Emergency Contraception

What is emergency contraception?

Normally, contraception is used to prevent a pregnancy before you’ve even had sex, by preventing the exchange of bodily fluids or hormonally disrupting the menstrual cycle.¹ Using long-term birth control, such as birth control pills or the contraceptive implant, is the most effective way to prevent a pregnancy.²

There are some circumstances, however, when you may need to prevent a pregnancy after you’ve had sex.^2,3 For example, if:^2,3

• You have had unprotected sex
• Your birth control method has failed (e.g. A condom has split, or you forgot to take your birth control pills)
• You've experienced non-consensual or forced intercourse (rape)

If this is the case, you can use emergency contraception within 3–5 days to temporarily prevent a pregnancy.^2,3 However, the sooner you use it, the more effective it’s likely to be.³ Research indicates that most emergency contraception methods work best when used within 24 hours.²

Importantly, emergency contraception does not protect against sexually transmitted infections (STIs).⁴ You can find out more about the different methods of contraception, including those that can protect against STIs, with Chemist4U.

It is essential to understand that we are only able to provide emergency contraception for advanced use. If you require emergency contraception for immediate use, please visit NHS Online to search for pharmacies near you. 

Where to get emergency contraception?

If you live in the UK, you can get emergency contraception for free on the NHS from:^3,4,5

• Sexual health clinics
• GP surgeries
• Some NHS walk-in centres
• Pharmacies
• Some young people's services

During your consultation, a healthcare provider may want to know:

• When you’ve had unprotected sex in your current menstrual cycle
• The date of the first day of your last period and how long your cycle usually is
• If you’ve used any contraception and how it’s failed (such as if you usually take the combined pill [e.g. the Rigevidon pill], how many pills you may have missed and when)
• If you’ve used any medications that may affect your contraception

Many pharmacies are also able to provide an initial 3-month supply of the progestogen-only pill (also known as the mini pill, desogestrel pill or Cerelle pill) without a prescription.⁴ This could be useful if you want to avoid the need to use emergency contraception again.⁴

Methods of emergency contraception

There are two main forms of emergency contraception:^4,6

• The emergency contraceptive pill (also known as the morning after pill)
• The copper coil (intrauterine device or IUD)

Emergency contraception pill

The emergency contraceptive pill is suitable for most people who can get pregnant, including those who can’t use hormonal contraception and those under the age of 16.⁴

There are two types of emergency contraception pills:^2,4,6–9

Levonelle

Levonelle contains levonorgestrel (a type of progestin), which needs to be taken within 72 hours (three days) of having unprotected sex.

If taken prior to the start of your luteinizing hormone (LH) surge (which triggers ovulation), levonorgestrel works by inhibiting ovulation for the next five days, until any sperm released during unprotected sex are no longer viable. However, if it is taken during your late follicular phase, just before ovulation occurs, levonorgestrel is ineffective.

If you vomit within two hours of taking levonorgestrel, it may not work. You should seek medical advice to find out what to do in this situation.

This pill can cause your period to start earlier or later than usual. You can take Levonelle while breastfeeding.

ellaOne

ellaOne contains ulipristal acetate, which needs to be taken within 120 hours (five days) of having unprotected sex.

Ulipristal acetate acts by delaying ovulation for at least five days, even after the start of your LH surge, until any sperm released during unprotected sex are no longer viable.

ellaOne is thought to be more effective than Levonelle. However, ellaOne won’t work if you’re already taking:

• St John’s Wort (a herbal medicine)
• Some epilepsy medications
• Some HIV medications
• Some medicines used to treat tuberculosis (TB)
• Some medicines like omeprazole (an antacid), which is used to make your stomach less acidic

Additionally, you shouldn’t take ellaOne if you:

• Are allergic to any of the components of the drug
• Have severe asthma that is treated with steroid tablets (glucocorticoids)
• Have certain rare hereditary problems with lactose metabolism
• Are taking liver enzyme-inducing medication

If you vomit within three hours of taking ellaOne, it may not work. You should seek medical advice to find out what to do in this situation.

This pill can cause your period to start earlier or later than usual. You should not breastfeed for one week after taking ellaOne.

The copper coil (IUD)

Up to ten times more effective than emergency pills, the copper IUD is the most effective method of emergency contraception.^6,7,10 It is a small T-shaped plastic and copper device that’s inserted into your womb (uterus) by a doctor or nurse.⁴

The copper IUD inhibits fertilisation by having a toxic effect on the sperm and eggs.⁷ If fertilisation does occur, it also has an anti-implantation effect.⁷

The IUD can be fitted up to five days after having unprotected sex or up to five days after the earliest possible time of ovulation, and it will even work after you have already ovulated.^{4,6,7 10} It will be effective immediately and will need to stay in for three weeks to ensure you don’t get pregnant.^4,6 You can then either choose to have it removed or it can be left in to provide a hormone free method of contraception for up to 10 years.^4,6 

Most people who can get pregnant can use an IUD, including those who have never been pregnant and those who are HIV positive.⁴ However, you should not use an IUD if:⁴

• You have an untreated STI or a pelvic infection
• You have certain abnormalities of the womb or cervix
• You have bleeding from your vagina between periods or after sex that is not explained
• There is a risk you may already be pregnant

You can use the IUD if you are breastfeeding. Side effects are rare but can include:

• Pain
• Infection
• The IUD coming out of your womb (expulsion)
• Damage to your womb

Sources

1. https://www.ncbi.nlm.nih.gov/books/NBK536949/
2. https://my.clevelandclinic.org/health/treatments/23386-morning-after-pill
3. https://www.nhs.uk/contraception/emergency-contraception/
4. https://www.nhsinform.scot/healthy-living/contraception/emergency-contraception/
5. https://www.nhs.uk/contraception/methods-of-contraception/emergency-contraceptive-pill-morning-after-pill/where-to-get-it/
6. https://www.therotherhamft.nhs.uk/services/sexual-health-services/emergency-contraception
7. https://cks.nice.org.uk/topics/contraception-emergency/
8. https://my.clevelandclinic.org/health/body/22255-luteinizing-hormone
9. https://my.clevelandclinic.org/health/body/23953-follicular-phase
10. https://www.sexualhealthwirral.nhs.uk/contraception/emergency-contraceptive/