Why are the side effects of I-pill different for me and my friend?
Patient's Query
Hi doctor,
I am a 24-year-old female. I had my last period a month ago. It lasted for four days. On the fourth day, my fiancé rubbed his genitals against mine. He did not ejaculate, but still, just to be sure, I took an I-pill within 12 hours.
After a week, I noticed a brown discharge. The next day, there was very little bleeding with clots; now it is the third day, and the spotting continues. Usually, my period flow is normal, but this time it is much less.
Should I consider this my period or withdrawal bleeding?
When can I expect my next period?
Also, my friend has taken an I-pill. She experienced heavy bleeding after a week of taking it, and her next period got normalized exactly a month after she had her withdrawal bleed.
Why is it not the case with me?
Kindly help.
Hello,
Welcome to icliniq.com.
As you were in the early proliferative phase of your cycle, the withdrawal bleeding following the I-pill (Levonorgestrel) is scanty, but it ensures that you are not pregnant. The bleeding may last for three to five days, and the next menses shall be only after a month from the start of this withdrawal bleed.
I hope I have answered your query.
Take care.
Regards.
Patient's Query
Hello doctor,
Thank you for your response.
My big concern is that my friend and I had taken the I-pill on the seventh day of our cycles, yet her bleeding was just like her usual periods, while I had only spotting. Is there a chance this could be implantation bleeding? If not, then should I consider this spotting as my period or a withdrawal bleed?
Please advise, as I am stuck with these thoughts in my head, with exams around the corner.
Hello,
Welcome back to icliniq.com.
The bleeding pattern varies from one patient to another. It cannot be generalized. It is not an implantation bleed because you were in your safe period when you had sex and took the pill. This is a typical withdrawal bleed after seven to ten days of Levonorgestrel intake. Implant bleeding is often in the form of spotting and not flow and is usually seen within three to four days of intercourse.
It is more apt to call the present bleed a withdrawal bleed, but at the same time, it marks the start of your fresh menstrual cycle. The next menses would be only after a month hence. Also, to conclusively rule out pregnancy, you may opt for a serum beta hCG (human chorionic gonadotropin) test. If the levels are less than 5 mIU/ml, then you are not pregnant.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply.
I have one last question for you. The day before yesterday, I had only a brownish discharge; yesterday, it was red spotting, and today it looks like it is about to stop. Should I still consider this as withdrawal bleeding?
Please help.
Hello,
Welcome back to icliniq.com.
For all practical purposes, this bleeding, even though scanty, should be considered as a withdrawal bleed. There is a possibility that the bleeding may stop and then restart again in a day or two.
It would be advisable to get a pelvic ultrasound, especially a transvaginal ultrasound, to check for endometrial thickness, which, if less than 6 mm, would not only rule out any pregnancy but also warrant this as a confirmed withdrawal bleed. The next menses should be only after a month, or it may be delayed by a week or 10 days, as presumed to be the most common side effect of Levonorgestrel.
I hope this has helped you out.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply.
So does it mean I have to wait until the middle of next month to get my period?
Hello,
Welcome back to icliniq.com.
Yes, I feel that would do for now. Anyhow, the chances of pregnancy are minimal. Take care.
I hope this helps.
Take care.
Patient's Query
Hi doctor,
Thanks for replying.
Today I went for the serum beta hCG blood tests as recommended by you. Please advise, as I have not gotten my period yet.
Hi,
Welcome back to icliniq.com.
Kindly attach your reports or type them with the units for my perusal.
I hope this has helped you.
Take care.
Patient's Query
Hi doctor,
Thanks for the reply.
My serum beta hCG report reads 0.100 mIU/mL.
-
Is there any chance of an ectopic pregnancy?
-
If the report is negative, then when can I expect my next period?
Please help.
Hi,
Welcome back to icliniq.com.
The report (attachment removed to protect the patient’s identity) is absolutely negative for any kind of pregnancy, be it intrauterine or an ectopic pregnancy. You are definitely not pregnant. You should expect your menses by the middle of next month, as discussed earlier. Please be patient until then.
Revert in case of queries.
Thank you.
Patient's Query
Hi doctor,
Thanks for your assurance.
The day before yesterday, I had a brown discharge for the whole day. Yesterday, I used up only one tampon and passed blood clots while urinating. Today I noticed blood on the tissue when I wiped. There was no other spotting or bleeding the whole day. This is my second period after the pill, and still, it has not normalized. I am worried. Please explain what is going wrong with my periods, and is there still a chance of pregnancy?
Hello,
Welcome back to icliniq.com.
I understand your concern here, but you have to understand that as a side effect of an emergency contraceptive intake, the next one or two cycles tend to get affected in terms of flow, regularity, or delay in arrival. It varies from one woman to another. Often dysmenorrhea persists, as in your case, for the next two cycles.
These are the most commonly known side effects of emergency contraceptive pills like I-pill and Unwanted 72, and happen in almost 85 to 90 % of the cases, especially for first-time users.
Regarding pregnancy, you need not fear the possibility, because your serum beta hCG levels were way too low, thus ruling out pregnancy completely, unless you have been sexually active during this cycle. If not, then just do not worry about pregnancy; these are your menses and not a threatened miscarriage.
There is a possibility that your next cycle, too, may follow a similar pattern, but it will naturally get corrected after two cycles unless the pill is repeated. I suggest not using emergency contraceptive pills again and to use barrier contraception instead.
Revert in case of queries.
I hope this helps you.
Thank you.
Patient's Query
Hi doctor,
Thank you for your guidance.
My period flow over the last three months has been scant, and it remains similar this month as well. I have neither been sexually active nor taken an emergency contraceptive pill after the earlier discussed episode.
Can you please suggest a medicine that can trigger my regular periods back?
I also visited a gynecologist and told her about the I-pill intake, but she said it does not cause scanty periods and suggested I take iron tablets instead.
Please help.
Hi,
Welcome back to icliniq.com.
I understand your concern.
If the menses are still scanty, then you need to get evaluated for hypothyroidism and hyperprolactinemia, which can cause hypomenorrhea. Once these two causes are ruled out, you can be safely placed on cyclical progesterone for three months to expect a normal flow during menses.
I hope this helps.
Thank you.
Patient's Query
Hello doctor,
Thanks for replying.
I want to bring to your attention that I underwent some tests as recommended by my gynecologist last month. I am attaching the reports for your consideration. My specialist told me that all the values are normal, except for my hemoglobin level, and I was prescribed Dexorange syrup for this. As I have already undergone the above tests and all the reports have come back normal, do you think I can safely be placed on cyclical Progesterone therapy without further investigation?
Please help.
Hi,
Welcome back to icliniq.com.
I understand your concern.
I have seen your reports (attachment removed to protect patient identity). I see that thyroid function tests have been done, but serum prolactin levels have not been measured.
Do you have any discharge from your nipples on squeezing them?
If yes, then serum prolactin level is mandatory for ruling out hyperprolactinemia. If no discharge is seen, then you can be started on cyclical progesterones from day 15 to 25 of your next cycle for three months.
Revert in case of queries.
Regards.
Patient's Query
Hi doctor,
Thank you for your prompt reply.
There is no fluid discharge from my nipples when I squeeze them.
-
May I know why you asked about this fluid discharge?
-
Do you suspect an undetected pregnancy?
My period started five days ago. So, when can I take this medicine?
Hi,
Welcome back to icliniq.com.
I understand your concern.
Discharge from nipples is seen not only in pregnancy, but also when they are excessively massaged or manipulated over a long period of time, resulting in an increased prolactin level, which causes scanty menses. It is good that there is no discharge.
Also, I suggest you start tablet Meprate (medroxyprogesterone acetate) 10 mg, twice a day from day 15 to day 25 of this very cycle, and the menses can be expected four to five days after the last pill intake. This protocol is to be continued for three months.
Take care.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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