From the Guidelines
The risk of hemorrhage after taking emergency contraception is extremely low and not a recognized risk of properly used emergency contraception. Emergency contraceptive pills like Plan B (levonorgestrel 1.5mg) or ella (ulipristal acetate 30mg) may cause some menstrual changes, including spotting or irregular bleeding, but these side effects are typically mild and temporary 1. Serious bleeding complications that could lead to death are not associated with emergency contraception. After taking emergency contraception, you might experience your next period earlier or later than expected, and it might be heavier or lighter than usual. These changes occur because the hormones in emergency contraception temporarily alter your body's natural hormone levels, affecting the uterine lining.
Key Points to Consider
- If you experience unusually heavy bleeding (soaking through more than one pad or tampon per hour for several consecutive hours), severe abdominal pain, or bleeding that lasts longer than a week after taking emergency contraception, you should seek medical attention 1.
- The copper IUD can be used as emergency contraception within 5 days of unprotected intercourse, and it is a safe and effective method of contraception with typical and perfect use failure rates of less than 1% 1.
- IUDs themselves do not cause tubal infertility in nulliparous women, and studies support a rapid return to fertility after IUD removal 1.
Important Considerations for Healthcare Providers
- Any contraceptive method may be started after completion of emergency contraceptive pills, and the patient should use a barrier method or abstain from intercourse for seven days (14 days after ulipristal use) 1.
- Patients who vomit within three hours after using emergency contraceptive pills should take another dose, at which point an antiemetic may be offered 1.
From the Research
Risk of Hemorrhage after Emergency Contraception
- The risk of hemorrhage after taking emergency contraception (EC) is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies do discuss bleeding patterns after EC use, with one study finding that intermenstrual bleeding occurred in only 5% of women in the first cycle after treatment with a single-dose levonorgestrel ECP regimen 4.
- Another study compared bleeding patterns after use of the levonorgestrel regimen with usual patterns reported by participants and found that the duration of the first menstrual period after treatment increased significantly with cycle week of treatment 4.
- A study also found 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, but noted that concordance was lower for the first period following use of the regimen 6.
- There is no mention of hemorrhage as a specific risk or side effect of EC in the provided studies, suggesting that it may not be a common or significant concern 2, 3, 5.