Morning-After Pill

The morning-after pill is a form of contraception that you use if you have unprotected sex. This can occur if you miss a pill, a condom breaks or falls off or you pull out incorrectly.

Unlike other forms of contraception, you use it after unprotected sex has occurred. However, you need to use it within a certain timeframe for it to be effective.

There are 2 forms of the morning-after pill available in the UK. Levonelle and ellaOne. The IUD can also be used as a form of emergency contraception.

During the menstrual cycle, hormone levels rise and fall. This cues certain reproductive processes such as ovulation (the process where the ovaries release an egg into the uterus). It also causes the womb lining to thicken.

The morning-after pill works by affecting the levels of these hormones to delay and prevent ovulation. It also prevents effects on the womb lining.

The two pills work in different ways:

• Levonelle contains a synthetic version of the hormone progesterone called levonorgestrel. This increases progesterone levels, mimicking the levels your body has after ovulation.
• ellaOne, on the other hand, contains ulipristal acetate. The active ingredient affects the progesterone receptors in the body which causes an anti-progesterone effect.

Both tablets, therefore, stop conception from happening by affecting natural hormone levels.

How does the IUD work for emergency contraception?

One emergency contraceptive that may surprise people is the IUD. The hormonal IUD (IUS), however, cannot be used in the case of an emergency.

The IUD is a small t-shaped device that is inserted into the uterus by a doctor or nurse. It is a long-acting reversible contraceptive (LARC) that can be used as emergency contraception.

When inserted 5 days after unprotected sex, or up to 5 days after ovulation, the IUD can prevent pregnancy. It contains copper which creates an inflammatory response. The reaction is toxic to eggs and sperm, which can prevent pregnancy even if ovulation has already occurred.

The IUD is unlike other types in that you can keep it in once you use it for emergency purposes.

The morning-after pill is highly effective when used correctly. Each emergency contraception method has a 3-5 day window of when you can take it.

However, the sooner you take it, the better. This is because the longer you wait, the more chance you will have ovulated by the time you take the pill, which is a common reason the morning-after pill doesn’t work.

How effective is Levonelle?

Levonelle can be taken up to 3 days after unprotected sex. But, it gets less effective the longer you leave it.

How effective is ellaOne?

You can take ellaOne up to 5 days after unprotected sex. If taken within 24 hours, ellaOne is 98% effective at preventing pregnancy.

One 2010 study investigated the effectiveness of ellaOne compared to Levonelle. They found that 1.4% of women got pregnant after taking it. This was compared to 2.2% of women on Levonelle who got pregnant.

You should still take it as soon as possible as if you have already ovulated, you may still become pregnant.

It is safe for most women and girls to use emergency contraception. You can still use it even if you use regular contraception.

Some factors can reduce the effectiveness of the morning-after pill, such as:

• taking certain medications
• having HIV
• being above a certain body weight (70kg for Levonelle or 89kg for ellaOne)

These factors may mean you take two Levonelle tablets to effectively prevent conception. Taking two ellaOne pills is no more effective. So if you fall under one of these categories, you should seek alternative methods of contraception.

In addition, if you are breastfeeding, you are advised to not use ellaOne.

You need to take the morning-after pill as soon as possible after unprotected sex. Depending on the type of pill, you can take it up until 3 or 5 days.

Can I take the morning-after pill twice in one cycle?

If you have unprotected sex twice in one cycle, you can take the morning-after pill twice. However, they’re not meant to be used as your regular contraceptive.

You should consider other contraception options if you have to use the morning-after pill too often.

When should I take my regular contraceptive after using the morning-after pill?

The advice depends on whether you use Levonelle or ellaOne.

If you take Levonelle, you should take your next contraceptive pill, patch or ring within 12 hours of taking the emergency pill.

If you take ellaOne, you should wait 5 days before restarting your usual contraceptive. You should also use barrier contraception for these 5 days.

You should then use a barrier contraceptive for:

• 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
• 9 days if you use the combined pill Qlaira
• 2 days if you use the progestogen-only pill (mini-pill)

If you’re unsure, ask a healthcare professional.

Emergency contraception does not cause serious or long-term side effects. However, you may experience some mild short-term effects.

IUD insertions can also be uncomfortable. However, the procedure only lasts for 30 seconds and the discomfort should disappear shortly after.

Most side effects of the morning-after pill should go away on their own. However, if you continue to experience side effects, you should consult your GP.

If your next period is lighter or shorter than usual, take a pregnancy test.

You can get the emergency contraceptive pill for free at contraception clinics or sexual health clinics.

Some GP surgeries, pharmacies, A&E departments and NHS walk-in centres even offer it for free as well. Always check the website or phone ahead of time to make sure they offer the option you want.

You can also buy the morning-after pill from most pharmacies, either in-person or online. The morning-after pill costs will depend on the pharmacy.