The morning-after pill
Written by Dr David Delvin, GP and family planning specialist

What is the morning-after pill?

© Morning-after pill - Getty
The morning-after Pill needs to be taken as soon as possible after unprotected sex.
The morning-after pill stops you from becoming pregnant after you've had unprotected sex. It's also very useful if a condom breaks during intercourse.

Although lots of people talk about the morning-after pill, this term is actually misleading. In reality, you don't have to take it on the morning after sex. You should take it as soon possible. The more quickly you take it, the better are the chances that it will work.

However, you do have a little time in which to obtain it. One type of morning-after pill can if necessary be taken up to three days after sexual intercourse. Another type can be taken up to five days following sex.

In Britain, nurses and doctors call this medication the post-coital pill (PCP).

Emergency contraception

The PCP is a form of emergency contraception (EC). The term EC is used to describe a birth control measure that is used after sex has occurred – with the intention of preventing pregnancy.

Some people have the idea that EC is a form of abortion, but this is not the case.

The main idea is to ensure that the lining of your womb becomes unreceptive to an ovum (egg). The PCP should not be confused with RU-486 (mifepristone), often known as 'the abortion tablet'. This works in a totally different way.

There are various types of emergency contraception, including the post-coital coil – an IUD that should work if it is inserted up to five days after sex.

Unfortunately, in practice it's often difficult to find a doctor who is capable of putting in a post-coital coil. The reality is that if you want emergency contraception, you'll almost certainly have to obtain a PCP – and quickly.

Therefore, you should try and find a doctor who can prescribe it for you right away.

Sadly, there have been instances in which doctors were unwilling to prescribe the PCP, or simply didn't know how.

For instance, it has been known for medics who were examining rape victims to refuse to give the woman a prescription. Practically speaking, you would probably find it quickest to go to one of the following:

  • a doctor at a family planning clinic

  • a GP – but not if you can't get an appointment for a day or two

  • NHS walk-in centre

  • your university or college health clinic

  • a genitourinary medicine (GUM) clinic

  • possibly an A & E Department

  • if you're under 25, a Brook Advisory Centre or youth clinic.

Failing that, a recent change in the law allows any woman who is 16 or over to go to a chemist's and buy the PCP after a short chat with the pharmacist.

Most chemists are now willing to provide this service. The cost at the moment is about £25.

In Britain, there are currently two different types of PCP available from doctors: Levonelle and EllaOne.

I advise you to have a full discussion with the doctor about which one would be better for your individual circumstances.


    Levonelle

    In the UK, the long-established PCP is called Levonelle one step or Levonelle 1500. These are identical, but Levonelle One Step is the brand that can be bought without prescription.

    It should be taken within three days (72 hours) after sex.

    This PCP contains 1.5 mg of a female-type hormone called levonorgestrel – which is one of the ingredients of several types of contraceptive Pill.

    It's believed that Levonelle works by:

    • preventing your ovaries from releasing an egg

    • altering the lining of your womb, so that an egg can't embed itself there.


    It won't work if you're already pregnant.

    What about side-effects? Levonelle doesn't often have troublesome side-effects. According to the 2011 British National Formulary, the commonest unwanted effects are:

    • nausea

    • mild menstrual irregularity – so your next period may be slightly early or late

    • low abdominal pain

    • tiredness

    • headache

    • vomiting.


    If you throw up within TWO hours of taking a Levonelle tablet, you've probably lost it. So you need to take another one.

    Important note: severe lower tummy pain could just possibly indicate an ectopic pregnancy (a pregnancy outside the womb), because Levonelle isn't good at preventing those. Contact a doctor immediately.

    If you're supposed to be on the Pill, mini-Pill, vaginal contraceptive ring or contraceptive patch, you can continue using your current method after taking Levonelle. But you should either avoid sex or employ condoms until the doctor tells you that you are safe from pregnancy.

    Contraindication: Levonelle shouldn't be used by women who have severe liver disease or the rare condition porphyria.


    EllaOne

    In 2010 an entirely new brand of PCP became available in the UK. It's called EllaOne – pronounced as if it were two words: 'Ella' and 'One'.

    Its non-commercial name is ulipristal acetate. The dose is 30mg.

    You can take EllaOne up to five days after unprotected sex.

    It would be fair to say that EllaOne is relatively new, so not a lot is known about its mode of action, or possible long-term effects.

    Experts state that it acts by blocking the receptors onto which your female hormone progesterone would normally bind.

    The manufacturers say that it 'is thought to work by stopping your ovaries from releasing an egg'. They also state that 'it may also alter the environment in the womb'.

    Although EllaOne definitely works, at present there's no overwhelming evidence that it works better than the Levonelle.

    So, unless you're too late to use Levonelle (for instance, if three days have already elapsed since you had sex), your doctor may see no point in giving you this newer brand.

    If you do use EllaOne, please first read the patient information leaflet that comes with it. It will be updated as more information becomes available about the drug and its side-effects.

    Contraindications: EllaOne is probably not advisable for women with severe asthma or with serious liver problems. It interacts with a number of other drugs; the leaflet gives details.

    The most common unwanted effects of EllaOne are:


    These side-effects occur in less than 10 per cent of women. The makers state that 75 per cent of EllaOne users have their next period more or less on time, but 7 per cent experience it a little early, and 18 per cent find that it is delayed.

    EllaOne's effect can be reduced by various medications, including the popular remedy St John's wort.

    Please note that the effectiveness of oral contraceptives may be reduced by EllaOne. So if you happen to be on the Pill or the Mini-Pill, in my view you should use condoms till your next period arrives. Or else, don't have sex.

    If you happened to throw up within THREE hours of taking EllaOne, you would need another dose.

    Important note: severe low abdominal pain might indicate an ectopic pregnancy. So consult a doctor.

Is the PCP effective?

Neither type of morning-after pill is 100 per cent effective, but the failure rate is quite low.

The US Food & Drug Administration (FDA) estimates that these medications are about 89 per cent effective, by which they mean that out of every eight women who would have got pregnant, seven will not. The odds are rather better than that if you take it as early as possible.

Who is it useful for?

The morning-after pill is now widely used by women who have had unprotected sex. In particular, it has proved of value to:

  • rape victims, who should insist that they are given it

  • couples who have a condom break during sex

  • women who have had sex under the influence of drink or drugs

  • couples who just get carried away – unfortunately, this does happen!

Is it dangerous to use?

Not at all. If anybody tells you that it has 'lots of side-effects' or 'makes you dreadfully sick', don't believe them.

An older form of PCP used in the 1990s did often cause severe nausea, but today's PCPS cause very little trouble.

Personally, I have never seen any severe side-effects from either type of PCP. But you can find more details about possible side-effects from the package leaflet.

How do I take it?

As soon as possible, just swallow it with some water.

Indeed, because of the urgency, I usually advise patients to ask the chemist for a glass of water, so they can take it right away.

Any other warnings?

  • Your next period may come early or late. If it doesn't arrive within a couple of days of the expected time, see a doctor.

  • The morning-after pill does not protect you from pregnancy for the rest of your menstrual cycle. So either abstain from sex or use a barrier method like a condom.

  • As stated above, the morning-after pill is not good at protecting against ectopic pregnancies, although these are rare. If you get lower tummy pain or abnormal bleeding in the weeks after using it, see your doctor.

If it doesn't work, could the tablet harm the unborn baby?

We simply don't know the answer to this question.

So far, no research has shown any increase in abnormalities among babies whose mothers took the morning-after pill.

But past experience does show that other hormones taken in early pregnancy have harmed children.

Can you use the post-coital pill more than once in a month?

Yes, if you really have to.

The latest advice from the Royal College of Obstetricians, which deals with contraception, says that Levonelle can be used more than once in a cycle. However, it does not recommend taking EllaOne in this way.

Other people also read:

  • The contraceptive pill: is the Pill safe?

  • Menstrual cycle: can you feel ovulation?

  • Ovarian cysts: how are ovarian cysts diagnosed?

  • Fibroids: is it possible to become pregnant with fibroids in the uterus?

  • Endometriosis: is endometriosis painful?


Last updated 10.07.2013

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