Morning after pill

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Dr Fox provides morning after pills as standby treatment. This does not replace the need to use a regular reliable method of contraception, but it is for occasional emergency use. Dr Fox can supply emergency contraception to women aged between 18 and 55 years. Women aged under 18 should contact their GP, pharmacist, or a sexual health clinic.

Do you need a morning after pill immediately?

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Text 'pharmacy EHC [and your post code]' to 80011 (UK). You will get a text response with the 3 nearest pharmacies with their names, addresses, telephone numbers and distance from the post code entered.

Morning after pill (Levonelle and ellaOne)

Levonelle (levonorgestrel 1.5mg) and ellaOne (ulipristal 30mg) are single dose morning after pills (emergency contraception).

Levonelle taken within 72 hours (3 days) or ellaOne taken within 120 hours (5 days) of sexual intercourse will prevent most pregnancies.

Women who are eligible can buy 1 or 2 doses of the morning after pill from Dr Fox to keep as a standby treatment for use when needed. Levonelle and ellaOne should not be taken together and may not work if taken within 7 days of each other, or in the same monthly cycle.

Generic versions of both morning after pills are available at a lower cost. These contain the same active ingredients as the branded originals and are equally effective.

Frequency of use: women requiring the morning after pill more than once in a monthly menstrual cycle should consult a doctor or specialist contraception advisor, to ensure the best use of both emergency and ongoing contraception. Having a copper IUD (coil) fitted may be a more reliable emergency contraception, especially later in the menstrual cycle, and will also be able to be used for continuing contraception.

Regular contraceptive pills are also available from Dr Fox pharmacy.

Other possible risks

If you need the morning after pill it may be that you are also at risk of catching sexually transmitted diseases. Contact a GP or sexual health clinic for a full sexually transmitted disease screen.

Local NHS Sexual Health Clinics

• England
• Wales
• Scotland
• Northern Ireland

How morning after pills work

Morning after pills work by delaying the release of an egg. The egg will be released later in the month than usual. You can still get pregnant later in the month if you do not use ongoing contraception.

Effectiveness of Levonelle and ellaOne

The most effective emergency contraception is provided by having a copper IUD (intrauterine device/coil) inserted and this is an alternative to morning after pills. Copper IUDs can prevent pregnancy if fitted within 5 days of unprotected sexual intercourse, or within 5 days of the predicted date of egg release from the ovaries (ovulation). Ovulation is usually 14 days before the period so in effect a copper IUD can be fitted up to 9 days before the expected start of the next period. Fewer than 1 in 1000 women become pregnant after having an IUD fitted for emergency contraception.

Studies on the effectiveness of levonelle and ellaOne show little difference between the two types of pill in preventing pregnancy when taken correctly. Overall ellaOne has been shown to be more effective as emergency contraception than Levonelle. 1-2 in a hundred women will still get pregnant after taking a morning after pill.

EllaOne remains equally effective up to 120 hours (5 days) after intercourse. Levonelle works best if taken early and should be taken as soon as possible after intercourse. Levonelle is not recommended later than 72 hours after sex.

If very close to ovulation ellaOne is better than Levonelle at preventing ovulation and possible pregnancy.

If ovulation has already occurred, morning after pills will not be effective, but a copper IUD can still be fitted up to 5 days after predicted ovulation.

Some studies suggest Levonelle is less reliable in women who are overweight. Women with a BMI (Body Mass Index calculator) result of 26 or above should order ellaOne instead. If ellaOne is not appropriate then overweight women should take a double dose (two tablets at once) of Levonelle.

EllaOne and Levonelle both affect regular hormonal contraceptives (both combined and progesterone only), but there are more issues with ellaOne. This affects how long it will take for you to be able to rely on your normal contraceptive again. See below when and how to start or restart your regular contraception.

Compare ellaOne and Levonelle

When to use the morning after pill

• After sexual intercourse where other contraception has not been used.
• After sexual intercourse where a condom has failed (split, come off, etc).
• After sexual intercourse where a cap or diaphragm was used incorrectly.
• Where a couple are using withdrawal and this has failed.
• If the next implant, coil, or depot injection has been delayed.
• Sometimes after forgetting your regular contraceptive pill, patch, or ring - see below.

When is the morning after pill not advised?

If you have taken any of the following medications in the previous month:

• Epilepsy medication.
• Antibiotics to treat tuberculosis.
• HIV treatment.
• Griseofulvin to treat fungal infections.
• St John's Wort.

Side effects of Levonelle and ellaOne

As with any medicine, there is a potential for side effects, although these are usually not severe, and do not occur in most cases.

• Common side-effects include headache, nausea, dysmenorrhea (painful period), irregular bleeding, abdominal pain, fatigue, and dizziness.
• If vomiting occurs within three hours of taking a tablet the dose should be repeated.
• Periods may come early or be delayed after taking a morning after pill.

Cautions

• The morning after pill is for use after sexual intercourse, not before.
• Morning after pills are for occasional emergency use. There are much more reliable methods of contraception for routine regular use.
• There is no increased risk of ectopic pregnancy (pregnancy outside the uterus/womb) after taking a morning after pill. However, ectopic pregnancy can still occur and if you have had an ectopic pregnancy in the past, there is an increased risk of a further ectopic pregnancy in the future. Take a pregnancy test and seek medical advice if there is unusual abdominal pain and vaginal bleeding 4-5 weeks after taking a morning after pill as there is a chance these could be symptoms of an ectopic pregnancy.
• If a woman becomes pregnant after taking a morning after pill, or was already pregnant when it was taken, there is no evidence of adverse effects.
• The morning after pill does not provide contraception for any further intercourse during that monthly cycle.
• It is important to start an effective regular form of contraception as soon as possible after taking your morning after pill. When starting or restarting regular hormonal contraceptive pills or patches, use condoms as well until they are effective. See more below.
• GPs or sexual health clinics can provide effective ongoing contraception. The best methods are coils, implants, or injections (sometimes called LARC - long acting reversible contraception). Alternatives are contraceptive pills, patches, and vaginal rings.

  Local NHS Sexual Health Clinics

  • England
  • Wales
  • Scotland
  • Northern Ireland
• If, after using emergency contraception, a completely normal period (not lighter, or much more painful, than usual) does not arrive within 5-7 days of when expected, take a pregnancy test.
• Some medications can also affect the absorption of the hormones in the pill so if you are starting on new medication, please ensure you read the patient information leaflet supplied with it to check.

Breastfeeding

The active ingredient of Levonelle passes into breast milk. The manufacturer's advice is to take Levonelle immediately after feeding and not to breastfeed again within the next 8 hours.

The active ingredient of ellaOne may pass into breast milk for up to 7 days. The manufacturers advise that breastfeeding should be avoided during this time as risk to the infant cannot be excluded.

Whilst not feeding, a breast pump can be used to maintain milk production.

However, there are different medical opinions. See FAQ on breastfeeding for further information.

Alternative treatments

A copper IUD (intrauterine device/coil) can be inserted as an emergency contraceptive by some GPs or at sexual health clinics. This would be more effective than the morning after pill and also provides ongoing contraception.

I've missed a pill, do I need emergency contraception?

The risk of getting pregnant after missing contraceptive pills (including at the beginning of a pack, i.e. starting a pack late) depends on how many pills are missed and when in the pack the pills are missed.

See manufacturer's information leaflet packet insert for your pill (see list of patient leaflets).

NHS information - what should I do if I miss a pill?

• Combined pill
• Progestogen-only pill

Contraception after taking the morning after pill

A reliable contraceptive must be used for the rest of the menstrual cycle. See a GP or sexual health clinic to arrange long-acting contraceptives like IUD, IUS, depot injection or an implant, or restart your regular hormonal contraception.

When and how to start or restart your regular hormonal contraception

Contraception (combined contraceptive pills, progestogen-only pills, contraceptive patches, and vaginal rings)

After taking Levonelle (levonorgestrel 1.5mg)
Start/restart the hormonal contraception within 12 hours. Use condoms as well for 7 days with the patch, the ring, and the combined pill (9 days condom use for Qlaira). Use condoms as well for 2 days with the progestogen-only pill (mini pill).

After taking ellaOne (ulipristal acetate 30mg)
Hormonal contraceptives will stop EllaOne from working. Wait for a full 5 days (120 hours) before taking your pill, inserting a new ring, or applying a new patch. Use condoms as well during these 5 days and for a further 7 days, so 12 days condom use in total with the patch, the ring, and the combined pill (for Qlaira: 9 extra days, total 14 days condom use); and with the progestogen-only pill an extra 2 days, totalling 9 days condom use.

Buy treatment

Dr Fox supplies the morning after pill on prescription – you are required to answer a short medical questionnaire before your order can be completed. Emergency contraception can be obtained free of charge from an NHS provider such as your GP or a sexual health clinic following a consultation with them.

1. Medical questions
2. Choose treatment
3. Complete order

Answer medical questions to order(morning after pill)

Women only

Honest & accurate responses are necessary for safe medical assessment