“The Morning After Pill”
“The Night Before, The Night Before, The Day Before, The Morning After”
Emergency Hormonal Contraception
The following is an extract from “Sexplained Two – For Changing Times”, by Helen J Knox
Used here under licence. All rights reserved. © Knox Publishing/Helen Knox
What’s Emergency Contraception?
There are two types of emergency contraception available in the UK, which aim to prevent an unplanned pregnancy after sex has taken place.
There are pills and devices.
1) Previously called ‘the morning after pill’ its new name is Emergency Hormonal Contraception (EHC).
2) An IUD (intra-uterine device/coil) can also be used as an emergency method of contraception.
Information about the three methods of emergency contraception.
Also see the Blog for an update on the use of ulipristal acetate (ellaOne®) and quick starting hormonal methods – new timelines advised.
In the meantime, here is a link to the information published by the UK’s Faculty of Sexual and Reproductive Health (FSRH)
2017 – Here is the HUGELY updated information from the UK’s Faculty of Sexual & Reproductive Health – the organisation to which practitioners in the UK all turn for advice on Family Planning / Birth Control Methods.
Why has the ‘morning after pill’ been renamed Emergency Hormonal Contraception (EHC)?
That’s because it works later than just the morning after unprotected sex.
OK! So what’s EHC?
At the time of writing, there are two types of EHC available (UK).
There are over 70 brand names of EHC available worldwide, and of these, there are three main types.
First: a high, single dose of the progestogen hormone, levonorgestrel, taken within 72 hours (3 days) of unprotected sex: e.g. if you’ve had an accident with your chosen method of contraception, to try and prevent an unplanned pregnancy. This medication has a long list of alternative names, and what your prescriber calls it will depend on where you are in the world.
In the UK it is called Levonelle®
Second: a single dose of a different hormone, Ulipristal acetate (UPA), as ella® (USA) / ellaOne® (The UK and Europe), licenced for use up to 120 hours (5 days) after unprotected sex.
(Internationally, this is also known as UPRIS® / Duprisal® and Dvella® .)
Third and no longer used in the UK: is a combined oral contraceptive method, available for emergency situations, comprising of four tablets. Worldwide, this method has a long list of alternative names. In the UK it was called PC4.
For information about the emergency IUD / coil, please see the pages about the IUD as the main method.
What would EC do to me?
Each emergency hormonal method delays ovulation if it has not already occurred in a particular cycle.
What should I do after I take EHC?
No methods of EHC provide ongoing contraception, only the IUD, which is non-hormonal.
If you continue to have sex in the same cycle, you should return to using your usual birth control immediately.
You if you are using hormonal contraception as your regular method, you should also use condoms or avoid sex for 7 days following EC with levonorgestrel, or 14 days following ulipristal acetate if you are using hormonal contraception.
(This extends to 9 or 16 days respectively if using the pill called Qlaira consisting of natural hormones rather than synthetic.)
However, if you take pills, the manufacturers recommend that you have no sex or use a condom until your next menstrual period to avoid further risk.
What if I miss the 72 hours or don’t want to take hormones?
If you miss the 72 hours (3 days) ellaOne® is licenced for use up to 120 hours (5 days) or don’t want to take hormones, an emergency IUD/coil can generally be fitted up to 5 days after unprotected sex (sometimes later, depending on the earliest chance of ovulation that cycle) .
Where can I get EHC?
The pills are available at a pharmacy but can be obtained free from all Contraception and Sexual Health Clinics, most GPs, and some hospital casualty departments.
At the GPs you may have to explain to the receptionist why you need an emergency appointment, otherwise, you may not be seen until it’s too late to prescribe the pills.
Some private clinics and pharmacies offer EHC, but you will have to pay for it.
When should I get my period after taking EHC?
Whichever hormonal method you use, you should bleed within 3 weeks of taking emergency contraceptive pills.
If you have a lighter bleed than usual or no bleed, see your doctor or Sexual Health Clinic to check that you’re OK.
Will EHC make me sick?
It is OK to take it on an empty stomach or if you have eaten.
You’re VERY unlikely to be sick but if you vomit within 3 hours of taking EHC you should seek medical attention, the same or next day, to obtain more pills or have an emergency IUD (intra-uterine device) / coil fitted.
Sometimes an anti-emetic tablet is given with the pills (anti-sickness).
How reliable is EHC?
It’s most effective when taken nearer the time of unprotected sex.
In some countries, women who weigh over 70kg or who have a BMI (Body Mass Index) of more than 25 may be guided towards a UPA pill instead of levonorgestrel, especially if they are close to the middle of their cycle; or, they may be advised to have an emergency IUD instead.
Alternatively, two levonorgestrel pills may be given.
As with other methods of birth control, you should appreciate that it can fail and should never be used as an alternative to the more reliable method.
Is it suitable for everyone?
If you’re pregnant you shouldn’t take it.
If you had unprotected sex more than 72 hours ago or are mid-cycle (half way between two menstrual periods) you may be offered ulipristal acetate or an emergency IUD / coil.
In countries where the third hormonal method is available, and you have a migraine at the time you need to take it, you may be prescribed the progesterone only method instead of a combined hormonal product – or offered an IUD.
How many times can I use it?**
There is no limit to the number of times you can have it, although, ulipristal acetate is only licensed to be given once in a particular menstrual cycle, but in practice, can be given more than once in a menstrual cycle now.**
Levonorgestrel can also be given more than once in a cycle.
If you need to use it often, you should consider using a more reliable method of regular contraception.
**See the Faculty of Sexual & Reproductive Health pdf link 2017 for the latest information and a set of guidance flow charts.
Will it make my periods heavier or lighter?
Your next period is unlikely to be any different but if it’s lighter than usual or you develop tummy pains, tell your nurse or doctor. There’s a very small risk it may not work for you (less than 1 in 100) in which case, you may become pregnant or develop an ectopic (tubal) pregnancy.
What should I be aware of if my girlfriend’s using it?
If you used a condom and it broke or came off, practise the correct way to wear them and try to avoid this happening again.
If you had unprotected sex and didn’t bother to use a condom, you should be better prepared next time you have sex and perhaps more responsible.
Don’t rely on emergency contraception instead of a regular method of birth control since it can fail.
Go “Double Dutch” and use a reliable method of contraception routinely to protect against pregnancy, AND a condom to protect against infection. This gives much better protection.
If either of you develops an unusual discharge, sores or pains after needing Emergency Contraception, seek a full check-up at a Sexual Health Clinic just in case you’ve acquired an infection.
This is especially important if you were having casual sex or if either of you was unfaithful, while in a regular relationship.
If EC fails, will it harm the baby?
As far as is known, levonorgestrel does not harm the baby.
However, as it is newer, Ulipristal acetate is not as well studied yet – however, it is not anticipated to do so.
But, no-one can guarantee a normal, healthy baby.
Will EC make me put on weight?
Will EC protect me from infection AND pregnancy?
No, EC can just aim to protect you against pregnancy.
Will it cause me to have an abortion?
This has been argued extensively around the world and no, it does not cause an abortion.
Do recreational drugs affect the reliability of Emergency Contraception?
No, they don’t.