Emergency Contraception - Causes and Symptoms

The effectiveness of emergency contraception depends on the amount of time passed after unprotected sex; the longer you wait, the less effective the morning after pill will be.

Levonelle can be effective at preventing pregnancy up to three days after sex, ellaOne can be effective for up to five days after. The IUD must be fitted by a doctor or nurse up to five days after unprotected sex and can be left in for long-term contraception.

• IUD – 99.9% effective up to five days after unprotected sex
• ellaOne – 95% effective up to five days after unprotected sex
• Levonelle – 95% effective in the first 24 hours, 85% effective in the first 48 hours and 58% effective in the first 72 hours.

The morning after pill can be used by young women under the age of 16, however to buy online, you must be 18 and over.

How long is emergency contraception effective for?

The IUD is a long-term form of contraception. Once you have had it fitted, it's there and protects you from pregnancy by up to 99.9%.

Whilst Levonelle can be used multiple times in each cycle, ellaOne cannot and the morning after pill is not intended to be used as a regular form of contraception. It is advised to review your contraceptive method if you feel you need the morning after pill often. This could be because you tend to forget to take the pill or change the patch or ring.

Once you've taken the morning after pill, you are not safeguarded if you have unprotected sex again. It only works for the previous encounter.

Has the emergency contraception worked?

It is likely that emergency contraception has worked if you have taken a pill within the first 24 hours correctly. This means not vomiting or experiencing severe diarrhoea in this timeframe.

The morning after pill may delay your period slightly so do not be concerned – it is likely that you'll begin your period a couple of days later.

If you haven't experienced a period in the following three weeks of taking the morning after pill or having the IUD inserted, or the next time you're on the seven-day break of hormonal contraception, then you may be pregnant. You may also experience other symptoms connected with early pregnancy including tender breasts, fatigue, backache, nausea, cramps, spotting, bloating and the need to urinate.

There are other less common symptoms as well. If you are unsure whether the emergency contraception has worked, you can take a pregnancy tests exceeding three weeks since you've had unprotected sex. Pregnancy tests taken within the first three weeks may not be as accurate.

Does emergency contraception cause an abortion?

No. Emergency contraception is used before ovulation or fertilisation to prevent pregnancy from occurring. If you are already pregnant, emergency contraception will not work.

This morning after pill is the newest on the market but highly effective. Whilst Levonelle is the same effectiveness over the first 24 hours after unprotected sex, it does diminish over time. ellaOne is continually 95% effective over five days.

It contains ulipristal acetate and comes in the form of one tablet taken as soon as possible.

Where can I get ellaOne?

ellaOne isn't always available at every pharmacy, despite its effectiveness rate over five days. It would be best to check before you leave, or have a back-up plan just in case. The cost of ellaOne in a pharmacy is usually about £25-£35 depending on the place.

Some doctors and sexual health walk-in centres stock the morning after pill. Again, it is advised to check the particular surgery or clinic before heading there to make sure it stocks ellaOne. This is especially advised if it's beyond three days where Levonelle's effectiveness might have lessened.

ellaOne can also be bought online from Medilico with free next-day delivery when ordered before 4.30pm across the UK. If you're based within London, there is free same-day delivery up until the late evening with a requested two-hour delivery slot. There is also nominated day delivery.

As all of our packaging is anonymous, you can even get the morning after pill delivered to your place of work discreetly.

Levonelle contains progestogen and works in the same way as hormonal contraception by preventing ovulation from occurring. It is just one pill that is taken immediately and contains a higher dosage of the hormone.

It can be taken up to 72 days after unprotected sex, however, it does lessen in effectiveness over time. For 95% effectiveness, Levonelle should be taken within the first 24 hours.

Where can I get Levonelle?

Levonelle can be obtained from many local pharmacies. If the pharmacy doesn't stock the morning after pill for any reason, they will need to know the location of the nearest pharmacy that does. There is a cost for Levonelle and this will depend on the pharmacy; it is around £25-£35.

Some STI clinics and doctors stock the morning after pill for free. It would be worth researching through the NHS site first to make sure they stock emergency contraception.

Both Levonelle and ellaOne work in the same way, however, there are a few notable differences. For example, they contain different active ingredients; Levonelle contains levonorgestrel and ellaOne contains ulipristal acetate.

There are some significant differences between the two, especially when it comes to the effectiveness. Levonelle will start to reduce in efficiency over the next coming days whilst ellaOne remains 95% effective up to five days (120 hours) after.

Both are 95% effective at preventing pregnancy 24 hours after unprotected sex. They are also taken in the same way; one tablet swallowed soon after unprotected intercourse. If you fall ill – whether that's diarrhoea or vomiting – soon after ingesting the morning after pill, both will become invalid and you will need to take another pill. Both are typically available online, in pharmacies and doctor surgeries as well as sexual health clinics.

Some women find that the morning after pill may delay their period by a few days, for others it prompts them to start earlier. The majority of women start as usual and note no changes to their schedule.

If you are using hormonal contraception such as the combined pill, mini pill, patch or ring, missing a couple of dosages can reduce efficiency meaning you require emergency contraception. If you decide to insert the IUD, you're immediately protected and don't require any back-up contraception. Please follow the below for the morning after pill:

ellaOne

• Wait around five days before starting a new combined pill blister pack (except Qlaira which is nine days), ring, patch, implant or injection.
• Start your contraceptive method on the fifth day and use condoms for the following seven days.
• Wait nine days for the mini pill. Use additional barrier contraception during this time.

Levonelle

• Start/take your preferred method within 12 hours of taking Levonelle.
• Use condoms for the following seven days if you're on the combined pill *minus Qlaira which is nine days), implant, injection, patch and ring.
• Use condoms for the next two days when using the mini pill.

Both types of morning after pill can give you the same side effects. Usually these are temporary but if you find they persist, you should contact a doctor about the next steps.

As emergency contraception contains an stronger influx of hormones, you may experience irregular bleeding, headaches, abdominal pain and tiredness. One particular side effect to look out for is nausea as, if this develops into vomiting, this can void the pill's effectiveness.

There are no serious side effects of the morning after pill, but do disclose all health information at the pharmacy, doctor's surgery or in an online consultation to make certain ellaOne or Levonelle is right for you.

Can I use the morning after pill when breastfeeding?

Levonelle can be taken if you are breastfeeding; it's been recorded that some hormones pass through breast milk but not a dangerous amount. ellaOne has not been thoroughly tested so the manufacturer advises a one week break before breastfeeding again.

If you are taking medicine for HIV, epilepsy, St John's Wort, tuberculosis (TB) and antacids, you cannot take ellaOne. You might be able to take Levonelle, but you may need an increased dosage. Both rifampicin and rifabutin used for meningitis or TB may also affect the efficiency of ellaOne. There is no recorded interaction with antibiotics in both ellaOne and Levonelle.

The IUD is a long-term form of contraception, however it is also an effective emergency contraceptive option. It can be used up to five days after unprotected sex and is nearly 100% effective.

It is a T-shaped device that must be inserted by a medical professional. It is plastic and copper.

The coil must always be inserted by a doctor or nurse qualified to do so. It is a similar process to a cervical smear test. Depending on your pain threshold, it can be a sore procedure with some cramping shortly after, however, the length and effectiveness of the IUD often outweighs the uncomfortable yet quick process.

Before heading to your doctor or sexual health clinic, it is advised to ring them to check that they A) fit the IUD B) are able to give you an appointment in the correct timeframe and C) you don't have any of the precautions listed below.

Before the procedure:

• You will be given a physical exam beforehand to ensure there are no abnormalities, and how long you wish to have the IUD for.
• The procedure takes approximately 15 minutes and is very similar to a smear test (cervical screening test).
• The best time to have the IUD inserted is during your period, unless you require the IUD for emergency contraception in which case, this must be inserted up to five days after unprotected sex.
• Sometimes an anaesthetic can be used, otherwise it is recommended to take pain relievers to help alleviate cramping.

During the procedure:

• The doctor will place you in a comfortable position as the procedure can take about 15-20 minutes.
• A speculum is inserted and used to hold the vagina open ensuring that the IUD is fitted correctly.
• The IUD is inserted using a tube. Once the doctor has placed the IUD, it is opened into a T-shape.
• The tube and speculum is removed. A string hangs from the IUD but you will not be able to see this.
• You should not be able to feel the IUD during sex, and neither should your partner. You should never feel the IUD when exercising, no matter how strenuous that may be.

Removing the IUD:

• The coil is effective for years at a time, which makes the procedure worthwhile. Depending on the length of your contraceptive cover is when it needs removing. You can get the new IUD replaced at the same time.
• Removing the IUD is often quicker and pain is reduced. A medical professional MUST remove it. Never try to remove your IUD yourself.
• You will lie down in a comfortable position and a speculum is inserted for easy access.
• The doctor will look for the string and use an implement to remove the IUD. As the coil is being removed, the T-shape will change into an I.

The coil works in the same way as other hormonal contraception; it stops sperm from fertilising the egg by releasing progestogen. Often it prevents an egg from being released altogether and thickens the cervical mucus as well.

How effective is the IUD?

The IUD is over 99% effective as a contraceptive. It is immediately effective making it a good option for emergency contraception.

Side effects of the coil are unlikely and often mild in nature. As the IUD contains a version of progestogen like many other hormonal contraceptives, if you do experience side effects, these tend to pass after the initial three months or be manageable in nature.

Side effects include acne, headaches and breast tenderness. Some women might experience depression, especially if they are prone to mental health issues.

If you have a pelvic infection or a sexually transmitted infection, you cannot get the IUD fitted. If you have any abnormalities in that area, including the womb or cervix, you must let your doctor know beforehand. This could mean that the IUD is not suitable for you and you will need to obtain the morning after pill post-haste.

Women who have abnormal bleeding or a heart condition must also consult their doctor before having the coil fitted.

The coil must be fitted by a medical professional such as the sexual health nurse at a local doctor's surgery or at the sexual health clinic/GUM clinic. The good thing about the IUD is it is a long-term form of contraception; once you have it fitted, it will remain for up to three-12 years, depending on the type of IUD you are advised.

It's essential to get the IUD fitted within five days of unprotected sex or contraceptive failure so do not delay ringing your doctor's surgery and be completely honest about why you need the IUD fitted soon. In the unlikely event, you can't get an appointment within five days, head to the sexual health clinic and consider purchasing a morning after pill as a safeguard. You can decide to get the coil at a later date as your form of contraception as well.