The risk of pregnancy in this scenario is very low. Pregnancy during menstruation is unlikely, and taking emergency contraception (such as levonorgestrel) within two hours is highly effective.\n\nA low body mass index (BMI) does not decrease the effectiveness of emergency contraception. However, a low BMI can sometimes cause irregular menstrual cycles, which might make predicting ovulation or periods more difficult.\n\nFor peace of mind, a home pregnancy test can be taken three weeks after the encounter. If there are ongoing concerns about irregular cycles or BMI, consulting a healthcare professional is a great next step.

Since this bleeding is occurring just one day before your expected date, it is highly likely to be your actual menstrual period starting slightly early, or a harmless side effect of the pill. The hormones in the i-pill frequently alter your cycle, causing temporary spotting or early bleeding. Please rest assured this is normal and not a cause for concern. Monitor your flow over the next few days. If your bleeding is much lighter than usual or if a normal period does not establish, taking a home pregnancy test in a week can provide peace of mind.

When taken within one hour of intercourse, it is highly effective, preventing about 95% of expected pregnancies. Because you acted so rapidly, your chances of getting pregnant are extremely low. You might experience some mild, temporary side effects like spotting, nausea, or a slight delay in your next period. To help put your mind completely at ease, you can take a home pregnancy test if your period is delayed by more than a week.

Taking the emergency contraceptive pill (like i-pill) three or four times will not impact your long-term ability to get pregnant, though it is best used only for emergencies. Regarding your second question, infections in the uterus, such as pelvic inflammatory disease, can sometimes cause difficulties in becoming pregnant if left untreated because they can cause inflammation or scarring. The good news is that most infections are highly treatable when caught early. I gently recommend consulting a gynecologist who can offer a simple evaluation and guide you with personalized care and peace of mind.

Given that both your blood and urine pregnancy tests were negative one month after intercourse, and you have had normal periods since, you are not pregnant from that encounter. Those tests are highly accurate at that stage. The darkening of your nipples and areolas is likely due to hormonal fluctuations, which are very common with polycystic ovary syndrome (PCOS). I recommend scheduling an appointment with your doctor to discuss your PCOS symptoms and manage your hormone levels.

Yes, it is safe and necessary to take a second dose of emergency contraception like the iPill (levonorgestrel) if you have another episode of unprotected intercourse. The first dose only protects you from intercourse that occurred before taking it; it does not provide ongoing protection. While safe, a repeat dose might cause temporary side effects like nausea or an irregular next period. For reliable, ongoing protection, I gently encourage you to discuss regular birth control options with your healthcare provider when you can.