Emergency Contraceptive Pills (the “Morning-After Pill”): What You Need to Know

By Dr. Francis Kutin, ND, MPH | Naturopathic Physician and Medical Science Communicator | BF Naturopathic Health Care and Research, Agona Duakwa, Central Region, Ghana

Educational information only. This article is not medical advice. Read the leaflet that comes with your pill and speak to a pharmacist, nurse or doctor about your own situation. If you have been sexually assaulted, seek care at a health facility as soon as you can.

Emergency contraceptive pills, often called the “morning-after pill” or “EC pills”, can help prevent pregnancy after unprotected sex or a failed contraceptive method. They are widely used in Ghana, but there is a lot of confusion about when they work, how they work and what they do not do. This guide sets out the facts.

Key Takeaways

• Emergency contraception works best the sooner it is taken. Most pills can be used up to 5 days (120 hours) after unprotected sex, though they are most effective in the first 72 hours.
• The pill works mainly by delaying ovulation. It is not an abortion pill and cannot end an existing pregnancy.
• The most effective form of emergency contraception is a copper IUD (coil) fitted by a health professional within 5 days.
• EC pills may be less effective for women with a higher body weight, and some medicines can reduce their effect.
• EC pills do not protect against HIV or other sexually transmitted infections (STIs), and they are not meant to be a regular method of family planning.

What Are Emergency Contraceptive Pills?

The most common emergency contraceptive pill contains levonorgestrel (usually 1.5 mg in a single tablet), a synthetic hormone similar to progesterone. Another type contains ulipristal acetate (30 mg), which may be available in some pharmacies and clinics. Both work mainly by delaying or preventing the release of an egg (ovulation), so that sperm have no egg to fertilise.

Emergency contraception is meant for emergencies only: for example, when no contraception was used, a condom broke or slipped, pills were missed, or another method failed.

When Should You Take It?

As soon as possible. The effectiveness of the pill falls the longer you wait. Many package leaflets still say “within 72 hours”, but the World Health Organization (WHO) says emergency contraceptive pills can be taken up to 120 hours (5 days) after unprotected sex. Levonorgestrel is less effective after 72 hours, and ulipristal keeps a higher level of effectiveness between 72 and 120 hours.

You can take it at any point in your cycle. If you are not sure when you last had unprotected sex, or you had unprotected sex more than once in the same cycle, take it anyway and speak to a health worker, because it cannot protect against earlier acts of sex.

How Effective Is It?

You may see figures such as “95% within 24 hours, 85% between 24 and 48 hours and 58% between 48 and 72 hours”. These come from an old trial and are not a reliable guide, because effectiveness is difficult to measure and results differ between studies. A clearer way to put it is this:

• Pregnancy rates after emergency contraception are about 2 to 3% with levonorgestrel and 1.5% with ulipristal when taken in time, compared with a much higher chance of pregnancy without it.
• A copper IUD is the most effective method, with a failure rate of about 0.1%, or more than 99% effective, when fitted within 5 days.
• No method is 100% effective, and the pill works best the earlier it is taken.

Body weight

Levonorgestrel emergency contraception may be less effective in women with a higher body mass index (BMI). Ulipristal works better than levonorgestrel for women who are heavier, though it too is less effective as BMI increases. A copper IUD is not affected by weight. Women should never be refused emergency contraception because of their weight. If you are worried, ask a health worker about the copper IUD or ulipristal.

How Does It Work? (And What It Does Not Do)

Emergency contraceptive pills prevent pregnancy mainly by delaying or blocking ovulation. They:

• Do not end an established pregnancy.
• Do not harm a developing baby if you are already pregnant (though the pill will not work, and you should confirm pregnancy if your period is late).
• Do not protect against HIV or other STIs.

Who Can Use It?

Most women and girls can safely use emergency contraception, including teenagers and women who cannot use regular hormonal methods. There are no absolute medical reasons to avoid levonorgestrel or ulipristal, other than a known allergy to an ingredient. Tell a health worker if you:

• have severe liver disease or severe bowel conditions that affect absorption, such as Crohn’s disease, which may reduce how well the pill works;
• take medicines that can interfere with the pill (see below);
• might already be pregnant, or
• have a history of ectopic pregnancy.

Medicines That Can Reduce Its Effect

Some medicines speed up how the liver breaks down the hormone, so the pill may not work as well. These include:

• Some epilepsy medicines (for example carbamazepine and phenytoin)
• Rifampicin and rifabutin, used for tuberculosis
• Efavirenz, used in some HIV treatment regimens
• The herbal remedy St John’s wort

Most common antibiotics do not affect emergency contraception. If you take any of these medicines, tell the pharmacist or doctor. They may advise a copper IUD or a different dose.

How to Take It

• Swallow the tablet with water, with or without food.
• If you vomit within 2 to 3 hours of taking it, the pill may not have been absorbed. Contact a pharmacist or clinic, because you may need another dose.
• Do not take extra tablets unless a health worker tells you to.

Side Effects and Your Next Period

Side effects are usually mild and short-lived. They can include nausea, headache, tiredness, dizziness, breast tenderness, lower abdominal discomfort and irregular spotting or bleeding. Your next period may come earlier or later than usual, and may be heavier or lighter.

See a doctor or take a pregnancy test if:

• your period is more than a week late;
• your period is unusually light or different, or you think you may be pregnant;
• you have severe lower abdominal pain, particularly 3 to 5 weeks after taking the pill, which could signal an ectopic pregnancy, a medical emergency.

Can You Use It More Than Once? Does It Affect Fertility?

Using emergency contraception more than once, even several times, is not known to cause long-term harm, and there is no evidence that it reduces your future fertility or damages the womb. But it is not recommended as your main method of contraception, because:

• it is less effective than regular methods used correctly;
• it can upset your menstrual cycle if used often, and
• it costs more over time.

Your fertility returns quickly after taking it, so you can become pregnant again in the same cycle if you have unprotected sex again. Start or continue a regular method straight away, and use condoms until your health worker tells you that your method is protecting you.

After You Take It: Plan Ahead

• Choose a regular method. Options include condoms, pills, injections, implants (which last 3 to 5 years depending on the type), a hormonal intrauterine system (5 years or more) and the copper IUD (5 to 10 years). A family planning nurse can help you choose.
• Think about STIs and HIV. If the sex was unprotected, consider testing for STIs, and for HIV if there was a risk. If the exposure was within the last 72 hours, ask about post-exposure prophylaxis (PEP) to prevent HIV straight away.
• Take a pregnancy test if your period is late, to be sure.

Common Myths

“It causes an abortion.”
No. It works before ovulation and does not interrupt an established pregnancy.

“It makes you infertile.”
No. There is no evidence of future infertility.

“It only works if you take it the next morning.”
No. The sooner the better, but it can still help for up to 5 days.

“It protects against HIV and STIs.”
No. Only condoms, PrEP/PEP and other prevention methods help here.

Access to Emergency Contraception

The World Health Organization says that all women and girls at risk of an unintended pregnancy have a right to access emergency contraception, and that it should be part of every national family planning programme. It should also be included in care after sexual assault and in services for women and girls living in emergencies and humanitarian settings. In Ghana you can ask for emergency contraception at pharmacies, family planning clinics and health facilities.

Frequently Asked Questions

How long after sex can I take the morning-after pill?
Up to 5 days (120 hours), but the earlier the better.

Is the morning-after pill safe for teenagers?
Yes. It is safe for adolescents, and they have the same right to information and access.

Will it work if I am already pregnant?
No, but it will not harm the pregnancy. Take a pregnancy test if you are unsure.

Can I use herbal medicines for emergency contraception?
No herbal product has been proven to work as emergency contraception. Using unproven products risks an unplanned pregnancy, and St John’s wort can actually make the pill less effective.

Conclusion

Emergency contraceptive pills are a safe and valuable backup, but only a backup. Take them as soon as possible after unprotected sex, check for interactions and body weight issues, and follow up with a health worker about regular contraception and STI or HIV prevention. Accurate information helps women and girls protect their health and make their own choices.

Medical Disclaimer: This article is for general educational purposes only and does not replace professional medical advice, diagnosis or treatment. Consult a qualified healthcare professional about contraception that suits you. See our full Medical Disclaimer.

References and Further Reading

• World Health Organization. Emergency contraception (fact sheet).
• Merck Manual Consumer Version. Emergency Contraception.
• Merck Manual Professional Edition. Emergency Contraception.
• Faculty of Sexual and Reproductive Healthcare (FSRH). Emergency Contraception guideline.
• International Planned Parenthood Federation. Is emergency contraception effective?

About the Author

Dr. Francis Kutin, ND, MPH, is a naturopathic physician, public health researcher and medical science communicator based at Agona Duakwa in the Central Region of Ghana. He writes about health education, naturopathic health care and evidence-informed wellness through BF Naturopathic Health Care and Research. Contact us.