Morning After Pill

What is the morning after pill?

The morning after pill is a form of emergency contraception that is taken following unprotected sex to avoid pregnancy. Sex is considered unprotected if you do not use a contraceptive or if a contraceptive fails i.e. a condom breaks or slips or you miss a birth control pill etc.

How does it work?

Most varieties of the morning after pill contain synthetic hormones. These hormones help to prevent implantation of an egg cell after it is released during ovulation. They do this by making the lining of the uterus (womb) inhospitable to the fertilized egg, and also by interfering with how the fertilized egg cell moves down the fallopian tube (tube connecting the ovaries and uterus) so that the fertilised egg arrives too late or dies before it can implant itself. There is some limited evidence that suggests that the morning after pill may also inhibit ovulation, preventing fertilisation from occurring in the first place.

Who can take the morning after pill?

The Morning After Pill can be taken by women who are not pregnant, but who also wish to avoid pregnancy. Even women who cannot take oral contraceptive pills because of medical conditions like liver disease, smokers, high blood pressure, heart disease or women who are over 35 can take the morning after pill [6].

How effective is it?

The morning after pill is 89-95% effective if taken within three days of unprotected sex. The earlier you take the morning after pill the more effective it will be.

How many times can I take it?

The morning after pill should not be used as a method of regular contraception. The pills contain high levels of hormones and the long term effects of regular use has not yet been assessed.There is no formal limit on the amount of times you can take the morning after pill, but it is less reliable than other methods of contraception i.e. the contraceptive pill.

How will I know if it has worked? (early signs of pregnancy)

The morning after pill can alter your next period making it earlier, later, lighter or heavier than usual. This can also happen if you are pregnant, therefore it is recommended that you also take a pregnancy test 3 weeks after taking the pill. If your periods do not return to normal after the first month, you may wish to take another pregnancy test and speak to your doctor for advice.

If the morning after pill has failed, you may be pregnant. Early signs of pregnancy include:

• Light bleeding, instead of your period
• Nausea
• Vomiting
• Tiredness
• Feeling emotional
• Breast tenderness
• Altered taste
• Heightened sense of smell
• Cravings

How to give the morning after pill the best chance of working

To give the morning after pill the best chance of preventing pregnancy, you should take it as soon as possible after unprotected sex. It is a good idea to keep a morning after pill at home, so you can take it straight away if you need to.

You should also be aware of any medications that may interact with the morning after pill. If you are taking these, you should speak to your doctor about your options. Finally, you should also avoid doing anything that might exacerbate the side effects of the morning after pill, especially nausea. If you vomit within a 1-3 hours of taking the morning after pill, it may not have been properly absorbed. It is a good idea to avoid drinking alcohol, as this can increase nausea and make you more likely to vomit.

Morning after pill vs IUD

The morning after pill is more effective the sooner you take it after having unprotected sex. Most pills are only effective up to 72 hours after unprotected sex, but the IUD (copper coil or intrauterine device) can be fitted up to 120 hours after unprotected sex and is 99% effective at preventing pregnancy. The IUD can be left in place for 5-10 years as a regular method of contraception to protect you from unwanted pregnancy.

Options for emergency contraception include:

• Progestin-only pill i.e. Plan B-One Step or My Way. Progestin-only pills are a good option to avoid the side effects associated with estrogen i.e. nausea. Progestin-only types are only effective if taken within the first 3 days after unprotected sex, so if you leave it longer you will need to take a Levonorgestrel type, such as Ella, which is effective up to 5 days after unprotected sex. Some varieties of progestin-only pills are taken as a single dose, others are two pills. If you take two pills, they can be taken together as a single dose or one pill can be taken first, followed by the second pill 12 hours later. Plan-B One Step is available without a prescription, but My Way is only available without a prescription to people over the age of 17 (ID is required).
• Combined estrogen and progestin pills. These pills are often also daily birth control pills (combined oral contraceptive pills). If you take your first dose within 120 hours of unprotected sex and your second dose 12 hours later, they can be used as an emergency contraceptive. A doctor should be able to tell you the number of pills you would need to take - this is dependent upon the strength of each pill. Each dose will need to contain at least 100mcg of estrogen and 0.5mg of progestin. Please see this table for more information about which birth control pills can be used and how they can be used for emergency contraception: https://ec.princeton.edu/questions/dose.html#dose
• Selective progesterone receptor modulator (ulipristal acetate) Pill i.e. Ella. This is more effective than other types of morning after pill if taken outside the first 24 hours after unprotected sex. Ella is thought to be 95% effective at preventing pregnancy up to 120 hours after unprotected sex. A prescription is required. It cannot be used by patients with liver or kidney disease [7] and there is limited knowledge about the specific effects of Ella on a fetus if you are already pregnant. [8]
• Copper intrauterine device (IUD). This is the most effective form of emergency contraception available, but it does requires an examination, it has risks [1] and you can’t insert it yourself. It can also be placed up to 120 hours after unprotected intercourse [2] and it is still 99% effective. It can be left in place for 5-10 years to act as a contraceptive.

Please note: Emergency contraception is not effective if implantation has already occurred [3].  If the method fails to prevent pregnancy, hormones in the emergency pills will not hurt the fetus or the ongoing pregnancy since the hormones will be long gone by the time the embryo develops a blood supply [4, 5].

Side effects

Side effects of the morning after pill can include:

• Headache
• Earlier or later next period
• Breast soreness
• Nausea and vomiting - this is less common with progestin-online pills [10].

Important information:

• If you vomit within 1-3 hours of taking the morning after pill, you may need to take another dose [11,12].
• If you do not have a period within 21 days of taking the morning after pill, you may be pregnant. You should take a pregnancy test to confirm.
• Ulipristal acetate pills can decrease the effectiveness of birth control pills and other forms of hormonal contraception. Therefore, it is important to use condoms if you have sex during the rest of your menstrual cycle.

Do I need a prescription for the morning after pill?

Most types of morning after pill do require a prescription, but Plan B-One Step is currently available without a prescription.

Are morning after pills dangerous?

As with all medications, the morning after pill can cause side effects, however these are usually not dangerous and should not cause any serious health problems. If you are still concerned, you should speak to your doctor about alternatives. 

How does the morning after pill affect your period?

The high dose of hormones in the morning after pill means that it can temporarily affect your period. Many women report that their periods come up to a week earlier or later than usual, or that the experience unexpected bleeding between periods. If you miss a period, it is a good idea to take a pregnancy test. 

Can the morning after pill cause ectopic pregnancy?

There is no evidence to suggest that using the morning after pill can increase your risk of ectopic pregnancy. Conversely, as the morning after pill reduces your overall risk of pregnancy, it also reduces your chances of having an ectopic pregnancy.

Can you take the morning after pill if you’re on birth control pills?

Some morning after pills, such as Plan B, are safe for use even if you are currently using another form of hormonal birth control, such as the pill. However, you should check with your doctor first if you are using any hormonal birth control. 

Will the morning after pill harm a pregnancy?

The morning after pill is not recommended for use during pregnancy as there may be associated risks. However, the morning after pill is not an abortion pill and should not cause any harm to the fetus. If you take the morning after pill, but you still become pregnant, the pregnancy should not be harmed in anyway.