Morning After Pill

How does the morning after pill work?

It works by delaying ovulation, releasing the progesterone hormone to send a signal to the body that ovulation has already occurred. This will prevent an egg from being released so that fertilisation cannot take place. 

How effective is the treatment?

It is most effective if it is taken within the first 12-24 hours after having unprotected sex or if your contraception fails. There are two different types of these pills; ellaOne and Levonelle. ellaOne can be taken up to five days after unprotected sex and it is thought to be 95% effective for the duration of this time period. Levonelle needs to be taken within 72 hours for it to work. Within the first 24 hours it is 95% effective, reducing to 85% between 24-48 hours and 58% within 72 hours. 

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. This may be a better option if it has been longer than 24 hours as it is 95% effective for up to five days.

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 to be on the safe side.  

Is it safe for regular use?

Yes - It can be used as often as you need it but it should not be used regularly. It is designed for emergency situations only and should not be used in place of contraception as it is 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. However, it is not as effective as contraception and it's not recommended to rely on it. 

How do I know if the treatment was effective?

After taking one of these pills your period will 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 and it has been 3-4 weeks since taking the medication then take a pregnancy test.

What are the early signs of pregnancy?

The most reliable early indicator of pregnancy is a missed period. Some women may experience light bleeding in place of a period. Other signs include: 

• Nausea
• Vomiting 
• Tiredness
• Feeling emotional 
• Breast tenderness
• Altered taste
• Heightened sense of smell
• Cravings 

How to prevent pregnancy

There are various contraceptive methods which 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 which is inserted into the vagina, lasting either 5 or 10 years depending on the type. The implant is a small plastic rod which is inserted into the inner arm and releases hormones into your bloodstream. It lasts for three years. The injection is given every three months. Condoms are freely available and are the only contraceptive which protect you from sexually transmitted infections.

What are the alternative emergency contraception treatments?

The IUD can also be used as emergency contraception. The intrauterine device is more commonly known as the copper coil and can be inserted up to five days after having unprotected sex. It is more effective and provides reliable long term contraception. Regular use of contraception will prevent pregnancy the majority of the time however accidents can happen, such as condoms breaking. The morning after pill is available should this happen.

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 95% effective at preventing pregnancy for five days. 
If you are taking any of the following medications then these types of pill may not be suitable. In this case you will be given an IUD which can be fitted within 5 days and is 99% effective: 

• Barbiatures
• 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.
 

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, providing an efficiency rate of 95%. 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. After 24-48 hours it drops to 85% and again to 55% after 48-72 hours. If you are unable to take one of these pills in the first 24 hours then ellaOne will be more effective at preventing pregnancy. It can be taken up to five days (120 hours) after unprotected sex and it remains 95% effective during this time. The IUD can also be used as emergency contraception for up to five days after unprotected sex. It is more effective than both ellaOne and Levonelle, preventing pregnancy in less than 1% 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 will need to take the morning after pill if you require 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 after 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, only condoms function in this way.

Can I buy these emergency contraception pills for future use?

Yes. These are iavailable to buy from Dr Felix in advance. They are not available as an emergency treatment due to the time sensitive nature of the treatments but you can order them for future use. This is recommended if you are travelling somewhere where you might not have access to contraception. 

Will my other medication interfere with the morning after pill?

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

• Barbiatures
• Epilepsy medications
• 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. Both types of pill are 95% effective if taken in the first 24 hours. Levonelle reduces in effectiveness after this, dropping to 85% after 24-48 hours and 58% within 48-72 hours. EllaOne remains 95% effective within a 5 day period.

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

If you are on the pill and have missed any then you can take ellaOne or Levonelle if you need emergency contraception. If you are in doubt then ask your pharmacist who will be able to advise you. 

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?

If you have not had a period 3-4 weeks after taking the treatment then you can take a pregnancy test. If you take one too soon you may not get a reliable result. 

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 in to your cycle. Pregnancy is 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 vagina for several days. If your periods are irregular then you should not rely on this timescale. 

Are emergency contraceptive pills dangerous?

No they are not dangerous. They contain synthetic versions of the progesterone hormone and works in a similar way to the contraceptive pill. 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 are below the age of consent. We would encourage you to speak to your parents about why you need the morning after pill. If this isn't possible then you can seek advice from a sexual health clinic who can issue you with an emergency contraceptive pill or see your GP who can give you a prescription. They may ask you a series of questions to determine your circumstances before giving you any treatment. Being under the age of 16 will not prevent you from being able to access this type of medication if you need it. 

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, retaining its efficiency rate of 95%. 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. 

What can interfere with this medication?

Certain medications can interfere with these treatments potentially causing them not to work. These include: 

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

If you have taken any of these medicines in the past four weeks then inform your doctor. You will be given the option of having an IUD (intrauterine device) fitted instead. Often referred to as the copper coil, the IUD can be used effectively as emergency contraception for up to five days after having unprotected sex. 

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?

Yes, these pills will delay your period so you can expect it to be around a week later than usual. 

Sources

• NHS > Emergency Contraception
• Mayo Clinic > Morning After Pill
• Patient Information Leaflet > ellaOne
• Patient Information Leaflet > Levonelle