Emergency contraception
Emergency contraception is given to those who have had unprotected sex, are not taking regular contraception and want to avoid pregnancy. It’s commonly known as the morning-after pill, but this isn’t accurate, as it's available for up to 5 days after any unprotected sex. But the sooner it’s taken, the more effective it will be at preventing pregnancy.
It’s important to emphasise that this is not an abortion or termination of an embryo or foetus. The pill delays the release of a woman's egg, and the coil creates a hostile environment for sperm to fuse with a woman’s egg. It prevents a pregnancy, rather than ending a pregnancy.
Your local sexual health clinic is best for all types of emergency contraception, but tablets are available on prescription from your GP, the emergency department and some pharmacies.
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What are my choices?
The choices available to you depend on a number of factors. The first is, what’s available in your local area within a tight time window. It also depends on how long it is since intercourse, any other emergency contraception you have taken since your last period, and personal risk factors such as taking certain other medications and how much you weigh.
This is assessed and evaluated by a doctor, specially qualified pharmacist or specialist nurse, and the method that is likely to be most effective with your circumstances is offered.
The copper coil, otherwise known as an IUD (intrauterine device), is considered the most effective method. It’s inserted into your uterus (womb) via the vagina, and is an effective contraceptive going forward. It can be given up to 5 days after you’ve had intercourse. Unfortunately, it’s not available that quickly everywhere, and some women would rather opt for a different method.
Another option is a tablet containing a large dose of progestogen, one of the hormones used in regular daily contraception. There are two tablets available, depending on your set of circumstances, levonorgestrel 1.5mg, known by the brand name Levonelle, within 3 days of unprotected sex, or ulipristal acetate 30mg, brand name EllaOne, if within 5 days of unprotected sex. Your clinician will advise which is best for you, and you only need to take one tablet.
How effective is it?
No method of contraception or emergency contraception is 100% effective, but it’s pretty good. The most effective, the coil, means less than 1% of women will become pregnant.
Effectiveness declines the longer it is since you had unprotected sex, and the hours count, so it’s important to prioritise getting it as soon as possible.
It may be less effective if you are just passed ovulation (typically Day 14, if we count Day 1 as your first day of bleeding). Chances are reduced if you’ve had unprotected sex previously in your cycle, and if you’ve already taken the emergency contraception that month.
You should take a pregnancy test three weeks after unprotected sex, to check.
It’s important to remember that contraceptive pills and coils, and those used in emergency contraception, do not protect you against sexually transmitted infections (STIs), so it’s a good idea to get yourself tested. If you think you’ve been exposed to HIV, contact your nearest Sexual Health Clinic as soon as possible, and they will test and may consider giving you PEP, post-exposure prophylaxis to minimise the chance of HIV settling in your body.
Are there any risks or long-term effects?
IUD insertion can be an uncomfortable procedure, and painkillers can help. If you choose to keep it in, it can change the nature of your periods, becoming heavier or more painful for some women.
Either pill can sometimes cause stomach pains, feeling sick or vomiting, and a headache, but not really serious side effects.
Your periods are likely to be disrupted for the following months – either earlier, later, lighter, heavier or more painful. It’s possible this may take up to 3 months to settle down.
If you do fall pregnant and have had the coil inserted or taken an emergency contraception tablet, while very rare, this is not known to harm the growing foetus. You have the same choices of continuing or terminating the pregnancy, as usual, according to UK law.
Can I start hormonal contraception when I get emergency contraception?
It might be a good opportunity to start regular and reliable contraception in the same appointment as getting emergency contraception. You have the same choices of hormonal contraception available as usual, and your clinician will assess which is right for you based on a number of personal risk factors.
Emergency contraception can interfere with hormonal contraception. Either you can start within the first 5 days of your next period, or you can “quick-start”. Depending on which emergency contraception you have been given, this will either be immediately or 5 days later. It sounds complicated, but don’t worry, your clinician will know what they’re doing.
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