1. What is emergency contraception?
Emergency contraception is contraception (sometimes known as birth control) that you use to prevent a pregnancy AFTER an episode of unprotected sex (sex without a condom or other contraception). There are different types of emergency contraception available in the UK and the best option for you will depend on a few different factors. We will discuss these factors below. The two main variations are:
Tablets – a single dose taken orally
Intrauterine device (IUD) – a device placed inside your uterus (womb) by a trained doctor or nurse
When should I use emergency contraception?
Emergency contraception should be used if you do not want to become pregnant and you have had unprotected sex.
You may also need to use emergency contraception if you are in any of the following situations:
You used a condom, but it broke/fell off
You are usually on a contraceptive pill, but you forgot to take your pill recently
You are usually on a contraceptive pill but have had a diarrhoea or vomiting illness in the last week
You have been taking medications that interfere with your contraceptive pill such as some antibiotics
You were late getting your contraceptive injection or having your implant replaced
What options do I have?
Emergency contraceptive pill (ECP) – often known as the “morning after” pill
There are 2 tablets available in the UK as emergency contraceptives – Levonelle and ellaOne
The ECP should be taken within 3 days (Levonelle) or 5 days (ellaOne) of when you had unprotected sex and the earlier you take it, the better it will work
Intrauterine device (IUD)
There are many IUDs available in the UK but the only one that is suitable for emergency contraception is the copper IUD
The IUD will be effective if it is placed up to 5 days after unprotected sex or up to 5 days after you could have ovulated (whichever is later)
The IUD should stay in place at least until your next period but it can stay in for 5-10 years (depending on the type of IUD) to provide you with long term contraception
The IUD is more effective at preventing pregnancy than the ECP
Depending on your risk of having a sexually transmitted infection, you may be given antibiotics to treat these infections at the time of IUD placement. This is to ensure that the infection is not carried into your uterus by putting the IUD in. Your doctor or nurse will discuss this with you
How does it work?
Sperm can survive in the vagina and uterus for up to seven days following sex. If the ovaries release an egg (ovulate) during this time, then pregnancy can occur.
Levonelle
Levonelle contains a compound called levonorgestrel. This is a man-made form of a hormone called progesterone which is usually produced by the ovaries
Levonelle works by delaying the time that your ovaries release and egg (ovulation). By delaying ovulation, the pill prevents you from becoming pregnant
It is important to note that if you have already ovulated then the ECP will not work. For this reason, your healthcare provider will ask you some questions to help work out whether this applies to you or not
ellaOne
ellaOne is made of ulipristal acetate which blocks progesterone from working in your body as usual
This also works by delaying ovulation
IUD
The IUD is a small device that is made of plastic and copper that is placed inside your uterus (womb) by a trained nurse or doctor
The copper in the device prevents an egg being fertilised or implanting in your uterus and, therefore, prevents pregnancy
Less than 1% of women who have an IUD fitted appropriately after unprotected sex will get pregnant
Who can take the emergency contraceptive pill?
There are very few reasons a woman would not be able to take the ECP. Even women who cannot take combined oral contraceptives (sometimes known as “the pill”) can take the ECP.
The most common reason for the ECP not being suitable is if you are taking other medications that may interfere with how well it works. These include things such as:
St John’s Wort
Medications for epilepsy, HIV, or antibiotics that are used to treat tuberculosis (TB)
Some medications that are used for acid reflux such as omeprazole
ellaOne may not work if taken with any of these medications. You may be able to take Levonelle, but you may need to take a higher dose than usual.
You should not take ellaOne if you have severe asthma that you take steroids tablets to control. This is because the ellaOne will decrease how well your asthma medication works.
It is important to discuss any medications you are taking with your healthcare provider and they will be able to advise you whether it is safe to take an emergency contraceptive pill.
The ECP will also come with an information leaflet that you should read before you take any medication.
Who can have an IUD?
Most women can have a copper IUD as the IUD does not contain any medication that could interact anything else you may be taking.
The IUD may not be a suitable option for you if you have a pelvic infection or sexually transmitted infection (STI) that has not been treated; if you have any problems with your uterus or cervix; or if you have any abnormal bleeding between your periods or after sex that has not been discussed with a doctor.
You should not have an IUD fitted if there is a risk you could already be pregnant, prior to this episode of unprotected sex.
Does emergency contraception continue to protect me against pregnancy?
Levonelle and ellaOne are one-off doses of hormones which means they do not continue working to prevent you getting pregnant. If you have further episodes of unprotected sex, you will need to take another dose of the pill. You can take more than one dose of the ECP per menstrual cycle, but they are not supposed to be used as long term pregnancy prevention. Please talk to your healthcare provider about alternative forms of contraception if you find you are needing the ECP frequently.
The IUD will continue to protect you against pregnancy for up to 5-10 years (depending on which type of IUD you have).
What are the side effects?
There are no long term or serious side effects associated with taking emergency contraceptive pills. They can cause some mild symptoms such as nausea, headache, pain in your tummy or vomiting.
It is important to see a healthcare professional if you vomit within 3 hours of taking the pill as you will need another dose or may need to change to using an IUD instead.
Because the pills change when you ovulate, your next period may be slightly earlier, later or more painful than usual. If your period is more than a week late and you think you might be pregnant you should see a doctor or a nurse.
It is important to see a doctor urgently if you have sudden pain in your pelvis or lower part of your tummy as, very rarely, a pregnancy can grow in the wrong place, outside your uterus. This is called an ectopic pregnancy and needs to be assessed by a doctor urgently.
Complications associated with having in IUD placed are very uncommon, however, they can include infection, damage to your uterus or the IUD falling out. If you are going to keep your IUD in to use as long term contraception, we recommend that you check that you can still feel the strings in the top of your vagina after each period.
Sometimes a copper IUD can make your periods heavier and more painful than usual. We do not recommend using a copper IUD long term if you already have very painful or heavy periods, but they can still be used on a short-term basis as emergency contraception if required.
Breastfeeding: There is no evidence that Levonelle causes harm to a baby if taken while breast feeding. It is recommended to take the tablet after feeding and avoid feeding for 8 hours after taking the tablet. The effects of ellaOne on breastfeeding have not yet been established so the company that makes the pills recommend that you do not breast feed for a week after taking this medication.
The IUD does not affect breastfeeding.
What is the chance it will work?
| Time since sex | IUD | Levonelle | ellaOne |
|---|---|---|---|
|
<72 hours |
<1% chance of pregnancy |
1-2% chance of pregnancy |
1-2% chance of pregnancy |
|
72-120 hours |
<1% chance of pregnancy |
Ineffective |
1-2% chance of pregnancy |
|
>120 hours |
<1% chance of pregnancy |
Ineffective |
Ineffective |
|
After ovulation |
<1% chance of pregnancy if <5 days since ovulation |
Ineffective |
Ineffective |
NOTE: Overall, the IUD is the most effective, followed by ellaOne and then Levonelle.
Where can I get emergency contraception?
Emergency contraception can be accessed for free from contraception clinics, sexual health clinics, most pharmacies, some GP practices, some youth health clinics, online pharmacies and most NHS walk-in centres or accident and emergency centres. Not all of these places will be able to fit an IUD so if this is your preference it would pay to call first and check.
If you are over the age of 16 you can also buy the ECP from most pharmacies. The cost is usually between £25-35.
Do I keep taking my usual contraception?
If you needed emergency contraception because you were concerned that your usual contraception had failed, run out or you forgot to take it then you will need to know what to do next.
If you have an IUD inserted as emergency contraception, you do not need to keep using your other form of contraception.
Please note that an IUD does not protect you against infections, so it is important to use condoms for this purpose.
After taking Levonelle, you should continue your regular contraception immediately. If you have taken ellaOne, you should wait for five days before continuing to use your regular contraception. During these five days you must use condoms or avoid having sex in order to avoid pregnancy. Some forms of hormonal contraception take up to a week to become effective so you must also use condoms or avoid sex until this time has passed. This will depend on the type of contraception you are using. Your doctor or nurse can give you more information about this.
Will the doctor tell my parents if I am under 16?
No. If you are under the age of 16 you can access confidential contraception care for free. As long as the healthcare professional believes that you can understand the information about contraception, and the decisions you are making, they will not talk to your parents or caregivers about it. They will encourage you to tell a trusted adult, but no one will force you to do this.
The only reason that a doctor, nurse or pharmacist, may need to tell someone else is if they are worried about your safety. This might be if they are worried that someone else could harm you or that you might harm yourself. They would discuss their concerns with you first before telling anyone else.
What else do I need to do?
It is recommended take a pregnancy test in three weeks or if your next period is more than seven days late, to ensure the emergency contraception has worked. Pregnancy tests are reliable as long as it has been at least 21 days since you had unprotected sex.
It is also recommended to have vaginal swabs for STIs in the near future in order to be sure that you have not picked up any infections. If the swabs show that you have an infection this will need to be treated.
If you feel unsafe, or someone has forced or coerced you into having sex with them without your consent there are many services that can provide you with support:
NHS 111
National Domestic Abuse Helpline 0808 2000 247 (available 24 hours)
Rape Crisis national freephone helpline 0808 802 9999 (12-2.30pm and 7-9.30pm every day)
The police, dial 101
In an emergency, dial 999
Your local hospital or A&E department
Your GP
A sexual health clinic
Please talk to your healthcare provider if you have further questions or would like to arrange some long-term contraception.