THE MORNING AFTER PILL: FACTS AND FICTION

Morning after pill

“The morning after pill is dangerous”. “You can’t take it more than once or twice in your lifetime”. “If you take it you won’t be able to become pregnant in the future”…

You may have heard all these rumours about the morning after pill and, in case “an accident” happens, you will think twice whether to take it or not… The truth is, the morning after pill has been around for more that 40 years now, but still many misconceptions and controversies persist.

In this article we will try to sort fact from fiction regarding the morning after pill in order to help you make your educated decision…

What is the morning after pill?

Emergency contraception by doctor emergency-contraception_171x200_M9201502The morning after pill, or post-coital pill is a form of emergency contraception that will prevent you from becoming pregnant after an unprotected intercourse, or if a condom breaks during intercourse.

In most countries, there are two types of emergency contraception pills (ECP):

-one containing levonorgestrel (LNG: Norlevo, Levonelle, Plan B, in different countries)

-another containing ulipristal acetate (EllaOne).

In many countries such as the UK, France, USA, you may be able to get it without a prescription.

How does it work? Does it cause abortion?

The morning after pill prevents pregnancy by temporarily blocking the egg from being released (that is, inhibits ovulation). In addition, it may stop fertilization. Some people are concerned that the ECP may prevent a fertilised egg from becoming implanted in the uterus, which may be considered as an early abortion. Recent studies have shown that this medication is not effective when ovulation has already occurred, thus it does not seem to prevent implantation. Furthermore, in case an implantation has already occurred before you took it, the morning after pill will not provoke an abortion.

Do I have to take it right away?

Actually “morning after” is a bit of a misnomer. The pills containing LNG (Norlevo, Levonelle, Plan B) can be taken up to 72 hours (three days) after the unprotected intercourse; EllaOne can be taken up to five days after. But the sooner you take it, the more effective it is (see below).

Is it effective?

Emergency contraception uhoh_poster_collageNeither type of morning-after pill is 100 per cent effective, but the failure rate is quite low. Like we said, you should take it as soon as possible after unprotected sex, no matter which pill you use. If you take LNG pills within the first 24 hours after sex, they reduce your risk of pregnancy by up to 95%; the efficacy will be reduced the more you delay the ingestion of the pill, roughly to 85% the 2nd day, 60% the third day. EllaOne seems to be slightly more effective than the LNG pill, and you can take it up to 5 days after an unprotected intercourse.

Will I get severe side effects?

Emergency contraception pills are very safe and do not harm future fertility. Side effects are uncommon and generally mild.

The most common side effects are nausea, vomits and menstrual abnormalities (your period may came earlier, later, with more or less blood than usual); more rare side effects are fatigue, breast tenderness, headache and abdominal pain.

There is some controversy as to whether the morning after pill is associated with an increased risk of ectopic pregnancy (a pregnancy outside the uterus, usually inside the fallopian tube). Available evidence suggests that ECPs do not increase the chance of ectopic pregnancy; moreover, like all contraceptive methods, ECPs reduce the absolute risk of ectopic pregnancy by preventing pregnancy in general.

Is there any limit to the number of times I can take it?

Emergency contraception womant taking 47929It has been suggested (mostly by internet rumours) that it could be dangerous to take the ECP more than one or twice in your life. The following is an excerpt from the World Health Organization’s (WHO) site which throws light on this subject:

“Emergency contraceptive pills are for emergency use only and are not appropriate for regular use as an ongoing contraceptive method because of the higher possibility of failure compared with non-emergency contraceptives. In addition, frequent use of emergency contraception can result in side-effects such as menstrual irregularities, although their repeated use poses no known health risks.”

In other words, you shouldn’t take the ECP very often because: 1) you’d rather take the regular contraceptive pills and you will be better protected from unwanted pregnancy; 2) you may get some abnormal periods; BUT NOT because it’s dangerous!

In fact, the Royal College of Obstetricians, says that the LNG pill can be used even more than once in the same cycle. However, it does not recommend taking EllaOne in this way because, being a newer medication, we have not enough evidence for repeated use in the same cycle.

If you find yourself using the morning after pill very often, it might mean that you haven’t yet found a regular method of birth control that works for you. In that case, talk to your doctor about some of your other options.

If ECP fails and I get pregnant, will it affect my unborn baby?

LNG have been used for many years, and evidence shows that there is no increased risk of birth defects or other effects on the baby. The evidence is less clear for EllaOne because is a newer medication. You may even take the LNG pill if you are breastfeeding (EllaOne is not recommended).

Some final warnings…

  • Emergency contraception keep-calm-and-take-the-morning-after-pill-7The ECP will protect you from an unwanted pregnancy, but it will not provide any protection from sexually transmitted diseases. It is very important that you are aware of safe sexual practices and  incorporate them into your relationships.
  • There is some evidence that the LNG pill might be less effective in women weighting 75kg or more, while the efficacy of EllaOne does not seem to be affected by body weight. Thus, if you are over 75 kg you may prefer to take EllaOne.
  • The efficacy of the ECP will be decreased if you vomit after taking it. If you vomit within 2 hours of taking LNG pill, or 3 hours of taking EllaOne, you will need to take it again.
  • Contraindications: according to the WHO: “There are no medical contraindications to the use of levonorgestrel emergency contraception pills”. Some experts advise against its use in women with severe liver disease.
  • Interaction with other medications: some medications may eventually reduce the effectiveness of the ECP: Saint John’s wort, barbiturates, rifampicin. Talk to your doctor if you are taking any of these medications.
  • When to see your doctor: although the ECP may delay your period, contact you doctor if your period doesn’t come some days after the expected time. Likewise, it’s very important that you see your doctor right away if you have irregular bleeding and abdominal pain, to rule out the possibility of an ectopic pregnancy.

The bottom line:

Emergency contraception plan B 1258645.largeThe emergency contraception pill is a safe and effective method of contraception. Most of the rumours you may have heard  about it are unfounded.

Having said that, it should not be abused.

The (very clever) brand name of the ECP in the USA, Plan B, indicates clearly how this medication should be used: as an option when your plan A (your regular contraception) failed…or wasn’t there.

Related reading:

Contraception: 14 common myths – busted

References:

World Health Organization: Emergency Contraception. Fact sheet N°244
July 2012

Trussell J, Raymond E, Cleland K; Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. March 2015

151 thoughts on “THE MORNING AFTER PILL: FACTS AND FICTION

  1. Hy I was a week away from my monthly periods I had sex with another guy on the 16 october with a condom than it broke leaving a piece behind,I did a preg test before taking the pill n it was negative, I took a morning after pill in 10-11 hours time in the morning than later at night on the 17 october I had unprotected sex continuaslly with my boyfriend. 4-5 days later on the 21-25 october I had my periods they were a bit heavy for 3 days ending with spotting the last 2days n yesterday I did a preg test n it read positive , I took a clear blue n it said positive 3+ . Is it possible that its the other guy that made me pregnant whilst i took the pill after him.

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    • Hi Yobho, the fact that you took the morning after pill doesn’t mean that you are 100% protected! In your case, may have got pregnant both the 16 or the 17 of October. At this point though, it’s impossible to know from whom you got pregnant…

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  2. I had my last period on 21-24th November and had unprotected sex on 15th of December and I took postinor 2 at 11am da next day.Am I really safe from pregnancy?!?

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    • Hi Babra, the morning after pill is about 95% effective when you take it within the first 24 hours, 85% when you take 24-48 hours after the unprotected intercourse. This means that the morning after pill is very effective, but not 100%.

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  3. I had unprotected sex with my boyfriend almost three days ago and have just taken the morning after pill with only a few hours before the cut off 72 hour period is it likely it hasn’t worked due to the timing any answers will be appreciated xx

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    • Hi Angel,
      The morning after pill is about 60% effective when taken the third day after the unprotected intercourse. But your chances of getting pregnant will also depend on the moment of the cycle you had the “accident”. For example, if the intercourse was during your fertile days your chances are higher, if your were right before your period your chances are low.

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    • Hi Vivian, since you took the pill within 24 hours of the unprotected intercourse, you have reduced your chances of getting pregnant by 95%. But you will be sure whether you are pregnant or not by the time you expect your period.

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  4. Hy. I had unprotected sex with my boyfriend on the 17th of February around 4:00am which happens to be the day I was ovulating. he released inside me. I took a post pill around 2:40 pm of the same day. please is the any possibility of me still getting pregnant because am really worried. Also today have been having some abdominal cramps, the type I do have when am menstruating. Awaiting your reply please.

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    • Dear Blessing, the morning after pill is very effective, but not 100%. Since you took it within 24 hours of the unprotected intercourse, you have reduced your chances of pregnancy by 95%. The cramping is most likely related to the pill.

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  5. Hi I had unprotected sex Feb 4 took ellaon Feb 7 then had unprotected sex Feb 9 ..Did the pill work ? Did I get pregnant after the pill ?? No period yet

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    • Hi Nikki, the morning after pill protects you against pregnancy when you take it AFTER sex. It is not clear for how long the MAP will keep working, so if you had sex again 2 days after taking it, you should have probably taken it again. In any case, if you don’t get your period by the time you are expecting it, take a pregnancy test, just in case. Keep in mind that if you find yourself having unprotected intercourse very often, a more regular contraceptive method will provide you much better protection.

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  6. Hi,
    My period was from 9th – 15th Feb and I had unprotected sex on the last day of ovulation (23rd Feb) and on 24th Feb. I took the morning after pill on 25th Feb in the morning but I still haven’t got my period. What are the chances that I am pregnant?

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  7. hi, it’s been atleast 12hours since I had unprotected sex with my boyfriend, and I’m scared of taking the morning after pill as Iam breastfeeding and fear the effects it will have on my baby. My question is will it cause any harm to my baby and cause her problems in future, she’s six months old right now?please advise I’m really anxious.

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    • Hi Penny,
      As I mentioned in the article the LNG pill (Norlevo, Postinor, etc) is safe for breastfeeding: “You may take the LNG pill if you are breastfeeding (EllaOne is not recommended)”.

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  8. Please help. My period came as expected 28 days later on the 1st of May. The condom broke on the 19th April and I took Norlevo the next day. The problem is that my period started off light brownish for about two days before actual blood (a few spoons of bright red blood p/day WITH DULL CRAMPS ) came on the 1st. On that 1st day of May i also started a regular combinationion pill called Biphasil. It is the 6th today and the bleeding and cramps have not stopped. I am getting worried as the bright colour of my period usually diminishes around the 4th day of my period. I am so scared because i can already imagine bleeding throughouth the entire month. What should i do?

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    • Hi Deseré, most likely what you are having is a menstrual irregularity due to Norlevo. However, if you keep having blood and cramps you should take a pregnancy test, just in case. If the test is negative, you can wait a few more days. But if you keep bleeding past few days, you should see a doctor.

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    • Hi Dianeishimwe, the morning after pill protects you against pregnancy when you take it AFTER sex. It is not clear for how long the MAP will keep working, so if you had sex again 1 day after taking it, you should have probably taken it again.
      Keep in mind that if you find yourself having unprotected intercourse very often, a more regular contraceptive method will provide you much better protection.

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    • The most common side effect if you take the morning after pill twice in a month is menstrual irregularities, that is, your period coming earlier, later, heavier or lighter.
      In any case, if you find yourself taking the morning after pill very often you’d rather take the regular contraceptive pills, which are more effective in preventing unwanted pregnancy.

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  9. We had sex and i took ECP 48hrs after the deed. 7 days later, Ive experienced withdrawal bleeding that lasted for 5 days. The last day of bleeding (or the day after) we’ve had unprotected sex again. He didnt ejaculate inside me but the pre cum makes me anxious. Should I take another set of ECP? Will my period be moved again or should i expect it to come on my regular period date even after the 2nd take of ecp?

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    • Hi anxiety, your chances of getting pregnant after withdrawal bleeding are very low. We cannot be sure when you will get your period again, whether you took it once or twice. In any case, you may consider a more permanent contraceptive method, so you will be better protected and less anxious 😉

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  10. Pls I had a sex on the 6 of August and took a contraceptive pill on dat same day and I saw my menstruation on 11 of dat Aug but sometimes days nw I be been having headache and abdominal pain Wot is really going on am scared

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  11. Hi I had unprotected sex with my boyfriend on the 25th I took nerlovo the following day, so my periods normally come the second week of the month today is the 3rd november I need to if I should be worried on not?

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  12. I had sex with my boyfriend on 1st of november at around 9pm, we he used a condom but it was removed accidentally ,,, and i took levonorgestrel on 2nd november but am still having abdominal pains… What is the problem? Am worried,, help me please.

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  13. Hi i had unprotected sex October 27 multiple times and he was cumming in me..then we had unprotected ses again the next day 1 time he came in me again.. i took the ella pill that night around 9 something..its now November 8 and my period is 2 days late.. can I possibly be pregnant??

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  14. Hi there ,I took emergency contraceptive within 24 hours of having unprotected sex and after two days of taking morning after pill I experience abdominal pain /back ache ,nausea and I pee often ,I want to know if I might if these are the side effect of pregnancy or morning after pill

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