Emergency Contraception

There are two forms of emergency contraception -the morning after pill and the intrauterine device (IUD). There are two morning-after pill options - ellaOne and Levonelle. Despite their common name, they are effective for a more extensive period than the 'morning after'.

Morning After Pill

ellaOne is a tablet with a single dose of the synthetic hormone ulipristal acetate. It can be taken up to five days after unprotected sex and remains effective during that time period.

Levonelle is a tablet with a single dose of the synthetic hormone levonorgestrel. It can be taken up to 72 hours after unprotected sex, but the sooner it is taken the more effective it will be. In the first 24 hours, it is between 85-95% effective.

Another option is an intrauterine device (IUD).

Intrauterine device (IUD)

An IUD is a small flexible T–shaped rod that contains copper. It's placed in the womb to prevent pregnancy. Copper influences fluid in the womb so that an egg cannot survive. It also prevents eggs embedding in the womb lining.

An IUD can prevent pregnancy up to five days after unprotected sex, but it must be fitted by a trained nurse. It is over 99% effective.

Emergency contraception is highly effective if it's taken quickly. ellaOne is 98% effective up to five days after unprotected sex, whereas Levonelle (the original morning after pill) is less effective over time but will prevent 95% of pregnancies if taken with 24 hours. After two days it is 85% effective and after three days it is 58% effective.

An IUD is over 99% effective if it is fitted with five days of intercourse. It can be left in place after the fitting and used as a regular form of non hormonal contraception.

If you've had unprotected sex then you're at risk of becoming pregnant. Emergency contraception is available and is effective when taken quickly. You can take the morning after pill even if you are not suitable for the combined contraceptive pill because it is just one dose.

ellaOne can be taken up to five days after sex and Levonelle after three days, however, Levonelle's effectiveness drops each day you leave it. For peace of mind its recommend you take an emergency contraceptive as soon as possible to reduce the risk of pregnancy.

An IUD fitting needs to be booked, so it's important to seek out your doctor straight away if this is your choice.

If you've had unprotected sex then you are also at risk of developing a sexually transmitted infection. Some STIs produce no symptoms, such as chlamydia. It's worth booking a test to check. Many STIs can be treated simply with antibiotics.

Morning after pills contain a hormone that works in a similar way to daily contraceptive pills, but bear in mind morning after pills do not provide any contraceptive cover after you have taken them.

The hormones in both pills work by disrupting the menstrual cycle. They prevent the ovaries releasing an egg and alter the womb lining so a fertilised egg cannot implant. If there is no egg to fertilise then pregnancy cannot take place. By disrupting the cycle morning after pills can offer a high degree of effectiveness.

The large single dose of hormones means you should not use the morning after pill regularly or long term. Speak to your doctor about long-term contraceptives if you do not currently use one. There are many available to suit all women.

The morning after pill is available over-the-counter at a pharmacy. The pharmacist will need to ask you questions but can sell it without a prescription. You can also make a doctor's appointment, but bear in mind the time involved. Emergency contraceptive pills can also be bought from a reputable online pharmacy with a quick delivery timeframe. You will need to undergo an online consultation.

An IUD fitting is done at your doctor's surgery if they have a trained nurse or at your local contraception clinic. Book an emergency appointment straight away.

You'll know your emergency contraception has worked when you have a period. The morning after pill can disrupt your cycle so your standard period routine may not appear as usual. However, the morning after pill is highly effective if you take it early and do not vomit or have severe diarrhoea.

What should I do if I miss my period?

Waiting for your period after unprotected sex is nerve-wracking, and this stress could alter your cycle. If you have taken the morning after pill or started a new form of contraception then this could disrupt your cycle too.

The large dose of hormones can make your period earlier or later, but if you miss a period entirely take a pregnancy test.

Most women can use the morning after pill even if they are not suitable for the combined pill as it is just one single dose of hormones. Your doctor or pharmacist will advise if it's unsuitable.

If you are taking certain medications this may alter the morning after pill's effectiveness or the effectiveness of your current medications. Make sure you tell your pharmacist or doctor about all medications you are taking or have recently taken; this includes herbal remedies and over-the-counter treatments. You may need a higher dose of hormones or an IUD as an alternative.

Medicines that may interfere with the morning after pill include:

• Some HIV treatments
• Some antibiotics
• Medications with St Johns' Wort
• Some epilepsy medications
• Some TB medications
• Some antacids

Morning after pill side effects

Side effects can be experienced with the morning after pill, but many women do not have any. The single dose means the hormones do not build up in your body and cause a problem. If you do have side effects they are likely to be short-lived as your body will remove the hormones in its usual way.

Side effects experienced by some women are:

• Abdominal pain
• Headaches
• Spotting before their period
• Nausea
• Tiredness
• Breast tenderness
• Dizziness
• Headache
• Vomiting

Vomiting is a potential side effect of the morning after pill. If you do vomit within two hours of taking Levonelle or three hours of ellaOne you may need another dose or an IUD. Speak to your doctor as soon as possible.

In short, yes you should keep taking your usual contraceptive because the morning after pill does not provide any long-term contraceptive benefit. If you are not using regular contraception, it's a good time to consider your options.

• ellaOne – Take your next contraceptive pill, ring, patch for at least five days after taking ellaOne. You will need to use barrier contraception for seven days, or nine for some pill users.
• Levonelle – Take or use your usual contraceptive within 12 hours of taking Levonelle and then use barrier contraception for seven days or nine days with some contraceptive pills.

Using the morning after pill long-term or regularly is not advised because the dosage is high. If you need contraception there are plenty of methods available. Hormonal methods include the combined pill, the mini pill, the injection, the patch, the IUS and the vaginal ring. Non-hormonal methods include the IUD, a cap or diaphragm or a condom.

Remember that only a condom can protect you against STIs, so even if you are using another form of contraception to protect against pregnancy, you should use a condom too.

Speak to your doctor, local contraceptive clinic or pharmacist about the right one for you.