From the Guidelines
Bleeding after emergency contraceptive pill use is a common side effect and can be considered normal in most cases. According to the most recent guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1, bleeding irregularities, including spotting or light bleeding, can occur after taking emergency contraception. The guidelines suggest that if the patient wants to continue use, they should be reassured and advised that they may contact their provider at any time to discuss bleeding irregularities or other side effects.
Management of Bleeding Irregularities
The guidelines provide the following management options for bleeding irregularities:
- For patients experiencing spotting or light bleeding, no interventions may be necessary, but nonsteroidal anti-inflammatory drugs (NSAIDs) can be considered for 5-7 days if needed.
- For heavy or prolonged bleeding, treatment options may include NSAIDs, hormonal treatment, or antifibrinolytic agents, depending on the patient's preferences, treatment goals, and medical history.
Key Considerations
It is essential to note that if an underlying health condition is suspected, such as interactions with other medications, sexually transmitted infections, pregnancy, thyroid disorders, or new pathologic uterine conditions, the patient should be evaluated and treated accordingly 1. Additionally, if the patient experiences very heavy bleeding, severe abdominal pain, or if bleeding continues for more than a week, they should contact a healthcare provider to rule out any complications.
Patient Counseling
Patients should be counseled on what to expect after taking emergency contraception and advised to contact their provider if they experience any unusual or concerning symptoms. The guidelines emphasize the importance of exploring patient goals, including continued method use or method discontinuation, and providing reassurance and support as needed 1.
From the FDA Drug Label
some women may have changes in their period, such as a period that is heavier or lighter or a period that is early or late.
Bleeding changes, including heavier or lighter periods, are possible after taking the emergency contraceptive (EC) pill, levonorgestrel. However, the label does not explicitly state that bleeding is a normal side effect after EC pill use. It only mentions changes in periods, which may include heavier or lighter bleeding. Therefore, while bleeding changes are possible, it is not explicitly stated as a normal side effect. 2
From the Research
Bleeding Patterns After Emergency Contraceptive Pill Use
- Bleeding after use of the levonorgestrel emergency contraceptive pill (ECP) regimen can vary depending on when during the cycle the pills are taken 3.
- The duration of the first menstrual period after treatment can increase significantly with cycle week of treatment and may be longer in women who use the treatment than in those who do not 3.
- Intermenstrual bleeding following treatment is uncommon, occurring in only 5% of women in the first cycle after treatment 3.
Menstrual Side Effects
- A single dose of 1.5mg levonorgestrel for emergency contraception can be associated with menstrual disturbances, including early or timely return of menses, late menses, intermenstrual bleeding, spotting, premenstrual bleeding, and menorrhagia 4.
- Non-menstrual side effects can include nausea, vomiting, dizziness, headache, breast tenderness, and low abdominal pain 4.
Comparison of Bleeding Patterns
- There is generally good concordance between the starts of menstrual periods as determined by an algorithm and the date of the start of a period as reported by participants on diary cards 5.
- However, concordance may be lower for the first period following use of the ECP regimen, with 81% of women recording a start date that was the same as or only 1 day later than the algorithm-determined start date 5.
Management of Bleeding
- Tranexamic acid and mefenamic acid may not be effective in alleviating "nuisance" bleeding or spotting after levonorgestrel-releasing intrauterine system placement 6.
- The solution to managing bleeding problems may need to be found empirically for each woman, as there is no one-size-fits-all answer 7.