Emergency contraception

Emergency contraception can prevent pregnancy after unprotected sex or if your contraceptive method has failed – for example, a condom has split or you've missed a pill.

There are two types: 

• the emergency contraceptive pill (sometimes called the morning after pill)
• the IUD (intrauterine device, or coil)

At a glance: emergency contraception

The emergency pill 

The IUD as emergency contraception

Where to get emergency contraception

Contraception for the future

There are two kinds of emergency contraceptive pill. Levonelle has to be taken within 72 hours (three days) of sex, and ellaOne has to be taken within 120 hours (five days) of sex. Both pills work by preventing or delaying ovulation (release of an egg). Emergency contraception is best taken as soon as possible to be effective.

The IUD can be inserted into your uterus up to five days after unprotected sex, or up to five days after the earliest time you could have ovulated. It may stop an egg from being fertilised or implanting in your womb.

Emergency contraception does not protect against sexually transmitted infections (STIs).

At a glance: facts about emergency contraception

• Both types of emergency contraception are effective at preventing pregnancy if they are used soon after unprotected sex. Less than 1% of women who use the IUD get pregnant, whereas pregnancies after the emergency contraceptive pill are not as rare. It’s thought that ellaOne is more effective than Levonelle.
• The sooner you take Levonelle or ellaOne, the more effective it will be.
• Levonelle or ellaOne can make you feel sick, dizzy or tired, or give you a headache, tender breasts or abdominal pain.
• Levonelle or ellaOne can make your period earlier or later than usual.
• If you’re sick (vomit) within two hours of taking Levonelle, or three hours of taking ellaOne, seek medical advice as you will need to take another dose or have an IUD fitted.
• If you use the IUD as emergency contraception, it can be left in as your regular contraceptive method.
• If you use the IUD as a regular method of contraception, it can make your periods longer, heavier or more painful.
• You may feel some discomfort when the IUD is put in – painkillers can help to relieve this.
• There are no serious side effects of using emergency contraception.
• Emergency contraception does not cause an abortion.

The emergency pill

Levonelle

Levonelle contains levonorgestrel, a synthetic version of the natural hormone progesterone. In a woman’s body, progesterone plays a role in ovulation and preparing the uterus for accepting a fertilised egg.

It’s not known exactly how Levonelle works, but it’s thought to work primarily by preventing or delaying ovulation. It does not interfere with your regular method of contraception.

ellaOne

ellaOne contains ulipristal acetate, which stops progesterone working normally. It prevents pregnancy mainly by preventing or delaying ovulation.`

Levonelle and ellaOne do not continue to protect you against pregnancy. This means that if you have unprotected sex at any time after taking the emergency pill you can become pregnant.

Even if you are starting or continuing another method of hormonal contraception, it may not be effective immediately. You will need to use condoms or avoid sex until the contraception is working effectively.

The time it takes for contraception to become effective depends on the emergency contraceptive pill and the method of hormonal contraception being started. Your doctor or nurse will tell you when you can start hormonal contraception and how long you will need to take additional precautions to prevent an unintended pregnancy.

Levonelle and ellaOne are not intended to be used as a regular form of contraception. However, you can use emergency contraception more than once in a menstrual cycle if necessary.

How effective is the emergency pill at preventing pregnancy?

It can be difficult to know how many pregnancies the emergency pill prevents, because there is no way to know for sure how many women would have got pregnant if they did not take it.

A study published in 2010 showed that of 1,696 women who received the emergency pill within 72 hours of sex, 37 became pregnant (1,659 did not). Of 203 women who took the emergency pill between 72 and 120 hours after unprotected sex, there were three pregnancies.

Find out more about the research on the effectiveness of both emergency contraception pills.

However, it's important to remember that the sooner you take emergency contraception after sex, the more effective it will be.

How it affects your period

After taking the emergency contraceptive pill, most women will have a normal period at the expected time. However, you may have your period later or earlier than normal.

If your period is more than seven days late, or is unusually light or short, contact your GP as soon as possible to check for pregnancy.

Who can use the emergency pill?

Most women can use the emergency contraceptive pill. This includes women who cannot usually use hormonal contraception, such as the combined pill and contraceptive patch. Girls aged under 16 years old can also use the emergency contraceptive pill.

Levonelle

The World Health Organisation (WHO) does not identify any medical condition that would mean a woman shouldn’t use Levonelle.

ellaOne

The manufacturer of ellaOne advises that it should not be used by women who: 

• 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

ellaOne may not be effective in women who are taking liver enzyme-inducing medication. 

Breastfeeding

Levonelle

Levonelle can be taken while breastfeeding. Although small amounts of the hormones contained in the pill may pass into your breast milk, it is not thought to be harmful to your baby.

ellaOne

The safety of ellaOne during breastfeeding is not yet known. The manufacturer recommends that you do not breastfeed for one week after taking this pill.

If you are already using the pill, patch, vaginal ring or contraceptive injection

You may need to take the emergency pill if you:

• forgot to take some of your regular contraceptive pills, or
• did not use your contraceptive patch or vaginal ring correctly, or
• were late having your contraceptive implant or contraceptive injection

If you have taken Levonelle, then you should: 

• take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking the emergency pill

You should then continue taking your regular contraceptive pill as normal.

You will need to use additional contraception, such as condoms, for:

• the next seven days if you use the patch, ring, combined pill (except Qlaira), implant or injection
• nine days for the combined pill Qlaira 
• the next two days if you use the progestogen-only pill

If you have taken ellaOne, you will need to wait at least five days before taking your next contraceptive pill, applying a new patch or inserting a new ring. You should then use additional contraception, such as condoms, while waiting to restart your contraceptive method and then for:

• the next seven days if you use the patch, ring, combined pill (except Qlaira), implant or injection
• nine days for the combined pill Qlaira 
• the next two days if you use the progestogen-only pill

What are the side effects of using the emergency pill?

Taking the emergency contraceptive pill has not been shown to cause any serious or long-term health problems. However, it can sometimes have side effects. Common side effects include: 

• abdominal (tummy) pain
• headache
• irregular menstrual bleeding (spotting or heavy bleeding) before your next period is due
• feeling sick
• tiredness

Less common side effects include:

• breast tenderness
• dizziness
• headache
• vomiting (seek medical advice if you vomit within two hours of taking Levonelle, or three hours of taking ellaOne, as you will need to take another dose or have an IUD fitted)

If you are concerned about any symptoms after taking the emergency contraceptive pill, contact your GP or speak to a nurse at a sexual health clinic. You should talk to a doctor or nurse if: 

• you think you might be pregnant
• your next period is more than seven days late
• your period is shorter or lighter than usual
• you have any sudden or unusual pain in your lower abdomen (this could be a sign of an ectopic pregnancy, where a fertilised egg implants outside the womb – this is rare but serious, and needs immediate medical attention) 

The emergency pill and other medicines

The emergency contraceptive pill may interact with other medicines. These include: 

• the herbal medicine St John’s Wort
• some medicines used to treat epilepsy
• some medicines used to treat HIV
• some medicines used to treat tuberculosis (TB)
• medication such as omeprazole (an antacid) to make your stomach less acidic

ellaOne cannot be used if you are already taking one of these medicines, as it may not be effective.

Levonelle may still be used, but the dose may need to be increased – your doctor or pharmacist can advise on this.

There should be no interaction between the emergency pill and most antibiotics. Two enzyme-inducing antibiotics (called rifampicin and rifabutin), used to treat or prevent meningitis or TB, may affect ellaOne while they’re being taken and for 28 days afterwards.

If you want to check that your medicines are safe to take with the emergency contraceptive pill, ask your GP or a pharmacist. You should also read the patient information leaflet that comes with your medicines. 

Can I get the emergency contraceptive pill in advance?

You may be able to get the emergency contraceptive pill in advance of having unprotected sex if:

• you are worried about your contraceptive method failing
• you are going on holiday
• you cannot get hold of emergency contraception easily

Ask your GP or nurse for further information on getting advance emergency contraception.

The IUD as emergency contraception

The intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised.

If you’ve had unprotected sex, the IUD can be inserted up to five days afterwards, or up to five days after the earliest time you could have ovulated, to prevent pregnancy. It’s more effective at preventing pregnancy than the emergency pill, and it does not interact with any other medication.

You can also choose to have the IUD left in as an ongoing method of contraception.

How effective is the IUD at preventing pregnancy?

There are several types of IUD. Newer ones have more copper and are more than 99% effective. Fewer than two women in 100 who use a newer IUD over five years will get pregnant. IUDs with less copper in them are less effective than this, but are still effective. The IUD is more effective than the emergency pill at preventing pregnancy after unprotected sex.

Who can use the IUD?

Most women can use an IUD, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUD is suitable for you.

You should not use an IUD if you have:

• an untreated STI or a pelvic infection
• certain abnormalities of the womb or cervix
• any unexplained bleeding from your vagina – for example, between periods or after sex

Women who have a heart condition should consult their GP or cardiologist before having an IUD fitted.

Pregnancy and breastfeeding

The IUD should not be inserted if there is a risk that you may already be pregnant. The IUD can be used safely if you’re breastfeeding, but the risk of complications during insertion is slightly higher.

What are the side effects of the IUD

Complications after having an IUD fitted are rare, but can include pain, infection, damage to the womb or expulsion (the IUD coming out of your womb). If you use the IUD as an ongoing method of regular contraception, it may make your periods longer, heavier or more painful.

The IUD and other medicines

The emergency IUD will not react with any other medication.

Where can I get emergency contraception?

You can get the emergency contraceptive pill and the IUD for free from:

• a GP surgery that provides contraception (some GP surgeries may not provide the IUD)
• a contraception clinic 
• a sexual health clinic 
• some genitourinary medicine (GUM) clinics
• some young people's clinics (call our sexual helpline on 0800 22 44 88)

You can also get the emergency contraceptive pill free from:

• most pharmacies 
• some minor injuries units
• some Accident & Emergency departments

The doctor or nurse you see may ask for the following information:

• when you have had unprotected sex in your current menstrual cycle
• the date of the first day of your last period and the usual length of your cycle
• details of any contraceptive failure (such as how many pills you may have missed, and when)
• if you've used any medications that may affect your contraception

If you're aged 13 or over, you can get contraception from the majority of community pharmacies in Scotland, usually free of charge. If you are not eligible for NHS Scotland services, you can buy the emergency contraceptive pill from most pharmacies. The cost varies, but it will be around £30 to £35.

Contraception for the future

If you're not using a regular method of contraception, you might consider doing so in order to lower the risk of unintended pregnancy. Long-acting reversible contraception (LARC) offers the most reliable protection against pregnancy, and you don't have to think about it every day or each time you have sex.

LARC methods are the:

• injection
• implant
• IUS
• IUD

It depends what type of emergency contraception you use. There are two methods:

• the emergency contraceptive pill (morning after pill) – there are two types, Levonelle or ellaOne
• the intrauterine device (IUD, or coil)

Emergency contraception prevents pregnancy if:

• you haven't used contraception
• your usual method of contraception has failed

Emergency contraception should not be used instead of your usual method of contraception.

The sooner you use emergency contraception after having unprotected sex, the more effective it is. For more information, see How effective is emergency contraception?

The emergency contraceptive pill

Levonelle is available free of charge without a prescription. You can get it from most pharmacies and also from your GP or sexual health clinic. Use our National Service Directory to find nearest pharmacy, GP surgery or sexual health clinic.

Levonelle and ellaOne are both available free of charge. You can get them from most community pharmacies and also from your GP or sexual health clinic.

Levonelle can be taken within 72 hours (three days) of having unprotected sex, but it's most effective if taken within 12 hours of having unprotected sex.

You take one Levonelle tablet. It works by stopping or delaying ovulation (when your ovaries release an egg).

EllaOne can be taken within 120 hours (five days) of having unprotected sex, but it's most effective if taken as soon as possible after having unprotected sex.

You take one ellaOne tablet. It stops or delays ovulation and makes it more difficult for a fertilised egg to implant into your womb.

IUD

The IUD (intrauterine device) is available from:

• contraception clinics
• Brook centres
• most sexual health clinics (GUM clinics)
• most GP surgeries

The IUD is placed inside your womb. It damages both the sperm and the egg, and prevents a fertilised egg implanting in your womb.

It must be fitted by a healthcare professional within five days of having unprotected sex, or, if it's possible to estimate when you ovulate, up to five days after you ovulate. The IUD is the most effective type of emergency contraception.

You can keep the IUD in as your regular method of contraception, or a healthcare professional can remove it during your next period.

Cautions

Emergency contraception may not be suitable for everyone. Find out more about emergency contraception.

If you're sick

If you're sick (vomit) within three hours of taking Levonelle or ellaOne, speak to your GP. You may need to take another pill. 

It depends which type of emergency contraception you use and how soon you use it.

There are two methods of emergency contraception:

• the emergency contraceptive pill – or morning-after pill – known as Levonelle or ellaOne
• the copper IUD (intrauterine device, or coil)

Emergency contraception prevents pregnancy if you haven't used contraception or think your usual method of contraception has failed. 

Both types of emergency contraception are effective at preventing pregnancy if they are used soon after unprotected sex.

Less than 1% of women who use the IUD get pregnant, whereas pregnancies after the emergency contraceptive pill are not as rare. It's thought ellaOne is more effective than Levonelle.

Emergency contraception should not be used instead of your usual method of contraception. See Where can I get emergency contraception? if you need emergency contraception now.

The emergency contraceptive pill

It can be difficult to know how many pregnancies the emergency pill or IUD prevent, as there is no way to know for sure how many women would have got pregnant if they didn't take it.

Levonelle contains levonorgestrel and has to be taken within 72 hours (three days) of sex. EllaOne contains ulipristal acetate and is licensed to be taken within 120 hours (five days) of sex.

Both Levonelle and ellaOne are effective only if taken before the release of an egg from the ovary (ovulation). The sooner you take Levonelle or ellaOne, the more effective it will be.

Ovulation is triggered by rising levels of a hormone called luteinising hormone (LH).

Levonelle appears not to be effective after levels of LH start to rise. EllaOne continues to be effective a little later in the cycle.

This may be one reason why ellaOne has been slightly more effective than Levonelle in clinical trials.

A paper published in 2010 combined the results of two clinical trials, and showed:

• of 1,714 women who received ulipristal acetate, 22 (1.3%) became pregnant
• of 1,731 women who received levonorgestrel, 38 (2.2%) became pregnant 

If you vomit within two hours of taking Levonelle or three hours of taking ellaOne, seek medical advice as you will need to take another dose or have an IUD fitted.

The IUD (coil)

Trials suggest the failure rate for the IUD as emergency contraception is lower than 1%. This means less than 1 woman in 100 using the IUD as emergency contraception will get pregnant.

The IUD is more effective than the emergency pill at preventing pregnancy after unprotected sex.

The IUD must be fitted by a healthcare professional within five days (120 hours) of having unprotected sex or, if it's possible to estimate when you ovulate, up to five days after you ovulate.

Find out more about emergency contraception, including how it works and possible side effects.