Bleeding After the Morning After Pill: Is It Normal?

If you have taken an emergency contraceptive pill (after-pill), you might be feeling anxious about experiencing unexpected bleeding afterwards, commonly referred to as “irregular bleeding.”
This unanticipated bleeding can be worrying, leaving you unsure whether it’s a sign that the contraception worked or if something else is happening.
Bleeding after taking an after-pill is often a result of the medication’s effects, but there are also situations that require attention.
This article provides a detailed explanation of the causes and timing of irregular bleeding after taking an after-pill, how it differs from other types of bleeding, and when you should seek medical attention.
By gaining the correct knowledge, you can alleviate some of your anxiety and approach the situation with more composure.

Reasons for Irregular Bleeding After Taking an After-Pill

Taking an after-pill causes a significant shift in your body’s hormone balance.
This abrupt hormonal fluctuation is the primary cause of irregular bleeding.

Hormonal Changes Caused by After-Pills

After-pills primarily contain progestin, a synthetic form of the hormone progesterone, or a similar compound.
Let’s explain using levonorgestrel, which is commonly prescribed in Japan.
Levonorgestrel works by delivering a high dose of a hormone that is normally secreted after ovulation.
This high dose aims to suppress ovulation, impede the fertilization process, or prevent the implantation of a fertilized egg in the uterine lining.

When this high dose of progestin (or similar compound) enters the body, the uterine lining temporarily thickens or tries to maintain its state.
However, as the drug’s components are metabolized and eliminated over time, hormone levels in the body drop sharply.
This rapid decrease in hormone levels causes the uterine lining to shed, similar to what happens during a regular menstrual period, leading to bleeding.
A menstrual period typically occurs when the secretion of hormones (estrogen and progesterone) from the corpus luteum, formed after ovulation, ceases, causing the uterine lining to shed.
Irregular bleeding after taking an after-pill is thought to occur by artificially inducing this menstrual mechanism or by destabilizing the state of the uterine lining.

The mechanism of action can slightly differ depending on the type of after-pill (for example, ulipristal acetate, which is used in some countries), but all types can potentially cause bleeding by affecting hormone receptors and influencing the uterine lining.

Typical Period for Irregular Bleeding

The timing of irregular bleeding after taking an after-pill varies from person to person, but it commonly occurs within 2 to 3 days to about a week after taking the pill.
This bleeding can range from heavy bleeding similar to a period to light spotting, which may be brown or mixed with discharge.
The duration also varies, lasting from a few days for some people up to about a week for others.

However, it’s important to note that not everyone will experience irregular bleeding.
It is also not uncommon to have no bleeding at all, and the presence or absence of bleeding alone cannot determine whether the contraception was successful.
Furthermore, bleeding may sometimes start later than the typical timeframe.

Differences Between Bleeding After After-Pill and Other Bleeding

Experiencing bleeding after taking an after-pill can be confusing, leading you to wonder if it’s your period or implantation bleeding, a sign of pregnancy.
Each type of bleeding has distinct characteristics.

Distinguishing Irregular Bleeding from a Menstrual Period

You can generally distinguish irregular bleeding after an after-pill from your regular period based on appearance and timing.

Item	Irregular Bleeding After After-Pill (Withdrawal Bleeding)	Regular Menstrual Period
Timing	Often occurs within a few days to about a week after taking the pill.	Occurs regularly according to your cycle (potentially 3+ weeks after after-pill).
Duration	Often short (a few days to about a week). Tends to be shorter than a period.	Varies individually, but typically lasts 3 to 7 days.
Amount	Often light (spotting to moderate). Tends to be less than a period.	Varies individually, but typically a significant amount of blood requiring frequent pad changes.
Color	Can vary (brownish, pink, bright red, etc.).	Usually red to dark red. May have a distinct menstrual odor.
Associated Symptoms	May be accompanied by after-pill side effects like lower abdominal pain, nausea, headache.	May be accompanied by menstrual cramps (lower back/abdominal pain) or PMS symptoms.
Mechanism	Shedding of uterine lining due to sudden hormonal changes caused by the after-pill.	Cyclical shedding of uterine lining due to cessation of corpus luteum function after ovulation.

Bleeding that occurs after taking an after-pill is sometimes called “withdrawal bleeding.”
This bleeding is similar to the menstrual mechanism but is characterized by irregular timing and amount, occurring due to the drop in hormone levels that were temporarily raised by the medication.
This withdrawal bleeding should not be taken as confirmation that the contraception was successful.
To confirm whether the contraception was truly successful, you need to check if your next period arrives as expected or take a pregnancy test at least three weeks after the sexual encounter.

Distinguishing Irregular Bleeding from Implantation Bleeding

Another type of bleeding that can occur after sexual activity is “implantation bleeding.”
This is light spotting that may happen when a fertilized egg implants in the uterine lining and is considered an early sign of pregnancy.

Item	Irregular Bleeding After After-Pill (Withdrawal Bleeding)	Implantation Bleeding
Timing	Often occurs within a few days to about a week after taking the pill (a few days after sexual activity).	Often occurs about 1-2 weeks after sexual activity (about 10 days after ovulation).
Duration	Often short (a few days to about a week).	Usually lasts for a short period of 1 to 3 days.
Amount	Often light, but can be closer to a period amount in some cases.	Usually very light (spotting, much less than a period).
Color	Can vary (brownish, pink, bright red, etc.).	Often brownish, pink, or light red (not bright red).
Associated Symptoms	May be accompanied by after-pill side effects.	May be accompanied by mild abdominal cramps, breast tenderness, similar to PMS or early pregnancy symptoms.
Mechanism	Shedding of uterine lining due to sudden hormonal changes caused by the after-pill.	Physical bleeding that occurs as a fertilized egg burrows into the uterine lining.

Implantation bleeding is typically very light and short-lived and does not occur in everyone.
Irregular bleeding after an after-pill tends to be heavier and last longer than implantation bleeding, but due to significant individual variation, it can be difficult to make a definitive distinction based solely on the amount, color, or duration of bleeding.

About Bleeding After Plan B

Plan B One-Step, widely known as an emergency contraceptive pill overseas, contains levonorgestrel as its main ingredient.
Its basic mechanism of action and side effects are similar to levonorgestrel preparations prescribed in Japan.
Irregular bleeding (withdrawal bleeding) is also reported to occur after taking Plan B through a similar mechanism.
This bleeding is also caused by the shedding of the uterine lining due to hormonal fluctuations and is not a direct sign of contraceptive success.
While information regarding Plan B can be helpful in understanding bleeding after taking an after-pill, it is crucial to confirm the type of medication you took and follow the instructions of a doctor if you received a prescription from a medical institution in Japan.

Is Irregular Bleeding After an After-Pill a Sign That It Worked?

If you experience bleeding after taking an after-pill, you might feel relieved and think, “Now I know I’m not pregnant!”
However, having irregular bleeding does not necessarily mean that the contraception was successful.

As mentioned earlier, irregular bleeding after taking an after-pill is caused by the drastic hormonal changes brought about by the drug’s components.
This bleeding results from the temporary shedding of the uterine lining and is not directly related to whether the contraception was successful.
While it’s true that bleeding might occur as an effect when contraception is successful, the presence or absence of bleeding itself is not definitive proof of contraceptive success.

The most reliable way to determine if the contraception was successful is to see if your next period arrives as scheduled or to use a pregnancy test at least three weeks after the sexual encounter.
After taking an after-pill, your next period is typically expected to arrive within about a week of your scheduled date or on time.
If your period is more than a week late after the scheduled date, you should consider the possibility of pregnancy and confirm with a pregnancy test or consult a medical institution.

It is important to note that even if you experience irregular bleeding, there is still a chance of pregnancy if the after-pill was not fully effective.
This can happen because the after-pill’s success rate is not 100%, or if it was taken too late, or if there were factors that reduced its effectiveness (such as interaction with other medications or vomiting).

Therefore, instead of worrying about irregular bleeding, the final confirmation of contraceptive success should be done by the arrival of your period or by using a pregnancy test.

Is Pregnancy Possible Even If There Was Bleeding After Taking an After-Pill?

Cases where someone thought they were okay because of bleeding but later found out they were pregnant can occur.
As mentioned earlier, even if you experience bleeding after taking an after-pill, the possibility of pregnancy cannot be completely ruled out.

Situations where pregnancy is possible despite bleeding include the following:

1. The bleeding was “irregular bleeding” and not a menstrual period: This is a case where the uterine lining shed due to hormonal fluctuations caused by the after-pill, resulting in bleeding, but pregnancy had already been established.
   In this scenario, pregnancy continues despite the bleeding.
   If the bleeding is light irregular spotting or differs from your usual period, you should suspect the possibility of pregnancy.
2. The bleeding was “implantation bleeding”: This is a case where implantation bleeding, which can occur about 1 to 2 weeks after sexual activity, is mistaken for irregular bleeding caused by the after-pill.
   Implantation bleeding is an early sign of pregnancy, and its occurrence means that pregnancy is likely already established.
3. The after-pill was not fully effective: This is a case where pregnancy occurred because the medication did not provide sufficient effect despite taking the after-pill.
   This can happen if the pill was taken too late or if you vomited after taking it and the ingredients were not sufficiently absorbed.
   In this case, any bleeding after taking the pill is simply due to hormonal fluctuations and is not directly related to whether or not you are pregnant.
4. Bleeding due to other causes: There is also a non-zero possibility that the bleeding is from the uterus or vagina and is completely unrelated to the effects of the after-pill or pregnancy.

Thus, even if there is bleeding, the possibility of pregnancy varies depending on what the bleeding is and whether the after-pill functioned correctly.
Do not assume you are safe just because there was bleeding.
It is crucial to use a pregnancy test about three weeks after taking the after-pill or consult a medical institution early if you are concerned.
This is especially important if the bleeding amount is very small, the color or condition is different from usual, or if you experience other early pregnancy symptoms (like nausea or breast tenderness) in addition to the bleeding.

When Irregular Bleeding After After-Pill Persists

In most cases, irregular bleeding after taking an after-pill subsides within a few days, but for some people, it may last longer.
When the bleeding continues, anxiety can increase.

How Long Should Bleeding Last Before Worrying?

Irregular bleeding after taking an after-pill typically ends within a few days to about a week.
If the bleeding is within this timeframe, it is likely due to the effects of the after-pill, and in most cases, there is no need to worry excessively.
The amount of bleeding is also usually light, similar to the beginning or end of a period.

However, if the bleeding continues for more than a week, or if the amount is heavy, there are large clots, or other unusual signs, you might need to pay closer attention.

If Bleeding Continues for More Than Two Weeks

If irregular bleeding continues for more than two weeks after taking an after-pill, it’s possible that the hormonal imbalance is more pronounced, or that the bleeding is caused by something else entirely.

Possible causes include:

• Lingering effects of the after-pill: Due to individual differences, it may take longer for hormone levels to normalize, causing irregular bleeding to persist.
• Possibility of pregnancy: As mentioned earlier, there is a possibility of bleeding occurring if you are pregnant, either due to implantation bleeding or other causes.
• Uterine or ovarian conditions: Irregular bleeding can also be caused by conditions unrelated to the after-pill, such as uterine fibroids, endometrial polyps, cervicitis, or cervical cancer.
• Experience with hormonal contraceptives (like low-dose pills): If you regularly use hormonal birth control, taking an after-pill might further complicate hormonal balance.
• Stress or poor health: Psychological stress and physical illness can also affect hormone levels and menstrual cycles.

If bleeding continues for more than two weeks, it is recommended to consult a doctor at a medical institution without self-diagnosing.

Signs of Severe or Abnormal Irregular Bleeding

You should also be concerned if the amount or condition of irregular bleeding is clearly different from what is considered typical.
If you notice any of the following signs, seek medical attention promptly:

• Very heavy bleeding: If you experience heavy bleeding similar to the second day of your period, or frequently pass large blood clots.
  This can potentially lead to anemia.
• Very long bleeding duration: If bleeding continues for three weeks, a month, or longer.
• Accompanied by severe pain: If you experience intense lower abdominal pain or pain unlike anything you’ve felt before.
• Fever: If you have a fever in addition to bleeding, it could indicate an infection or other condition.
• Foul odor: If the bleeding has an unusual strong odor.
• Dizziness or lightheadedness: This may indicate anemia due to heavy bleeding.
• Other symptoms suggestive of pregnancy: If you continue to experience nausea, breast tenderness, fatigue, etc.

These signs may indicate a cause other than the simple effects of the after-pill (e.g., miscarriage, ectopic pregnancy, gynecological conditions).

Cases When You Should Consult a Medical Institution

For irregular bleeding after taking an after-pill, it is strongly recommended to consult a medical institution (such as an obstetrician-gynecologist) in the following cases:

• If irregular bleeding continues for more than two weeks.
• If the amount of bleeding is significantly heavier than your usual period, or if large clots are frequently passed.
• If the bleeding is accompanied by severe lower abdominal pain or other physical ailments (fever, dizziness, etc.).
• If your period does not arrive three weeks after the sexual encounter, regardless of whether there was bleeding.
• If you are concerned about the possibility of pregnancy, including mistaking implantation bleeding for irregular bleeding.
• If you are experiencing severe side effects from the after-pill (like severe nausea) in addition to or instead of bleeding.
• If you are simply very anxious and want to consult a doctor for reassurance.

Consulting an online clinic or using a phone consultation service may also be a good first step.
Getting an accurate diagnosis and advice is crucial for alleviating unnecessary anxiety and, if necessary, receiving appropriate treatment early.
When you visit a medical institution, it’s helpful to be prepared to provide information about when you took the after-pill, the date of your last menstrual period, the date of the sexual encounter, and the specific details of the bleeding (when it started, amount, color, duration, associated symptoms).

Other Side Effects and Precautions Regarding After-Pills

Besides irregular bleeding, after-pills can cause various other side effects.
There are also several points to keep in mind when taking them.

Common Side Effects Like Nausea and Headache

The high dose of hormonal components in after-pills is at a level not typically experienced by the body.
Therefore, various side effects can occur.
Common side effects that are relatively frequent include:

• Nausea, Vomiting: This is one of the typical side effects of after-pills.
  It can occur within a few hours after taking the pill.
  If you vomit within 2 hours of taking the pill, the active ingredients may not have been fully absorbed, so you should consult a doctor to see if a repeat dose is necessary.
  If nausea is severe, you can ask your doctor to prescribe an anti-nausea medication beforehand.
• Headache: This can be caused by hormonal changes.
• Fatigue, Tiredness: You may feel a general sense of being unwell or tired.
• Breast Tenderness, Pain: This can occur due to hormonal stimulation of the mammary glands.
• Lower Abdominal Pain: Contractions of the uterus or other factors can cause pain similar to menstrual cramps.
  If accompanied by irregular bleeding, it could be related to the bleeding itself.
• Drowsiness, Dizziness: These can manifest as changes in your physical condition.
• Emotional Instability: Hormonal changes can affect mood, leading to irritability or feeling down.

These side effects are usually temporary and subside within a few hours to a few days.
If the symptoms are severe and interfere with your daily life, do not hesitate to consult a doctor.

Serious Side Effects and Risks

Serious side effects from taking after-pills are very rare, but they are not non-existent.
One point that requires particular attention is a slightly increased risk of blood clots (thrombosis).

Thrombosis is a condition where a blood clot forms inside a blood vessel, causing a blockage.
Especially if you have a history of blood clots or are at high risk for thrombosis (e.g., obesity, smoking, high blood pressure, diabetes, certain genetic conditions), you must consult a doctor before taking an after-pill to determine if it is safe for you.
Symptoms of thrombosis include sudden chest pain, shortness of breath, pain or swelling in the calf, numbness or paralysis in limbs, severe headache, or visual disturbances.
If you experience any of these symptoms, seek immediate medical attention.

Furthermore, after-pills do not protect against sexually transmitted infections (STIs).
For STI prevention, other methods like using condoms are necessary.

Additionally, after-pills are not intended for regular or repeated use as a birth control method.
Taking high doses of hormones frequently can put a significant strain on your body.
For ongoing contraception, safer and more reliable methods like low-dose birth control pills or intrauterine devices (IUDs) should be discussed with a healthcare provider.

Who Should Not Take After-Pills:

• Individuals with an allergy to the components of after-pills (like levonorgestrel).
• Individuals with severe liver dysfunction.
• Individuals with undiagnosed genital bleeding (taking the pill may be delayed until the cause of bleeding is identified).
• Individuals with a history of or current symptoms of thrombosis, pulmonary embolism, cerebrovascular accident, or coronary artery disease, or those at high risk (as determined by a doctor).
• Individuals who may be pregnant (the pill is not effective if pregnancy is already established and potential harm to the fetus cannot be ruled out).

This information is general, and suitability for taking the pill varies based on individual health status.
It is crucial to consult a doctor for a proper diagnosis and personalized advice.

Frequently Asked Questions About Irregular Bleeding After After-Pills

Here are some common questions about irregular bleeding after taking an after-pill and their answers.

Is Bleeding a Week After Taking It Okay?

Experiencing irregular bleeding within a few days to about a week after taking an after-pill is not uncommon.
This is considered an effect of the after-pill’s hormonal action and is usually not a cause for concern.
This bleeding is called “withdrawal bleeding” and occurs when the uterine lining sheds.
If the bleeding amount is not as heavy as a regular period and lasts only for a few days, it can be considered a typical reaction to the medication.
However, the presence or absence of bleeding alone does not determine the success of contraception.

How Long Will Irregular Bleeding Last?

Irregular bleeding after taking an after-pill usually subsides within a few days to about a week.
It generally stops within 10 days to two weeks at the most.
If bleeding continues for more than two weeks, or if the amount is very heavy, it is accompanied by pain, or there are other abnormalities, causes other than the effects of the after-pill may be involved, so it is recommended to consult a medical institution.

When Will My Period Come After Irregular Bleeding?

Irregular bleeding after taking an after-pill is not your regular period.
Your next regular period after taking an after-pill usually arrives around your scheduled date or up to about a week late, based on your cycle before taking the pill.
However, the after-pill can affect your hormone balance, so your menstrual cycle might be temporarily irregular.
Your period might come earlier or significantly later than expected.
If your period does not arrive three weeks after taking the pill, you should consider the possibility of pregnancy and confirm with a pregnancy test or consult a medical institution.
Irregular bleeding, even if it occurs, does not count as your period.

Conclusion: If You Are Worried About Irregular Bleeding, Consult a Professional

Irregular bleeding after taking an after-pill is a relatively common phenomenon caused by the hormonal changes from the medication.
In most cases, it resolves on its own within a few days to about a week.
This irregular bleeding is not necessarily a sign that contraception was successful, and the presence or absence of bleeding alone cannot determine the success of contraception.

Whether you experience irregular bleeding or no bleeding at all, it is important to take a pregnancy test about three weeks after taking the after-pill or to check if your next period arrives as expected.

If the irregular bleeding continues for more than two weeks, the amount is very heavy, it is accompanied by severe pain, or you notice other unusual symptoms, causes other than the effects of the after-pill (possibility of pregnancy, gynecological conditions, etc.) may be involved.
In such cases, do not try to self-diagnose and seek prompt consultation with a doctor at a medical institution (such as an obstetrician-gynecologist).
Consulting a professional without holding onto your anxiety is the best choice for both your physical and mental health.

Disclaimer:
This article is for general informational purposes only and does not constitute medical advice.
For individual symptoms or situations, please consult a doctor, pharmacist, or other healthcare professional.
This website assumes no responsibility for any damages arising from actions taken based on the information provided in this article.