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 is unable to supply contraception online to women aged 55 years and above. Women aged under 18 should contact their GP or a sexual health clinic.

Morning after pill (Levonelle and ellaOne)

Levonelle (levonorgestrel 1.5mg) and ellaOne (ulipristal acetate 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 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 the morning after pill more than once in a menstrual cycle should consult a doctor or specialist contraception advisor.

Regular contraceptive pills 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 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

Effectiveness of Levonelle and ellaOne

The most effective emergency contraception is provided by having a copper IUD (intrauterine device/coil) 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 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.

If ovulation has already occurred, morning after pills will not be effective. The timing of ovulation can be difficult to predict and therefore morning after pills should be taken as soon as possible after unprotected intercourse.

Some studies suggest Levonelle is less reliable in women who are overweight. Women with a BMI (Body Mass Index 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 start or restart 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.
• Sometimes after forgetting your regular contraceptive pill - see below.

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 5-7 days late a pregnancy test is required.

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.

Cautions

• 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 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.
  • EllaOne: Start/restart regular contraceptive pills/patches after 5 full days (120 hours).
  • Levonelle: Start/restart regular contraceptive pills/patches within 12 hours.
• 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.

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/coil) 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.

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

When and how to start or restart your regular hormonal contraception

Combined contraceptive pills, mini pills, contraceptive patches, and vaginal rings

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); and for 2 days condom use with the progestogen-only pill (mini pill).

ellaOne (ulipristal acetate 30mg)
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.

Further information: NHS Scotland - Emergency contraception.

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 26 March 2021

Reviewed by Dr A. Wood, Dr B. Babor, Dr P. Hunt, Dr D. Lee
Last reviewed 17 February 2021

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