Protect yourself from pregnancy discreetly with the morning after pill

Accidents can happen to everybody. The morning-after pill can significantly improve your chances of there not being consequences, but you’ll need to take it within 72 hours after sex. 

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Reviewed by Dr Roy Kedem, MD

Information last reviewed 12/18/19

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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 (see below). If you are taking medication which can potentially interact with the morning after pill, you should speak to your doctor about other 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.

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).

How does it work?

Most varieties of the morning after pill contain synthetic hormones which work 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 by interfering with the movement of the fertilized egg cell down the fallopian tube (tube connecting the ovaries and uterus).  This in turn causes the fertilized egg to arrive too late or expire 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 non-pregnant females who wish to avoid pregnancy. This includes women who cannot take oral contraceptive pills due to medical conditions such as liver disease, high blood pressure or heart disease.  Women who are over 35 or smoke cigarettes can also take the morning after pill.

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 effect 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 oral contraceptive pill)

How to give the morning after pill the best chance of workin...

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.

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 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 consult your doctor.

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

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

Treatment

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 such as nausea. They are only effective if taken within the first 3 days after unprotected sex.  If you waited longer, you will need to take a Levonorgestrel-type pill, 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, while My Way is available without a prescription to people over the age of 17 (ID is required).
  • Combined estrogen and progestin pills. These pills are prescribed as 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, which 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). Copper intrauterine device (IUD).  This is the most effective form of emergency contraception available.  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, however it does require an in-person examination, has risks and cannot be inserted manually.

Type

Ingredients

Brands

Efficacy

Time Frame

Features

Single progestin-only pill

1.5mg levonorgestrel

Plan B-One Step,
My Way

95% within 24 hrs. 89% within 72 hrs

Up to 72 hrs

Available without prescription

Two progestin-only pills

2 x 0.75mg levonorgestrel

Take Action, My Way, After Pill

95% within 24 hrs. 85% within 25-48 hrs. 58% within 49-72 hrs

Up to 72 hrs

Can be taken together as a single dose or the first pill, followed by the second pill 12 hours later.

Estrogen & Progesterone pills

Ingredients vary depending upon brand. At least 100mcg estrogen and 0.5mg progesterone per dose.

All brands of combined oral contraceptive pill

Up to 94% effective if first dose taken within 120 hours More effective if taken earlier.

Up to 120 hours

Can be taken in multiple doses 12-24 hours apart

Selective progesterone receptor modulator

30mg ulipristal acetate

Ella

95% effective within 120 hours

Up to 120 hours [1]

Taken as a single dose. Not suitable for patients with severe kidney or liver disease [7]. Limited knowledge of possible effects on pregnancy [8]

Please note: Emergency contraception is not effective if implantation has already occurred.  If the medication fails to prevent pregnancy, the hormones in the pills will not harm the fetus as they will be eliminated by the time the embryo develops a blood supply. 

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.

Important information:

  • If you vomit within 1-3 hours of taking the morning after pill, you may need to take another dose.
  • 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 for confirmation.
  • 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 after taking Ulepristal acetates and prior to your next period..

Q&A

Disclaimer: This is not medical advice. You and your physician will determine if and how you should take any medication prescribed to you following a medical consultation.

  1. Cheng L, Che Y, Gülmezoglu AM. Interventions for emergency contraception. Cochrane Database Syst Rev. 2012. 8: CD001324. [Medline].
  2. Lee JK, Schwarz EB. The safety of available and emerging options for emergency contraception. Expert Opin Drug Saf. 2017 Oct. 16 (10):1163-1171.
  3. Committee opinion no. 505: understanding and using the U.S. Medical Eligibility Criteria For Contraceptive Use, 2010. Obstet Gynecol. 2011 Sep. 118(3):754-60.
  4. Bracken MB. Oral contraception and congenital malformations in offspring: a review and meta-analysis of the prospective studies. Obstet Gynecol. 1990 Sep. 76(3 Pt 2):552-7.
  5. Zhang L, Chen J, Wang Y, Ren F, Yu W, Cheng L. Pregnancy outcome after levonorgestrel-only emergency contraception failure: a prospective cohort study. Hum Reprod. 2009 Jul. 24(7):1605-11.
  6. U S. Medical Eligibility Criteria for Contraceptive Use, 2010. MMWR Recomm Rep. 2010 Jun 18. 59(RR-4):1-86.
  7. Koyama A, Hagopian L, Linden J. Emerging Options for Emergency Contraception. Clin Med Insights Reprod Health. 2013 Feb 18. 7:23-35.
  8. Gemzell-Danielsson K, Rabe T, Cheng L. Emergency contraception. Gynecol Endocrinol. 2013 Mar. 29 Suppl 1:1-14.
  9. Gemzell-Danielsson K, Berger C, P G L L. Emergency contraception -- mechanisms of action. Contraception. 2013 Mar. 87(3):300-8.
  10. Shen J, Che Y, Showell E, Chen K, Cheng L. Interventions for emergency contraception. Cochrane Database Syst Rev. 2017 Aug 2. 8: CD001324.
  11. The U.S. Selected Practice Recommendations for Contraceptive Use, 2013: adapted from the World Health Organization selected practice recommendations for contraceptive use, 2nd edition. MMWR Recomm Rep. 2013 Jun 21. 62(RR-05):1-60.
  12. Curtis KM, Jatlaoui TC, Tepper NK, Zapata LB, Horton LG, Jamieson DJ, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR Recomm Rep. 2016 Jul 29. 65 (4):1-66.
  13. https://ec.princeton.edu/info/combecp.html

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