Morning after pill

The morning after pill is a type of emergency contraception that can protect against pregnancy if you have had unprotected sex or your current contraception has failed.

Depending on the type, you’ll need to take the morning after pill within 3 or 5 days after having unprotected sex. The earlier you take pills containing levonorgestrel, the more effective they will be, but ellaOne maintains its effectiveness for up to 5 days.

The morning after pill works by delaying or stopping ovulation, so that you do not get pregnant. However, it does not protect against sexually transmitted infections (STIs) if you have had unprotected sex.

There are 2 main types of emergency contraception in the UK:

1. Emergency contraceptive pill.
2. Copper intrauterine device (IUD).

Emergency contraceptive pill

The emergency contraceptive pill, also known as the morning after pill, is available in 2 forms, depending on the active ingredient. They are:

• ulipristal acetate, available under the brand name ellaOne, which must be taken within 5 days (120 hours) of having unprotected sex
• levonorgestrel or Levonelle, which contains 1.5mg of the active ingredient and must be taken within 72 hours (3 days) of unprotected sex

Copper intrauterine device (IUD)

A copper IUD is another method of emergency contraception. It should be fitted within 5 days of having unprotected sex, and you will need to make an appointment at a sexual health clinic or a GP surgery to have the IUD fitted by a healthcare professional.

It’s inserted into your uterus and is a small T-shaped device that slowly releases copper, which is toxic to sperm, so they cannot survive and meet with an egg. Once fitted, you can leave the IUD in and use it as your usual method of contraception. It can remain effective for 5 to 10 years, depending on which type you have fitted.

The morning after pill works by stopping your ovaries from releasing an egg to stop you from getting pregnant. Depending on the active ingredient in the pill you choose or are prescribed, it may also prevent pregnancy in additional ways.

ellaOne contains ulipristal acetate and works by binding to progesterone receptors, blocking the effects of progesterone on the body, and stopping or delaying ovulation.

Levonorgestrel (Levonelle) also prevents ovulation, but in addition to this, it thickens cervical mucus, making it difficult for sperm to reach an egg that may have already been released by the ovaries.

“The morning after pill temporarily stops ovulation, this means it will only work if you have not already ovulated. If you have ovulated in the last 24 hours, it will not work. Ovulation usually happens around the middle of your cycle (day 14), and the egg can be fertilised for 24 to 48 hours after.

This means the morning after pill may not be effective around day 14 to 16 of your menstrual cycle, though ovulation can vary depending on your average cycle length and if you have any female reproductive conditions. If you know for sure you’ve ovulated, the IUD is the best choice because it can be used even if you have just ovulated, and up to 5 days after unprotected sex.”

— Dr Brenda Ikeji

You should swallow the morning after pill whole with a glass of water, if needed. Ideally, you should take Levonelle as soon as possible after having unprotected sex because the earlier it’s taken, the more effective it can be. Whichever emergency contraceptive pill you take, it will only work if you take it before ovulation happens.

How long after sex can you take the morning after pill?

You will need to take:

• ellaOne (ulipristal acetate) within 5 days of unprotected sex
• levonorgestrel (Levonelle) within 3 days of unprotected sex

What to do if you vomit after taking the morning after pill?

If you vomit within 3 hours of taking the morning after pill, there is a chance that the active ingredients may not have been absorbed, so it might not be effective. You should take another pill as soon as possible.

How many times can you take emergency contraception?

You can take the morning after pill more than once in a menstrual cycle, but if you need to take it twice in the same week, you should take the same type of pill each time.

The morning after pill is not designed to be used as a regular method of contraception, and it’s usually not as effective as a long-term contraceptive. Taking it regularly may also affect your menstrual cycles. If you find you need to keep taking it, you should consider a more regular method, like the contraceptive pill.

The morning after pill will only work if it is taken before ovulation happens, and the different types of pills have different effectiveness windows. For example, levonorgestrel (Levonelle) is effective for up to 3 days after unprotected sex, while ellaOne can be taken up to 5 days after the event.

Levonelle or levonorgestrel pills are up to 97% effective at preventing pregnancy when taken within 72 hours. However, an earlier study found that Levonelle (levonorgestrel) was:

• 95% effective if taken on day 1
• 85% effective on day 2
• 58% effective if taken on day 3

ellaOne, on the other hand, is 98 to 99% effective at preventing pregnancy within the 5-day window it can be taken. Women who took ellaOne 48 to 120 hours after unprotected sex had a pregnancy rate of just over 2%, while no pregnancies occurred in a study where ellaOne was taken 72 to 120 hours after.

Important: Although evidence is limited, it’s thought that the morning after pill may be less effective if you are overweight. If you decide to take Levonelle and have a body mass index (BMI) over 26 or weigh over 70kg, let your doctor or pharmacist know. You will need a higher dose for the pill to be effective, or you may be given ellaOne instead. If you weigh over 85kg or your BMI is 30 or more, the IUD is recommended instead.

The side effects of emergency contraception can differ between the types. However, they can all cause side effects, but not everyone will get them. They are often temporary and improve within a few days.

Common side effects of ellaOne include:

• feeling sick (nausea)
• being sick (vomiting)
• abdominal pain or discomfort
• painful periods
• pelvic pain
• breast tenderness
• headaches
• dizziness
• mood swings
• muscle pain
• back pain
• tiredness

As ellaOne is taken as a single pill, most side effects should only last a few hours to a few days. As it delays ovulation, period side effects can last a bit longer, but should get better after your next period. If side effects are persistent or severe, speak to a pharmacist or doctor straight away.

Very common and common side effects of levonorgestrel and Levonelle are:

• feeling sick (nausea)
• irregular bleeding until your next period
• lower abdominal pain
• tiredness
• headache
• being sick (vomiting)
• changes to your period
• sore breasts
• diarrhoea
• dizziness

Levonelle and levonorgestrel are only taken as a single dose, meaning most side effects should not last very long, usually a few hours to a few days. Period changes and bleeding may happen for longer because of delayed ovulation, but speak to a pharmacist or doctor if this does not get better after your next period.

Copper IUD side effects include:

• period-like pain after it’s fitted – this should go away within a few days
• bleeding between periods
• changes to your periods, such as them becoming heavier, longer, or more painful than before
• thrush that keeps coming back

Copper IUD side effects can last anywhere from a few days to a few months, as your body gets used to the device. If your period symptoms do not improve after a few months or you keep getting thrush, speak to your doctor.

The morning after pill may not be suitable for everyone. That’s why it is important to have a consultation with a doctor, nurse, or pharmacist before taking it, so that they can make sure it is safe and suitable for you to take.

The morning after pill may not be right for you if you:

• are allergic to any of its ingredients, including ulipristal acetate or levonorgestrel
• are or may already be pregnant
• have small bowel disease, like Crohn’s disease
• have severe liver problems
• have a history of ectopic pregnancy
• have inflammation of the fallopian tubes (salpingitis)
• have severe asthma

The morning after pill and other medications

Some medications can make the morning after pill less effective. So, it is important to let your doctor or pharmacist know if you are taking any prescribed, over-the-counter, or herbal medications, including:

• barbiturates and other epilepsy medications
• tuberculosis treatments
• HIV medications
• griseofulvin to treat fungal infections
• St John’s wort

The levonorgestrel-based morning after pill can also make ciclosporin less effective.

If you are taking the contraceptive pill, continue to take your doses at the usual times.

You can request the morning after pill online from Asda Online Doctor. You’ll need to complete a short online health questionnaire for one of our doctors to review. Once approved, we will dispatch your medication in discreet packaging to your home address with next-day delivery. Alternatively, you can choose to collect it from your chosen Asda Pharmacy.

Can you get the morning after pill over the counter?

Yes, you can buy the morning after pill over the counter from most UK pharmacies without a prescription. You will need to speak to a pharmacist who will assess if it’s safe and suitable to take. The consultation will take place in a private consultation room, so no one can hear your conversation. If the pharmacist thinks the morning after pill is suitable for you, you will be able to buy it straight away. It is also available for free in some pharmacies.

Can you get emergency contraception on the NHS?

Yes, emergency contraception is available on the NHS from:

• sexual health clinics
• GP surgeries
• some pharmacies
• A&E
• NHS walk-in centres

If you buy the morning after pill online from a private provider like Asda Online Doctor, the price can vary. We have the following pills available:

• ellaOne from £33.00
• levonorgestrel (generic Levonelle) from £9.89
• Levonelle from £22.35

Can you get the morning after pill for free?

Yes, the morning after pill is available for free on the NHS.

If the morning after pill is not suitable for you or you’d prefer a non-hormonal method of emergency contraception, the copper IUD is available as an alternative. An IUD is a small T-shaped plastic device that releases copper into the womb, preventing an egg from being fertilised as it’s toxic to sperm.

It must be inserted by a specially trained nurse or doctor, and the appointment should take around 15 to 30 minutes. This can cause some pain and discomfort for a few days afterwards. However, the IUD can be left in and used as a long-term method of birth control, remaining effective for 5 to 10 years.

The copper IUD needs to be fitted within 5 days when used as emergency contraception. As a method of contraception, the copper IUD is more than 99% effective.