THE MORNING AFTER PILL: FACTS AND FICTION

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UPDATED JANUARY 2018Morning 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 (ella in the USA, EllaOne in Europe).

In many countries such as the UK, France, USA, you may be able to get it (just LNG or both of them) without a prescription.

-When these ECPs are not available, certain ordinary birth control pills can be used as emergency contraception. The regimen is one dose of 4 to 6 pills -depending on the brand- followed by a second dose 12 hours later (the Yuzpe regimen, read more here). If you choose this method, though, it may be a good idea to talk to a health care provider for guidance.

–Mifepristone is another highly effective emergency contraception method, available in few countries. However, this medication is also used to induce medical abortion, which may limit its widespread acceptability for use as ECP.

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: you can take ECP up to five days following unprotected sex. 

Until recently, it was accepted that pills containing LNG (Norlevo, Levonelle, Plan B) should be taken within 72 hours (three days) after the “accident”. However, recent evidence shows that LNG pills continue to be moderately effective if started between 72 and 120 hours; therefore LNG ECP can be taken up to five days after unprotected intercourse.The same is true for EllaOne/ella: it can be safely used up to five days after non-protected sex.

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.

Recent studies have confirmed that EllaOne/ella is more effective than the LNG pill, not only when taken 3-5 days after an unprotected intercourse, but also within the first three days.

Will I get severe side effects?

Emergency contraception pills are very safe: no deaths or serious complications have been ever linked to their use. Moreover, emergency contraception pills do not harm future fertility.

In general, side effects are uncommon and generally mild: the most common are nausea, vomits and menstrual abnormalities (your period may come 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 ECP do not increase the chance of ectopic pregnancy; moreover, like all contraceptive methods, they 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 47929

It 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:

“There are no restrictions for the medical eligibility of who can use ECPs. Some women, however, use ECPs repeatedly (…) as their main method of contraception. In such situations, further counselling needs to be given on what other and more regular contraceptive options may be more appropriate and more effective. Frequent and repeated ECP use may be harmful for women with conditions classified as medical eligibility criteria (MEC) category 2, 3,or 4 for combined hormonal contraception or Progestin-only contraceptives (POC). Frequent use of emergency contraception can result in increased 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 IN MOST WOMEN, ECP ARE NOT DANGEROUS! 3) in case you have a severe health problems such as history of stroke, blood clots, certain cancers, etc, then you should avoid frequent and repeat use.

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 (although recent evidence indicates that it can be safely used more than once per 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 has been used for many years, and evidence shows that there is no increased risk of birth defects or other effects on the baby; new data supports that Ellaone/ella is as safe as LNG and no birth defects have been reported so far.

Can I take ECP if I breastfeed?

You may safely take the LNG pill if you are breastfeeding. Although EllaOne was not recommended during lactation until recently, updated guidelines state that ellaOne is not contraindicated for breastfeeding women, but that breastmilk should not be given to a baby for 24 hours (in the USA guidelines) or one week (in Europe) after a woman has taken the product.

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, among others.
  • 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

Fact or myth? Truths, half-truths and misconceptions about the Birth Control Pill

References:

World Health Organization: Emergency Contraception. Fact sheet N°244  June 2017

Trussell J, Raymond E, Cleland K; Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy. November 2017

173 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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  5. 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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  6. 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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  7. 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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  8. 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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  9. 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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  13. 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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  14. 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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  15. 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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  16. 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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  17. 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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  18. 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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    • Hello Sonya, it may still work, but its efficacy may be reduced.
      In fact, in most countries the two-dose pill (with 0,75 mg each) has been discontinued and only a single-dose 1,5 mg is available. Therefore, for next time you may consider taking both pills at the same time.

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  20. Hi. my last cycle ended on 08 January. I had unprotected sex with my hubby on 12 January, my ovulation date was 13 January. Then i took the morning after pill on 14 January. Im not sure how likely i am to get pregnant. I have a 15 month old so this isnt the ideal time.

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  21. Hi. I had my period on the 17th of March which ended around 4 or 5days after. Had unprotected sex on the 26th of March around 9am, took Levonelle around past 11am and then he came inside me unwittingly around 2pm. Should I be worried?

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    • Hi Cynthia, 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. In your case, that the unprotected intercourse was close to the moment you took the MAP, most likely it will be fine.

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  22. Hey .. just wondering i come off my period on Thursday, I had sex Friday in around 2 or 3 in the morning we had a condom on but it was off when we finished, not sure if it came off while he pulled out or not. I went around half 9 Saturday morning and got Elleone, I’m i okay? I have the meria coil in but can’t find the strings so I a waiting for be called to get them looked at?..

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  23. Hy, am 28 days cycle, had an unprotected sex with my boyfriend on my 12th day around 10pm and took Norlevo(morning after pill) on the 13th day around 7pm.
    am I really safe from pregnancy??
    on the 14th day also used pull out method.
    i would like to know how much safe i am.
    Thank You!

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    • Dear Sysy,
      The morning after pill is very effective, but not 100%. When taken within the first 24 hours after sex (like in your case), they reduce your risk of pregnancy by up to 95%.
      You should also know that the pull-out method is NOT an effective contraceptive method and does NOT protect you against sexually transmitted infections https://wp.me/p508D7-12p

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  24. I took Plan B TWICE in 3 days as advised by Planned Parenthood due to 2 broken condoms.

    I was 32 at the time and was propelled into menopause!! I am 39 now and still suffering – infertile and need to be on HRT permanently.

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  25. hi I had my period on the 2nd of June which lasted for five days.I had unprotected sex yesterday which was the 17th of June, I took Norlevo one hour after and in about two hours I still took menstrogen tablet.I am still very worried about my period.Its due on the 30th of June I am just scared because I was ovulating when I has the unprotected sex and I was made to understand that EC does not work when you are already ovulating.Could it be that the Norlevo and Menstrogen tablets I took was a waste of time?? I’m so worried because I was ovulating when I had unprotected sex…

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    • Hi Gina,
      I you were already taking Menstrogen tablets as instructed, then you should not be afraid and you did not need to take Norlevo. Menstrogen tablets work by avoiding ovulation, so you should be fine.
      If, on the contrary you STARTED taking Menstrogen on June 17 , then it will not work.
      Norlevo prevents pregnancy by blocking the egg from being released. Indeed, Norlevo does not seem to be effective when ovulation has already occurred. Furthermore, in case an implantation has already occurred before you took it, the morning after pill will not provoke an abortion.

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  26. I’ve taken Norlevo 32 hours after unprotected sex. i then took anguscaston (PMS) table about 20 hrs after the Norlevo and it says on the agnuscaston box that it shouldnt be taken with birth control pills.

    Will this effect the effectiveness of the norlevo? Im so scared

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    • Dear Amberlondt,
      According to some research I found, Agnucaston (chasteberry) seems to INCREASE the levels of progesterone. Therefore, the efficacy of Norlevo should not be reduced, on the contrary.
      In any case, there is not enough evidence to know for sure how chasteberry interacts with the morning after pill. Therefore, just to play on the safe side you should avoid this combination again in the future.

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  27. Hi I’ve had sex 14/7/18 about 10:12 pm which the condom brake and on the 15th 10:00 am I had to buy a morning after pill and took one 10:57am, on the following day I should have taken the other one 10pm in the night but I fall asleep before that time and end up taking it 2:01am on the 16th, but now I’m concerned will I still get pregnant for not taking the other on time?

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    • Dear Odisha, the morning after pills seem to be equally effective whether taken both doses at the same time, 12 hours apart (as recommended), or as long as 24 hours apart. Therefore, in your case you should be OK.
      In any case, you should keep in mind that the morning after pills are not 100 per cent effective at preventing pregnancy, although the failure rate is quite low when taking properly…

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  28. Hi! My fiancé and I had sex a day after my expected ovulation(sep 10) and used the pull-out method, but since we’re not sure if there were no sperm that went in, i took plan B an hour after the deed. Afterwards, i experienced nausea, vomiting(but did not vomit the pills) and fatigue. Could this mean i’m pregnant? What are my chances of getting pregnant?

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    • Hi Cayly, the symptoms you experienced are most likely caused by the morning after pill.
      Pregnancy symptoms would start about 2 weeks after conception, and generally nausea and vomits start even later, about une month after conception.
      Nevertheless, Plan B is not 100% effective, so if you don’t get your period when expected you should take a pregnancy test.

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