What is the morning after pill?

It is a pill to prevent pregnancy, which is taken after sexual intercourse has occurred. It is also called hormonal emergency contraception. There are two different types of morning after pill available, Levonelle/levonorgestrel and ellaOne/ulipristal. Having a copper IUD (coil) inserted can also prevent pregnancy after sex has happened and is the most reliable form of emergency contraception.

When is the morning after pill needed?

The morning after pill is used if you have had sexual intercourse without an effective form of contraception. This could be because:

• Contraception wasn't used.
• A condom has split or come off.
• A cap or diaphragm was used incorrectly.
• Using the withdrawal method failed.
• Sometimes after forgetting regular contraceptive pills, contraceptive patch or ring.
• The next implant, coil, or depot injection has been delayed.

How does the morning after pill work?

Morning after pills work mainly by delaying or stopping ovulation. Sperm survive for up to 5 days after intercourse. If ovulation does not occur during that time, fertilisation and pregnancy will not happen.

Does the morning after pill cause abortion?

No, the morning after pill does not cause an abortion, it prevents conception (fertilisation of an egg). The morning after pill will not cause abortion if you are already pregnant.

How soon should I take the morning after pill?

Take the medication as soon as possible after sex, not necessarily the next morning. Levonelle/levonorgestrel may be more effective the sooner it is taken. It can be taken up to 72 hours (3 days) after sex. ellaOne/ulipristal 30mg is usually effective when taken any time up to 120 hours (5 days) after sex.

How likely am I to get pregnant from having sex once, if I have not used any contraception at all?

The answer to this varies depending on the day in your monthly cycle that you had sex, your age and your fertility. There is a greater chance of pregnancy close to ovulation, which tends to be 14 days before the next expected period. However, ovulation is not always predictable and can occur at any point during a cycle, so emergency contraception is advised throughout. Averaged out over the whole month, estimates are that each single episode of sex has a 1 in 20 chance of leading to pregnancy.

How effective are morning after pills?

Emergency contraception reduces the risk of pregnancy after unprotected sex, but it is not completely effective.

ellaOne (ulipristal 30mg): Clinical data suggests it prevents approximately 6–8 out of 10 expected pregnancies. In practice, around 1–2 in 100 women who take ellaOne within a cycle will become pregnant.

Levonelle (levonorgestrel 1.5mg): When taken within 72 hours, the overall pregnancy rate is approximately 0.6% to 2.6%. This means that about 1–2 in 100 women who take Levonelle within a cycle will become pregnant.

Effectiveness depends on timing. It is best to take either treatment as soon as possible after sex, before ovulation occurs, and ellaOne may be more effective, particularly closer to ovulation.

Which morning after pills are available in the UK?

There are 2 types of morning after pill available:

• Levonorgestrel 1.5mg - a synthetic version of the naturally occurring hormone progesterone. This is produced under several names: Levonelle, Levonelle One Step, Ezinelle, and generic levonorgestrel 1.5mg.
• Ulipristal acetate 30mg (brand name ellaOne) - a selective progesterone receptor modulator (SPRM) which blocks natural progesterone function. This is also available as unbranded ulipristal 30mg.

Where can I get the morning after pill from?

There are several options. Dr Fox supplies Levonelle, generic levonorgestrel 1.5mg, ellaOne, and generic ulipristal 30mg for standby use. See morning after pill page.

Morning after pills are also available from an NHS walk in centre, GP or sexual health clinic or from most pharmacies without prescription.

To find a local pharmacy which provides emergency contraception, send an SMS TXT:

'Pharmacy emergency contraception [and your post code]' to 80011
You will get a text response with the 3 nearest pharmacies with their names, addresses, telephone numbers and distance from the post code you entered.
Standard text message rates from your provider may apply when using this service.

Further information available at NHS - Where can I get emergency contraception?

Which morning after pill should I take?

This depends on the following:

• Time since sex took place – Levonelle/levonorgestrel 1.5mg is effective if taken up to 72 hours (3 days) after unprotected intercourse, ellaOne/ulipristal 30mg up to 120 hours (5 days).
• Frequency of use – women requiring emergency contraception more than once in a menstrual cycle should consult a doctor or specialist contraception advisor.
• Whether you usually use a hormonal contraceptive – both ellaOne/ulipristal 30mg and Levonelle/levonorgestrel 1.5mg interfere with regular contraceptive pills (both combined and progesterone only), patches, and rings, but ellaOne/ulipristal 30mg disrupts their function for longer.
• Health issues – ellaOne/ulipristal 30mg can stop steroid tablets from working, so should not be taken if severe asthma is being controlled by steroid tablets. In severe liver disease, neither morning after pill is advised, and a copper IUD (coil) is recommended.
• Other medicines – some medicines interact with both pills. These medicines are specified in the online consultation. Progesterone in other medicines affects ellaOne/ulipristal 30mg.
• Cost – ulipristal 30mg costs significantly more than levonorgestrel 1.5mg. See prices on morning after pill page.

Compare ellaOne/ulipristal 30mg and Levonelle/levonorgestrel 1.5mg

How long after unprotected sex do I have to take the morning after pill?

Levonelle/levonorgestrel 1.5mg should be taken within 72 hours (3 days) and ellaOne/ulipristal 30mg within 120 hours (5 days) of sex. It is advised to take it as soon as possible.

Do I need to use emergency contraception if I am breastfeeding?

Maybe. Breastfeeding can be a contraceptive in itself and is over 98% at preventing pregnancy. These conditions must be met however:

• Baby under 6 months old.
• No period since birth.
• Fully breastfeeding only, with less than 4 hours between feeds during the day and 6 hours at night.

Women may consider not to use emergency contraception if these apply.

Further information from The Breastfeeeding Network.

Does the morning after pill prevent STIs?

No, only a physical barrier such as condoms will prevent STIs (sexually transmitted infections). If you need the morning after pill and are also concerned about being at risk of catching an STI, contact your GP or local sexual health clinic for a full STI screen.

Local NHS Sexual Health Clinics

• England
• Wales
• Scotland
• Northern Ireland

If I drink alcohol before or after taking a morning after pill, will it be less effective?

No, there is no effect of alcohol on the morning after pill. Alcohol can indirectly affect contraceptives – e.g. causing you to forget to use them, or not putting on a condom correctly. Drinking alcohol can also impact your decision making around choosing to have sex. See also Getting it on - Alcohol and unprotected sex.

What other emergency contraception is available?

The copper IUD (intrauterine device or coil) can be inserted into the womb to prevent implantation. It is effective up to 120 hours (5 days) after unprotected sex, or 5 days after expected ovulation (egg release). It is the most effective form of emergency contraception, although can be harder to access than a pill. IUDs can be fitted by a trained healthcare professional at sexual health clinics and some GP surgeries.

An IUD can be left in place as a regular method of contraception, or it can be removed during the next period.

What if I vomit after taking my morning after pill?

If you're sick/vomit within three hours of taking the morning after pill, the medicine cannot be guaranteed to work and you will need to take another dose or have an IUD fitted.

What if I took the morning after pill and then had unprotected sex the next day?

You would not be protected and would need a further dose. You are not protected for the rest of that monthly cycle, as the morning after pill only delays ovulation, and does not stop it completely. It is therefore best to start a regular form of contraception as soon as possible after taking the morning after pill.

When will my next period come if I have taken a morning after pill?

Levonelle/levonorgestrel 1.5mg and ellaOne/ulipristal 30mg can make your period a few days earlier or later than usual. Your next period should start within the next month. If, after using emergency contraception, a completely normal period (not lighter, or much more painful, than usual) does not start within 5-7 days of when expected, take a pregnancy test.

Are you more likely to have an ectopic pregnancy if you take the morning after pill?

There is a risk that any pregnancy can be ectopic (growing outside the womb, usually in the fallopian tubes).

If you have had an ectopic pregnancy in the past or have damage to your tubes, possibly from a chlamydia infection, it is more likely that a pregnancy could be ectopic.

When a copper IUD (coil) or hormonal coil (IUS) is used for contraception, it is more likely that any pregnancy occurring would be ectopic.

If you take the morning after pill you are much less likely to get pregnant. There is no difference in the proportion of pregnancies which would be ectopic, so the answer is no you are not more likely to have an ectopic pregnancy after taking the morning after pill.

Can I buy emergency contraception in advance in case I need it?

Yes, morning after pills are often more effective the sooner they are taken. Avoiding the delay in obtaining your medicine will decrease the risk of pregnancy. They can be purchased in advance online.

Emergency contraception is not as effective as regular contraception. If you are not using regular contraception and need it, you should see your GP or local sexual health clinic. A combined contraceptive or progestogen only pill (mini pill) can also be ordered online if you are suitable.

How often can I take the morning after pill?

In some circumstances morning after pills can be used more than once in the same cycle, but advice from your GP or a specialist contraception advisor is needed. In general it is better to use a regular form of contraception than use the morning after pill frequently. Using a Long Acting Reversible Contraceptive (LARC) such as an implant, depot injection, copper IUD(coil) or hormonal coil (IUS) is much more reliable and doesn't depend on you remembering it, for it to work. You should not take Levonelle/levonorgestrel and ellaOne/ulipristal in the same menstrual cycle as they can interact and prevent the other from being effective.

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

In some instances missing pills can lead to loss of contraceptive cover and you need to use extra contraception such as condoms.

When emergency contraception (EC) is needed after missing pills

Combined oral contraceptive pill (COC)

If EC is required, condoms will continue to be needed until after 7 days of correct combined oral contraceptive pill use.

Missed pill situation	Need for emergency contraception
Late restart after week off pills - over 9 days since last pill	EC needed for any sex without condom since last pill
1 missed pill anywhere in pack	No EC needed if all other pills taken correctly
2-7 missed pills in week 1	EC needed for any sex without condom, since last full pack of pills
2-7 missed pills in weeks 2 or 3 (or later weeks if taking pills continuously)	No EC needed if all other pills taken correctly
More than 7 pills missed at any time	EC needed for any sex without condom

Progestogen only pill (POP)

If EC is required, condoms will continue to be needed until after 48 hours of correct progestogen only pill use.

Missed pill situation	Need for emergency contraception
More than 12 hours late with desogestrel pill (e.g. Cerazette, Cerelle, Hana, Lovima)	EC needed for any sex without condom, before next 2 pills have been taken correctly, i.e. between 12 hours from last pill to 48 hours from restarting pills
More than 3 hours late with traditional progestogen only pill (rarely prescribed, e.g. Noriday, Norimin)	EC needed for any sex without condom, before next 2 pills have been taken correctly, i.e. between 3 hours from last pill to 48 hours from restarting pills

Depot contraceptive injection, implant, contraceptive patch, contraceptive vaginal ring

Emergency contraception can sometimes be needed if any of these are used incorrectly or not renewed at the correct time.

Depot contraceptive injection:

• EC is recommended if your injection is more than 14 weeks and 1 day since your last dose and you have had unprotected sex.

Contraceptive implant:

• The implant is very reliable while in date.
• EC may be needed if it has expired or been removed, and you have had unprotected sex.

Contraceptive patch:

• Less than 48 hours: Reapply patch or use a new one and change patch on usual day, no extra contraception is needed.
• More than 48 hours, the need for EC depends on timing in your cycle:
• Week 1 (or more than 8 days since your patch-free break): Highest risk. If the patch has been off for more than 48 hours and you have had sex, use EC.
• Week 2 or 3: More than 48 hours but less than 7 days, if the patch was used correctly before this, EC is usually not needed, but use condoms for 7 days.
• After the patch-free week: If you forget to apply a new patch on time, apply one as soon as possible and use condoms for 7 days. Consider EC if you had sex during the delay.

Contraceptive vaginal ring:

• Week 1 or more than 8 days since your last ring: If you have had sex, use EC.
• Week 2 or 3 less than 8 days total break: If the ring was used correctly for the previous 7 days, EC is usually not needed, but insert a new ring and use condoms for 7 days.

When and how do I start or restart 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.

Do morning after pills contain lactose?

Yes both types of morning after pill contain lactose and should not be used if you are severely lactose intolerant.

How do I get an emergency contraceptive coil fitted?

An emergency coil is an alternative to taking the morning after pill. They can be fitted up to 5 days after sex or up to 5 days after expected ovulation (up to about 9 days before your next expected period).

Many GPs offer a routine coil fitting service though it may be difficult to arrange an emergency fit and they may refer you elsewhere.

Sexual health clinics can also arrange an emergency coil fit, but get in touch as soon as possible as clinics can be busy.

Does taking a painkiller with the morning after pill make it more effective?

Recent research in Hong Kong (August 2023) has shown that taking the painkiller piroxicam with the levonorgestrel morning after pill prevents significantly more pregnancies than taking levonorgestrel on its own.

Anti-inflammatory painkillers, like piroxicam, block prostaglandins which cause inflammation and pain. Prostaglandins also play a part in ovulation, fertilisation and embryo implantation and so researchers looked at whether a painkiller may assist the effectiveness of the morning after pill.

Due to safety concerns, piroxicam use has been restricted in Europe and the UK since 2007, and it is not yet known if other safer anti-inflammatory painkillers will have the same effect.

Because of this, the College of Sexual and Reproductive Health have stated that, although this is exciting research, more studies need to be done, before they would recommend adding a painkiller to the morning after pill. For now, a copper IUD (coil) remains the most effective emergency contraceptive.