I have not got withdrawal bleeding after 10 days of taking Unwanted 72. Why?

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You have rightly taken the emergency contraceptive pill within 72 hours of unprotected intercourse. The success rate of ECP is 99 % and ideally,the withdrawal bleed should start in the next 4 to 7 days, but if it has not yet, then you can opt for a serum beta hCG test after eight days post last intercourse to rule out pregnancy, if any, due to possible emergency contraceptive pill failure. If the hCG levels are less than 3 mIU/mL then you are pregnancy safe else you are pregnant. If the test is negative then you can safely wait for the menses to return for at least two weeks and then, can get an ultrasound pelvis done to check for endometrial thickness and post that if the endometrial thickness is more than 9 mm then you can opt for a withdrawal bleed with Progesterone.

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The ultrasound shows an endometrial thickness of 8 mm and the uterus is empty without any sign of any pregnancy (attachment removed to protect patient identity). Moreover, the ovaries show multiple small subcenterimetric peripherally arranged follicles which have not ruptured as yet, indicating that you are still in your proliferative phase as on date. So, it indicates that you had sex during your safe period or in the early part of your menstrual cycle when estrogen levels were rising and hence high dose Progesterone pill like Unwanted 72 did not really cause an increase in progesterone level and then a withdrawal bleed in next 4 to 7 days.

Having said that, as there was no ovulation during this cycle as yet, so there was no chance of pregnancy. Eight days back, at the time of sex. You are pregnancy safe. Now, even if the withdrawal bleed does not occur as scheduled, it is fine. you can naturally wait for your menses to arrive. However, to be doubly sure, a serum beta hCG test would conclusively rule out pregnancy if the hCG levels as on date would be less than 3 mIU/mL. So you may opt to get it done as well, it is a simple blood test. If I may ask when was your last menstrual period, the date?

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Okay, that does not help much as you are a known case of PCOD, so going by the present USG report, pregnancy is unlikely. However, beta hCG levels shall be conclusive. Let us wait for them. In the meantime, do not get tensed, just relax.

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The hCG levels are well below 3 mIU/mL in the report (attachment removed to protect patient identity) and it confirms that you are not pregnant for sure and conclusively. You can opt for Deviry 10 mg twice a day for five days. Hence, to initiate your menses safely now. Also, please practice barrier contraception each time during sex in future as regular intake of emergency contraceptive pill is not healthy and also please seek treatment for PCOD. Else, irregularity of menses shall keep you confused more often. Take care.

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If your cycles have been irregular and PCOD features are not evident on ultrasound then you shall need to get a hormonal profile done to rule out hypothyroidism, hyperprolactinemia and other hormones like FSH , LH, AMH , serum testosterone, HEAS, 17 OHP as well to analyse your ovarian reserve and any hormonal deficiency which can contribute towards oligomenorrhoea.