Morning after pill

Medical information

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

Morning after pill (Levonelle and ellaOne)

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

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

Women who are eligible can buy 1 or 2 doses of the morning after pill to keep as a standby treatment for use when needed. Levonelle and ellaOne should not be taken together.

Frequency of use: women requiring emergency contraception more than once in a menstrual cycle should consult a doctor or specialist contraception advisor. If a woman is needing emergency contraception repeatedly, they may well be at risk of sexually transmitted diseases and should consider being tested either through their GP surgery or a specialist clinic.

Regular contraceptive pills also available from Dr Fox Pharmacy.

Effectiveness of Levonelle and ellaOne

The most effective emergency contraception is provided by having a copper IUD (intrauterine device) inserted and is an alternative to morning after pills. Copper IUDs can prevent pregnancy if fitted within 5 days of unprotected intercourse, or within 5 days of the earliest reasonably predicted date of ovulation.

EllaOne is slightly more effective than Levonelle. Studies show, if taken in the first 72 hours (3 days) after intercourse, pregnancy rates are close to 2 in 100 with Levonelle and 1.5 in 100 with ellaOne. EllaOne remains effective up to 120 hours (5 days) after intercourse.

Levonelle or ellaOne work best if taken early and should be taken as soon as possible after intercourse.

If ovulation has already occurred, ellaOne is no longer effective. The timing of ovulation cannot be predicted and therefore ellaOne should be taken as soon as possible after unprotected intercourse.

Recent studies suggest Levonelle is less reliable in women who are overweight. Women with a BMI (Body Mass Indicator calculator) result of 30 or above should order ellaOne instead.

EllaOne and Levonelle interfere with regular contraceptive pills (both combined and progesterone only), but ellaOne disrupts pill function for longer. This affects how long it will take for your normal contraceptive to be effective again. Please also see below When and how to re-start your regular contraception.

When to use the morning after pill

• After intercourse where other contraception has not been used.
• After intercourse where a condom has failed (split, come off, etc).
• Where a couple are using withdrawal and this has failed.
• See details at the bottom of page about when emergency contraception is needed for women who have missed their regular contraceptive pill.

We are unable to supply contraception online to women aged 55 years and above.

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 are headache, nausea, dysmenorrhea (painful period), 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. If a period is more than 5 days late a pregnancy test is required.

How morning after pills work

Morning after pills reduce the chance of fertilised eggs implanting in the womb.

Cautions

• Regular contraceptive pills cannot be relied on in the same menstrual cycle after a morning after pill has been taken and additional barrier contraception or abstinence is required for the remainder of the cycle (further details).
• The morning after pill is for use after intercourse, not before.
• Morning after pills are for occasional emergency use. There are more reliable methods of contraception for routine regular use.
• There is no increased risk of ectopic pregnancy after taking a morning after pill. However, ectopic pregnancy can still occur. Seek medical advice if there is 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.

Breastfeeding

The active ingredient of Levonelle is excreted in breast milk. Potential exposure of an infant can be reduced by taking Levonelle immediately after feeding.

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

Alternative treatments

Doctors and family planning clinics should be able to insert an IUD (intrauterine device) up to 5 days after unprotected intercourse. This would be more effective than the morning after pill and 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.

Ordinary contraceptive pills (mini pill information below)

The advice here does not apply to the newer pills Qlaira and Zoely, Eloine and Daylette. Please consult the patient information leaflet for these pills.

If you forget to take a pill, and it's not more than 24 hours late, it is fine - take it as soon as you remember. If it is more than 24 hours late, this is called a missed pill. This is still not a problem. Take the missed pill as soon as possible (even if this means taking two pills at once) and you are still protected. Just continue taking the rest of the pack and your seven-day pill-free break as usual.

Missing 2 or more pills (or starting a pack 2 or more days late) can mean the contraceptive is not effective. This is true of the start of the pack. It will have been 9 days since your last pill and the hormone levels will have decreased such that the ovaries are not suppressed and may release an egg.

Take the last missed pill as soon as possible (even if means taking two pills at once) discarding any earlier missed pills. Continue taking the rest of the pack as normal and use additional (barrier) contraception for the next seven days. You will need emergency contraception if you have had unprotected sex in the previous seven days and have missed two or more pills (you are taking your pill more than 48 hours late) in the first week of a pack. Then you should finish the packet and have the usual pill-free interval.

If the pills are missed in the second week of a pack (pills 8-14), the contraceptive effect has built up and there is no need for emergency contraception (as long as the pills in the first seven days of the pack were taken correctly). Then finish the packet and have the usual pill-free interval.

If the pills are missed in the third week of a pack (pills 15-21), you are protected, but start the next pack of pills straight away without the pill free break. If taking a packet with dummy/placebo pills, throw these away and start the new pack. You are ONLY protected if you start the next pack without a pill free break, emergency contraception is not required.

If more than seven pills are missed, the effect of the pills may have worn off. If you have had intercourse you will be at risk of pregnancy. If it is too late for emergency contraception you will need to see your doctor to test for pregnancy before re-starting the pill on the first day of your period.

Qlaira is a pill with 26 active tablets and just two inactive tablets. As there aren't 21 pills, the rules are different, please read and follow the manufacturer's missed pill advice in the patient information leaflet. Zoely has 24 active tablets, and 4 inactive tablets. Again special rules apply as per the manufacturer's patient leaflet.

Mini Pill (progesterone only pill)

Take your pill as soon as you remember - only take one, even if you've missed more than one pill. If you are more than 3 hours late (12 hours for desogestrel pills such as Cerazette) then contraception cover is not guaranteed and additional contraception is required for two days. Emergency contraception should be sought if there was unprotected sexual intercourse in the 2-3 days before the missed pills, or there has been intercourse since the missed pill(s).

When and how to restart your regular hormonal contraception

If Levonelle (levonorgestrel 1.5mg) is taken, then your pills are to be continued, a new contraceptive ring is to be inserted, or new contraceptive patch applied within 12 hours of taking your morning after pill. Hormonal contraception cannot be relied upon to provide contraception in the same menstrual cycle after Levonelle has been taken and an additional barrier method of contraception (condoms or caps) should be used for seven days with the patch, the ring, and the combined pill (nine days for Qlaira), and for two days with the progestogen-only pill.

If ellaOne is taken, you should wait for five days after taking ellaOne before taking your pill, inserting a new ring, or applying a new patch. Additional barrier contraception should be used during these 5 days and after re-starting hormonal contraception: with the patch, the ring, and the combined pill for seven days (nine days for Qlaira), and with the progestogen-only pill for two days.

Dr Fox supplies the morning after pill on prescription – you are required to answer a short medical questionnaire before your order can be completed.

Authored 29 November 2012 by Dr Tony Steele
Last updated 11 January 2021

Reviewed by Dr B. Babor, Dr A. Wood, Dr P. Hunt
Last reviewed 11 April 2018

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