Morning After Pill

How does the morning after pill work?

The morning after pill works by delaying ovulation, preventing an egg from being released so that fertilisation cannot take place. There’s some laboratory-based evidence that ellaOne may also affect the lining of the womb and act to prevent implantation.

How effective is the treatment?

The morning after pill is effective at preventing pregnancy, and the sooner you take it after unprotected sex, the greater the effectiveness. There are two different types of morning after pill; ellaOne and Levonelle. 

Levonelle is only effective if taken within 3 days (72 hours) of unprotected sex, and ellaOne is effective if taken within 5 days (120 hours) of unprotected sex. Clinical studies have shown that in all women taking ellaOne within 120 hours of unprotected sex, around 0.9–2.1% will become pregnant; and in all women taking Levonelle within 72 hours of unprotected sex, 0.6–3.1% will become pregnant. It’s important to remember that some of these women will have had sex at a point in their cycle where pregnancy would not have been possible anyway. 

Neither emergency contraceptive pill will be effective if you have already ovulated, however, it’s often difficult to predict exactly when ovulation may occur, so it’s important to take emergency contraception as soon as possible regardless of where you might be in your cycle.

When to take the treatment

It should be taken as soon as possible after sex. Levonelle is most effective in the first 24 hours. After this, it's effectiveness decreases. ellaOne can be taken up to five days after unprotected sex and therefore may be a better option if it has been longer than a day or two since you’ve had sex.

How long can you wait before you take the treatment?

You should take the treatment as soon as you can. Even though ellaOne provides a five-day time window, it is still better to take it right away for maximum protection against unwanted pregnancy.

Is it safe for regular use?

Both ulipristal acetate (ellaOne) and levonorgestrel (Levonelle) are safe for regular use, however, they are designed for emergency situations only and should not be used in place of contraception as they are not as effective. Taking it often can also have an effect on your menstrual cycle and may make it more likely for you to experience side effects.

How many times can you take this type of treatment?

Women can take this whenever they need to, there is no safety risk in taking it more than once, and both pills can even be taken more than once in the same month. However, it’s important to remember that oral emergency contraception methods are not as effective as contraception and should not be relied upon to prevent pregnancy.

How do I know if the treatment was effective?

After taking one of these pills your period may arrive later than usual. This is because the hormones contained in the pill will delay ovulation, temporarily slowing down your monthly cycle. If you don't get your period within 3–4 weeks, you should take a pregnancy test. 

What are the early signs of pregnancy?

The most reliable early indicator of pregnancy is a missed period. Other symptoms of early pregnancy may include?

• Light bleeding or spotting
• Nausea
• Vomiting 
• Tiredness
• Feeling emotional 
• Breast tenderness
• Altered taste
• Heightened sense of smell
• Cravings

How to prevent pregnancy?

There are various contraceptive methods that prevent unplanned pregnancies. The contraceptive pill is one of the most popular and easily accessible methods of contraception. Every brand of the pill available in the UK is stocked by Dr Felix. Long-term reversible contraceptives include the coil, the injection or the implant. The coil is a small t-shaped device that is inserted into the womb via the vagina, lasting from 3 to 10 years depending on the type. The implant is a small plastic rod that is inserted into the inner arm and releases hormones into your bloodstream. It lasts for three years. The injection is usually given every three months. Condoms are freely available and are the only contraceptive that also protects you from sexually transmitted infections.

What are the alternative emergency contraception treatments?

The copper intrauterine device (IUD) can also be used as an emergency contraception. The IUD, more commonly known as the copper coil and can be usually be inserted up to five days after having unprotected sex. It is more effective than either of the oral emergency contraceptive pills, with less than 0.1% of women becoming pregnant when a copper coil is fitted within 5 days of unprotected sex. It has the added advantage of providing reliable ongoing contraception too. Regular use of contraception will prevent pregnancy the majority of the time however accidents can happen, such as condoms breaking.

If it has been more than five days since unprotected sex has occurred, there is a possibility that pregnancy has already started. In which case, oral emergency contraception will not work. In this case, speak to your doctor or sexual health clinic as the copper coil may still be an option depending on where you are in your menstrual cycle.

Which type of emergency contraception do I need?

The type of emergency contraception you need will depend on how long it has been since you had unprotected sex, whether or not you are currently using contraception and what medications you are using. If it has been 24 hours or less, then both Levonelle and ellaOne will be equally effective. Levonelle loses efficiency after this and it must be taken within 72 hours. 

After this time period, you can still take ellaOne which is effective at preventing pregnancy for up to five days. 

If you are taking any of the following medications then these types of pills may not be suitable. In this case, you can still have an IUD which can usually be fitted within 5 days and is over 99% effective at preventing pregnancy. 

• Barbiturates
• HIV medications
• Epilepsy medications 
• Griseofulvin 
• Rifampicin 
• Rifabutin 
• St John's wort

Let your GP or clinic know if you have taken any of these medications in the last 4 weeks.

Being overweight or obese, or having a high body mass index (BMI) may affect the efficacy of the emergency contraceptive pill, particularly Levonelle. Your prescriber will ask about your weight to check which method is most suitable for you. 

The effectiveness of oral emergency contraception may be affected if you have taken progestogen-containing contraception in the preceding 7 days (for example, the combined or progestogen-only pill).

Ulipristal acetate (ellaOne) may not be suitable for women with severe asthma who take oral steroids.

ellaOne vs Levonelle vs IUD

There are two types of the morning after pill: ellaOne and Levonelle. In the first 24 hours, both these pills are equally effective. Levonelle needs to be taken within 72 hours of unprotected sex for it to work but it gets less effective the longer you leave it. ellaOne can be taken up to five days (120 hours) after unprotected sex and it remains effective during this time. The IUD can also be used as emergency contraception for up to five days after unprotected sex, or even later depending on your menstrual cycle. The IUD is more effective than both ellaOne and Levonelle, preventing pregnancy in more than 99% of cases.

Can some contraceptive pills be used as emergency contraception treatment?

The contraceptive pill cannot be used as emergency contraception and should not be taken in place of ellaOne or Levonelle. If you are taking the contraceptive pill already and have missed taking some pills then you must consider the need for emergency contraception. 

Does the treatment have to be taken in the morning?

No. It does not need to be taken in the morning, you can take it at any time of the day up to 3–5 days after having unprotected sex, depending on which type of pill you are given.

What should I do if I vomit after taking the treatment?

Vomiting is a potential side effect of taking ellaOne or Levonelle. If you are sick within 2 hours of taking one of these then you will need to get another one from a pharmacist to take it again otherwise it won't work.

Does this type of treatment protect against STIs?

No. These emergency contraception treatments are used to prevent an unplanned pregnancy. They cannot protect against STIs. If you have had unprotected sex you should consider the need for a sexually transmitted infection test.

Can I buy these emergency contraception pills for future use?

Yes, you can buy emergency contraception in advance from Dr Felix. They are not available as an emergency treatment due to the time-sensitive nature of the treatment, but you can order them for future use. This is recommended if you are travelling somewhere where you might not have access to emergency contraception. However, in this case, it may be better to opt for a long-acting reversible form of contraception such as the implant, coil or injection, as these will be more effective at preventing pregnancy.

Will my other medication interfere with the morning after pill?

Certain types of medication can interfere with the way these pills work. These include: 

• Barbiturates
• Epilepsy medications e.g. phenytoin, carbamazepine
• HIV medications
• Rifampicin 
• Rifabutin 
• Griseofulvin 
• St John's wort

If you are taking any of these medications then an IUD (intrauterine device) will be offered instead. Commonly known as the copper coil, the IUD is over 99% effective and can be fitted within 5 days of having unprotected sex as emergency contraception.

Can I drink alcohol after taking the treatment?

Drinking alcohol will not have an effect on these types of emergency contraceptive pills. However, if you vomit within two hours of taking it then it may not be effective so it's recommended to wait to see how the pill affects you before drinking any alcohol as this may emphasise any feelings of nausea. 

Is this treatment 100% effective?

No contraception is 100%, including the morning after pill. From clinical studies, if 100 women took ellaOne within the five-day timeframe, somewhere between 0.9–2.1% will become pregnant. If 100 women took Levonelle within the 3-day timeframe, between 0.6–3.1% would become pregnant. ellaOne remains effective for a period of five days, however, Levonelle reduces in effectiveness over time, which increases the chance of pregnancy.

Can I use this if I’m already on a regular contraceptive pill?

If you are on the pill and have missed any, it’s important to speak to your pharmacist or doctor with regard to if oral contraception would work for you. Taking an oral contraceptive within 7 days of requiring emergency contraception may mean the effects are less reliable; particularly for ellaOne. 

Is this treatment an abortion pill?

No, these treatments are not abortion pills. As a form of emergency contraception, it works by delaying ovulation and preventing pregnancy. This is different to the abortion pill which terminates a pregnancy that has already taken place.

When can I take a pregnancy test for a reliable result?

A pregnancy test is usually reliable if taken at least 3 weeks after unprotected intercourse.If you take one too soon you may not get a reliable result. It’s recommended to take a pregnancy test after using emergency contraception if your next period is late by more than 7 days or is lighter than usual. 

How likely am I to get pregnant after unprotected sex?

This will depend on where you are in your menstrual cycle. You are most likely to get pregnant while you are ovulating, which happens roughly two weeks before your period is due. Pregnancy is most likely to occur five days before and one day after ovulation occurs. This is not 100% reliable however as not all women's cycles are the same and sperm can live inside the genital tract for several days. If your periods are irregular then you should not rely on this timescale. Some studies have suggested that a single episode of unprotected sex during the fertile period harbours a pregnancy risk of up to 30%.

Are emergency contraceptive pills dangerous?

No, they are not dangerous. ellaOne contains a drug that modulates the receptors in the body that respond to the naturally occurring progesterone hormone. Levonorgestrel contains a synthetic version of the progesterone hormone. They both work to delay ovulation. They can be used as often as needed but are not as reliable as contraception at preventing pregnancy. 

How can I get emergency contraceptives if I’m under 16?

If you are under 16 then you should speak to your doctor or sexual health clinic who will be able to prescribe you emergency contraception. Being under the age of 16 will not prevent you from being able to access this type of medication if you need it. You are encouraged to speak to your parents or a responsible adult about your situation. 

I had unprotected sex more than 3 days ago, what can I do?

If it has been more than 3 days since you had unprotected sex then you can still take ellaOne. It is effective up to five days after having unprotected sex. You can also have the IUD (the copper coil) fitted within 5 days of unprotected sex where it will work as emergency contraception. It reliably protects against pregnancy in more than 99% of cases. 

I had unprotected sex more than 5 days ago, what can I do?

Oral emergency contraception is not effective at preventing pregnancy where unprotected sex occurred more than five days ago. Depending on where you are in your menstrual cycle, the copper coil may still be an option; you should speak with a sexual health clinic as soon as possible to discuss. 

How long do the effects of the medication last?

If you experience any side effects after taking one of these pills they will usually subside within a couple of days to a week. 

Does the medication affect your period?

Emergency contraception can affect your period, and it may be later than usual. If it is more than seven days late, you are advised to take a pregnancy test.