The Morning-after Pill

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Page Contents
Overview
Key Facts
How Does Emergency Contraception Work?
Who can use Emergency Contraception?
In what situations can Emergency Contraception be used?
Is the Emergency Hormonal Contraception Pill effective at preventing pregnancy?
What are the side effects of using the Emergency Hormonal Contraception Pill?
The Emergency Hormonal Contraception and other Medicines

Emergency contraception can prevent pregnancy after unprotected sex or if you think your contraception may have failed, for example, a condom has split or you have missed a pill. There are two types of emergency contraception available in the United Kingdom, the emergency contraceptive pill, often known as the 'morning-after pill', and the IUD (intrauterine device, or coil).

At P&S Chemist, we provide the emergency contraceptive pill as a confidential service, with an assessment for eligibility and appropriateness first, in one of our three private and discrete consultation rooms, free for women under 24, as an NHS service. However, for women over the age of 25, this is a private service, paid for by you.

We provide two different varieties of EHC at our pharmacy, depending on your specific needs. The first one is called Levonelle, which has to be taken within 72 hours or 3 days of sexual intercourse. The second variant ellaOne has to be taken within 120 hours or 5 days of intercourse. Both of these emergency hormonal contraception pills work by preventing or delaying ovulation. Our pharmacist will advise you on which contraceptive pill is the most suitable for you during your consultation.

Alternatively, the IUD can be inserted into your uterus up to 5 days after unprotected sex, or up to 5 days after the earliest time of your ovulation, and prevents an egg from being fertilised or implanting within the lining of the womb. Due to the nature of IUD's P&S Chemist cannot provide these, but if you require this form of contraception we can assist you in arranging this with your doctor via our safeguarding and signposting service.

Please note that the morning-after pill is only for emergency use when another form of contraceptive was not used or failed, and should never be used regularly or as a replacement for more standard forms of contraception. Emergency hormonal contraception also does not protect you against sexually transmitted infections.

Key Facts

Emergency hormonal contraception (EHC) can prevent over 95% of pregnancies when taken within 5 days after intercourse.
Both types of emergency contraception are effective at preventing pregnancy if they are used soon after unprotected sex. Less than 1% of women who use the IUD get pregnant, whereas pregnancies after the emergency contraceptive pill are not as rare. It is thought that ellaOne is more effective than Levonelle.
The sooner you take Levonelle or ellaOne, the more effective it will be.
Leveonelle or ellaOne can make you feel sick, dizzy, or tired, or give you a headache, tender breasts, or abdominal pain.
Levonelle or ellaOne can make your period earlier or later than usual.
If you are sick (vomit) within 2 hours of taking Levonelle, or three hours of taking ellaOne, seek medical advice, as you will need to take another dose or have an IUD fitted.
If you use IUD as emergency contraception, it can be left in as your regular contraceptive method.
If you use the IUD as a regular method of contraception, it can make your periods longer, heavier, or more painful.
You may feel some discomfort when the IUD is put in - painkillers can help to relieve this.
A copper-bearing IUD is the most effective form of emergency contraception available.
There are no serious effects of using emergency contraception.
Emergency contraception does not cause an abortion.

How Does Emergency Contraception Work?

Emergency contraceptive pills prevent pregnancy by preventing or delaying ovulation although they do not induce an abortion. The copper-bearing IUD prevents fertilisation by causing a chemical change in the sperm and egg before they meet. Emergency contraception cannot interrupt an established pregnancy nor harm a developing embryo. For specific details of the two emergency hormonal contraception pills provided at P&S Chemist, please see below:

Levonelle

Levonelle contains levonorgestrel, which is a synthetic version of the natural hormone progesterone. This hormone assists in ovulation and preparing the uterus for accepting a fertilised egg. It is not known exactly how Levonelle works, but it is generally thought to work primarily by preventing or delaying ovulation and does not interfere with your regular method of contraception. Levonelle has also been deemed suitable for women who are breastfeeding, although there is a possibility that small amounts of hormones contained within the Levonelle pill may pass into your breast milk, although this is not thought to be harmful to your baby.

ellaOne

ellaOne contains ulipristal acetate, which stops progesterone from working normally, consequently, ellaOne prevents pregnancy mainly by preventing or delaying ovulation. Although, the manufacturer advises that anyone who is allergic to any of the components of the drug, or has severe asthma that is treated with glucocorticoids (a steroid) tablets; or has certain rare hereditary problems with lactose metabolism, should not take ellaOne. It is also important to note that ellaOne recommends that you do not breastfeed for 1 week after taking this pill as the safety of ellaOne during breastfeeding is not yet known.

Levonelle and ellaOne do not continue to protect you against pregnancy. This means that if you have unprotected sex at any time after taking the emergency pill you can become pregnant. Even if you are starting or continuing another method of hormonal contraception, it may not be effective immediately. You will need to use condoms or avoid sex until the contraception is working effectively.

The time it takes for contraception to become effective depends on the emergency contraceptive pill and the method of hormonal contraception being started. Your doctor or nurse will tell you when you can start hormonal contraception and how long you will need to take additional precautions to prevent unintended pregnancy. Both Levonelle and ellaOne should not be used as a regular form of contraception. However, you can use emergency contraception more than once in a menstrual cycle if necessary.

Who can use Emergency Contraception?

Any woman or girl of reproductive age, including girls under the age of 16 may need emergency contraception to avoid an unwanted pregnancy. This includes women who cannot usually use hormonal contraception, such as the combined pill or the contraceptive patch. There are no absolute medical constraints for the use of emergency contraception. Nor are there any age limits for the use of emergency contraception. Although, please be aware that in the United Kingdom, the emergency hormonal contraceptive pill is free only for women under the age of 25. The eligibility criteria for the general use of a copper IUD also apply for use of a copper IUD for emergency contraception purposes.

In what situations can Emergency Contraception be used?

Emergency contraception can be used in a variety of different situations following sexual intercourse, which include:

When no contraceptive has been used.
Sexual assault when a woman was not protected by an effective contraceptive method.
When there is a concern of a possible contraceptive failure, from improper or incorrect use, such as condom breakage or slippage etc.
When you have three or more consecutively missed combined oral contraceptive pills.
More than 3 hours late from the usual time of intake of the progestogen-only pill (minipill), or more than 27 hours after the previous pill.
Dislodgement, breakage, tearing, or early removal of a diaphragm or cervical cap.
Failed withdrawal, for example, ejaculation in the vagina or on external genitalia.
Failure of a spermicide tablet or film to melt before intercourse.
Miscalculation of the abstinence period, or failure to abstain or use a barrier method on the fertile days of the cycle when using fertility awareness-based methods.
Explusion of an intrauterine contraceptive device (IUD) or hormonal contraceptive implant.

In some instances, an advanced supply of emergency hormonal contraception may be given to a woman to ensure that they will have it readily available when needed and can take a dose as soon as possible after unprotected intercourse.

Is the Emergency Hormonal Contraception Pill effective at preventing pregnancy?

It is extremely difficult to determine how many pregnancies the emergency hormonal contraceptive pill prevents, as there is no discernable way to determine how many women would have gotten pregnant if they did not take it. Although a study published in 2021 revealed that 1,696 women received the EHC pill within 72 hours of sexual intercourse, 37 became pregnant and 1,659 did not. Whereas, in the 203 women who took the EHC pill between 72 and 120 hours after unprotected sexual intercourse, there were 3 pregnancies.

Consequently, it is highly important to remember that the sooner you take the emergency hormonal contraceptive pill after sexual intercourse, the more effective it will be.

What are the side effects of using the Emergency Hormonal Contraception Pill?

Taking the emergency hormonal contraceptive pill has not been shown to cause any serious or long-term issues. Although, it can sometimes have side effects.

Common side effects of using EHC include:

Abdominal (stomach) pain
Headache
Irregular menstrual bleeding (spotting or heavy bleeding) before your next period is due
Feeling sick
Tiredness

Less common side effects include:

Breast tenderness
Dizziness
Headaches
Vomiting - Please seek medical advice if you vomit within two hours of taking Levonelle, or three hours of taking ellaOne, as you will need to take another dose or have an IUD fitted.

If you are concerned about any symptoms that you may have after taking the EHC pill, contact your pharmacist, or your doctor or speak to a nurse at your local health clinic. It is advisable to speak to your doctor or nurse if you think you may be pregnant, if your period is more than 7 days late, or if your period is shorter than usual, or if you have sudden or unusual pain coming from your lower abdomen. Pain emanating from your lower abdomen could be a sign of an ectopic pregnancy - this is when a fertilised egg implants outside the womb, although this is rare, it is an extremely serious health issue and needs immediate medical attention.

The Emergency Hormonal Contraception and other Medicines

The emergency hormonal contraceptive pill like many other medications available, may interact with other medicines you might be taking, these include:

The herbal medicine St John's Wort
Some of the medicines used to treat epilepsy
Some medications used to treat HIV
Some medicines that are used in the treatment of tuberculosis (TB)
Medications such as omeprazole, which is an antacid, are used to make your stomach less acidic

It is advisable that if you are taking any of the above medicines ellaOne cannot be used, as it may not be effective. Levonelle on the other hand may still be used, but the dosage may need to be increased - which our pharmacist at P&S Chemist or your doctor can and should provide advice upon.

If you are currently taking antibiotics and need the emergency hormonal contraception pill, generally, there should be no adverse reaction with the most common antibiotics. Although, 2 antibiotics called rifampicin and rifabutin, are usually prescribed as a treatment for meningitis or tuberculosis (TB), may affect ellaOne during a course of rifampicin and rifabutin antibiotics and for 28 days after.

If you want to check that your medicines are safe to take with the emergency hormonal contraceptive pill, the patient information leaflet that comes with your EHC may be useful, or you can speak to our pharmacist at P&S Chemist or your doctor.

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Page last reviewed: 28/12/2021
Next review date: 28/12/2023