Timing of Withdrawal Bleeding After Ella (Ulipristal Acetate) 30 mg
Withdrawal bleeding typically occurs within 3 weeks after taking Ella 30 mg, with most women experiencing a delay in their next menstrual period by approximately 2-3 days from the expected date. 1
Expected Timing and Pattern
- The onset of menses is generally delayed by a mean of 2.1 to 2.8 days following ulipristal acetate treatment 2
- Women should expect their next menstrual period to arrive within 3 weeks of taking the medication 1
- The cycle in which ulipristal acetate is used may be shortened, prolonged, or involve unscheduled bleeding 1
Critical Follow-Up Action
If withdrawal bleeding does not occur within 3 weeks of taking Ella, a pregnancy test must be performed to rule out pregnancy 1. This is a crucial safety measure, as the absence of withdrawal bleeding may indicate that emergency contraception failed.
Important Clinical Considerations
Contraceptive Resumption
- Any regular contraceptive method can be started immediately after taking ulipristal acetate 1
- The patient must abstain from sexual intercourse or use barrier contraception for 14 days or until her next menses, whichever comes first 1
- This extended barrier method period (14 days vs. 7 days for levonorgestrel) is necessary due to the antiprogestin properties of ulipristal acetate, which could theoretically decrease the effectiveness of hormonal contraception if started concurrently 1
Common Pitfalls to Avoid
- Do not reassure patients that bleeding will occur at their usual expected time—counsel them specifically about the 2-3 day delay 2
- Do not allow patients to start hormonal contraception without using barrier backup for the full 14-day period 1
- Do not dismiss the absence of withdrawal bleeding at 3 weeks—this mandates pregnancy testing 1