What could cause bleeding and painful urination after ECP?

Question

Hello doctor,

I take Tecfidera 240 milligrams for multiple sclerosis. I took an emergency contraceptive pill 16 days ago after unprotected sexual contact that occurred 14 to 15 days ago.

For the past seven days, I have been experiencing continuous bleeding with occasional red and brown blood, along with foul-smelling, cloudy urine, mild pain after urination, and some itching. I completed a five-day course of UT Cran, and although the symptoms have improved, they have not completely resolved.

Could this be due to the emergency contraceptive pill or a urinary or vaginal infection? Please suggest safe medicines or diagnostic tests considering my use of Tecfidera.

Kindly help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

It is understandable that you are worried about these symptoms, especially considering your medical condition and current medication. The prolonged bleeding you have been experiencing since taking the emergency contraceptive pill is likely related to the contraceptive rather than your Tecfidera (Dimethyl Fumarate).

High doses of hormones in the emergency contraceptive pill can temporarily disturb your menstrual cycle, leading to irregular or prolonged bleeding for several days or even a few weeks.

However, the cloudy urine, bad smell, pain after urination, and itching suggest that you may also have a urinary tract infection or possibly a vaginal infection such as bacterial vaginosis or a yeast infection, especially since the symptoms did not fully resolve after taking UT Cran (cranberry extract 500 milligrams).

It would be best to see a doctor for the following tests:

Urine routine test.
Urine culture.
Vaginal swab, if needed.

These will help confirm the exact cause. The doctor can then prescribe an antibiotic that is safe to use with Tecfidera (Dimethyl Fumarate), such as Nitrofurantoin or Fosfomycin, depending on your test results and kidney function.

In the meantime, I suggest you follow these instructions:

Drink plenty of water.
Avoid holding urine.
Wear loose cotton underwear.
Avoid scented hygiene products.

If the bleeding continues beyond three weeks, becomes heavy, or if you develop fever or pelvic pain, seek medical care promptly. With the correct diagnosis and appropriate treatment, your symptoms should improve soon.

I hope that this answers your query.

Kindly follow up if you have more doubts.

Thank you.