities and should only be used as a last resort.
It is advisable to practice effective preemptive contraception to avoid anxiety after each sexual encounter.

Reply Date: 2016/01/31

More Info

Hello! Thank you for sharing your concerns regarding emergency contraception and abnormal bleeding patterns. It’s important to address these issues with accurate information and reassurance.

First, let’s discuss the situation regarding the use of emergency contraception (EC). You mentioned that you had unprotected intercourse on January 10th, and due to concerns about potential pregnancy, you took an emergency contraceptive pill (ECP) shortly afterward. The ECP works primarily by delaying ovulation, which can prevent fertilization if taken within a specific time frame after unprotected sex.
Regarding the bleeding that started on January 20th, it is not uncommon for women to experience changes in their menstrual cycle after taking ECPs. The bleeding you described, which was similar in volume to a regular menstrual period but with a brighter red color, could be a side effect of the ECP. This bleeding is often referred to as "withdrawal bleeding" and can occur as the body reacts to the hormonal changes induced by the emergency contraceptive.

1. Regarding your first question: If the bleeding started on January 20th and lasted until January 24th, it is likely that this was a withdrawal bleed rather than a regular menstrual period. If this bleeding occurred within a week after taking the ECP, it generally indicates that the contraceptive was effective in preventing ovulation and, consequently, pregnancy. However, it is important to note that while the ECP is effective, it is not 100% guaranteed to prevent pregnancy. If your girlfriend's next period is delayed beyond a week from when it is expected, it would be advisable for her to take a pregnancy test to confirm whether or not she is pregnant.

2. As for your second question: The subsequent bleeding that began on January 28th and was described as dark brown could be due to several factors. Dark brown blood often indicates older blood that has taken longer to exit the body, which can happen during the menstrual cycle. It is not unusual for women to experience variations in bleeding patterns after taking ECPs, including spotting or irregular bleeding.
If the bleeding is persistent, heavy, or accompanied by severe pain, it would be wise for your girlfriend to consult a healthcare provider. A visit to a gynecologist can help rule out any underlying issues, such as hormonal imbalances or other gynecological conditions.
In summary, the bleeding patterns you described are not uncommon after taking emergency contraception. The initial bleeding likely indicates that the ECP worked to prevent pregnancy, while the subsequent dark brown bleeding could be a normal variation or a side effect of the hormonal changes. However, if there are any concerns about the nature of the bleeding or if it continues, seeking medical advice is always a good step to ensure everything is alright.

It's essential to maintain open communication with your girlfriend about these experiences and to support each other through any uncertainties. If you have further questions or concerns, feel free to ask!

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