I've had intercourse for 3 months, taken the I-pill (levonorgestrel) after intercourse, and experienced premenstrual syndrome (PMS) symptoms without menstrual bleeding, with multiple negative pregnancy tests, including human chorionic gonadotropin (HCG) tests, what could be the cause of my amenorrhea?

Amenorrhea After Emergency Contraception with Negative Pregnancy Tests

With multiple negative pregnancy tests (including HCG) taken 2-3 months after intercourse and emergency contraception use, pregnancy is effectively ruled out, and your amenorrhea is most likely caused by hormonal disruption from the levonorgestrel (I-pill). 1

Understanding Emergency Contraception Effects

Levonorgestrel emergency contraception commonly causes menstrual cycle disruptions:

• Emergency contraception works by delaying or stopping ovulation, which directly affects your normal menstrual cycle timing 1
• Changes in menstrual patterns are an expected side effect, including periods that are heavier, lighter, early, or late 1
• If your period is delayed beyond 1 week from expected timing, pregnancy testing is recommended—which you have already completed with negative results 1

Why Your Pregnancy Tests Are Reliable

Your negative pregnancy tests at 2-3 months post-intercourse definitively exclude pregnancy:

• HCG tests become positive 6-12 days after conception, well before your testing timeframe 2
• Multiple negative tests over this extended period provide extremely high certainty that you are not pregnant 2
• The combination of negative urine pregnancy tests (UPT) and HCG tests makes pregnancy virtually impossible 2

Causes of Amenorrhea in Your Situation

The most likely explanation is levonorgestrel-induced cycle disruption:

• Emergency contraception can cause significant menstrual irregularities that may persist for 1-3 cycles 1, 3
• The high-dose progestin in emergency contraception (1.5 mg levonorgestrel) disrupts normal hormonal feedback mechanisms 1
• Unscheduled bleeding or absence of bleeding is common during the first 3-6 months after hormonal contraceptive exposure 4

Additional factors to consider:

• Stress from pregnancy concern itself can delay menstruation through hypothalamic suppression
• If you have been using any ongoing hormonal contraception after the emergency contraception, this compounds cycle disruption 4, 3

What You Should Do Now

Immediate management steps:

• Reassurance is appropriate given multiple negative pregnancy tests at this timeframe 1
• Expect your menstrual cycle to resume within 1-2 additional cycles as hormonal balance restores 3
• No additional pregnancy testing is needed unless you have had unprotected intercourse since your last negative test 1

When to seek medical evaluation:

• If amenorrhea persists beyond 3 months total from emergency contraception use 4
• If you develop severe abdominal pain (to rule out ectopic pregnancy, though extremely unlikely with negative tests) 1
• If you have had any additional unprotected intercourse since your negative tests 1

Consider evaluation for other causes if bleeding does not resume:

• Underlying gynecological conditions such as polycystic ovary syndrome, thyroid disorders, or hyperprolactinemia 4
• Significant weight changes or excessive exercise
• New medications that might affect menstruation 4

Common Pitfalls to Avoid

• Do not assume pregnancy with multiple negative tests at 2-3 months—this timeframe makes pregnancy essentially impossible 2, 1
• Do not repeat emergency contraception unnecessarily, as this will further disrupt your cycle 1
• Avoid excessive pregnancy testing once adequate negative results are obtained, as this increases anxiety without providing additional information 1

Expected Timeline for Recovery

Your menstrual cycle should normalize:

• Most women resume normal menstruation within 1-2 cycles after emergency contraception 3
• Irregular bleeding patterns typically resolve within 3-6 months of hormonal contraceptive exposure 4
• If you desire contraception going forward, consider starting a regular method rather than relying on emergency contraception, which is not intended for routine use 1