Hi Ms. XXXXX,

Thanks for writing to us.

The emergency pill contains excess hormone enough to disturb the normal hormonal milieu of the body. This was the cause of the breakthrough bleeding that you experienced on the 9th of May onward. This is not your normal cycle. As you had the emergency pill, the next cycle is most likely to be delayed. A delay of more than two weeks should be investigated. Considering your cycle to be due on the 23rd of every month, you are quite overdue for your period. Though this is most likely due to the hormonal disturbance induced by the emergency pill, you should see a gynecologist and exclude pregnancy.

A home pregnancy test done with proper precautions should read positive by this time had you conceived. A negative test almost rules out the possibility of conception. You may also get the serum beta-hCG assay done for a definite confirmation and follow it up with a trans-vaginal sonogram.

If pregnancy has been excluded, your doctor may prescribe you progesterone supplements to induce a withdrawal bleeding as the ovaries may need a kickback to restore the normal function.

If, in case, you have conceived, and if you do not wish to retain this pregnancy, you may go for medical abortion under the surveillance of a specialist. There are several drug combinations available and the process is usually short. This should be followed after two weeks by a trans-vaginal sonogram for completion of the process.

Please use some regular form of contraception that suits your needs and avoid using the emergency pill frequently; its use should be restricted to only a couple of times in a year as it causes gross hormonal disturbances and infertility problems later.

Hope I have answered your queries. Please feel free to contact if you need further clarifications. I will be happy to help.

regards,
Shanti.V.

---

Hi,

Thanks for writing back.

Deviry is Medroxyprogesterone and is safe for use. Any progesterone supplement may cause side effects like bloating, gastric disturbances, breast tenderness and in rare instances, thromboembolic manifestations though these are mostly seen with estrogen use. Taking things into consideration, this would be the best possible treatment at present as it is only for a short period. You may expect a withdrawal bleed 3-7 days after completion of treatment.

Since using condoms alone carries a high failure rate, it is always advisable to club this with another form of contraception. You have an entire range available, from oral contraceptive pills of which several combinations are available, to implants, rings, depo shots and pessaries. You can discuss with your consultant and go for the one that suits you after some trial and error. Among the oral pills, micronized pills have lesser side effects and are equally effective. IUD is better avoided since you have never conceived before; it is best used after at least one pregnancy.

Hope I have clarified your query. Please get back if you need any more clarifications. I will be ready to help you.

regards,
Shanti.V.

---

Hi,

Thanks for your query.

A male condom has a safety rate of 85% while a female condom has a safety rate of 75%. Failure rate is the rate of pregnancies encountered when condom alone is used as the contraception. Breakage while use may occur when the condom is too old or improperly stored; improper lubricant application can be another important cause- lubricants that contain oil should not be used with latex condoms. The appropriate size should always be chosen.

Taking appropriate precautions is the only way to avoid accidents and if in case such a thing happens even after proper precautions, additional contraception should be used if you happen to be in the fertile period. Emergency contraception may be used only on the very few occasions when it is really needed.

Hope your query is answered. You may contact me if you have further queries.

Wish you good health.

regards,
Shanti.V.

---

Hi,

Thanks for writing to us.

You may choose drugs with estradiol and desogestrel combination at low doses (mini pill) or progestin-only pills that are devoid of the side effects of the combined pills. Estrogen component in the pills at the usual dose is shown to be mostly responsible for the thromboembolic manifestations and replacement with progesterone relieves this risk, but in the first few months bleeding can be erratic. Norethindrone and Norgestrel are the preparations used. I am very sorry I am unable to give you a prescription as this is an online consultation; you may get the proper prescription from your consultant.

You may contact me whenever you wish to. I shall be available to answer.

Wish you good health.

regards,
Shanti.V.

---