Contraception - emergency contraception

Emergency contraception is used to help prevent an unplanned pregnancy after unprotected sex, for example if you did not use any contraception, a condom broke, or you missed or were late taking your usual pill.

Using emergency contraception is not the same as having an abortion. It also does not protect you from sexually transmissible infections (STIs).

Types of emergency contraception#

There are two main options:

• The copper intrauterine device (copper IUD), a non-hormonal IUD. It must be inserted by a specially trained doctor or nurse.
• The emergency contraceptive pill (sometimes called the “morning after pill”), available as two types:
  • ulipristal acetate, which can be taken within 5 days after unprotected sex
  • levonorgestrel, available under several brand names

The emergency contraceptive pill is not recommended for ongoing contraception.

When to use it#

Emergency contraception can be used up to 5 days after unprotected sex:

• The copper IUD must be inserted within 120 hours (5 days). You will need to see a specially trained doctor or nurse to have it inserted.
• The emergency contraceptive pill should be taken as soon as possible, up to 4 or 5 days after unprotected sex depending on the type. It can usually be bought at a pharmacy without a prescription.

If you have unprotected sex again, you may need another dose of the pill.

How effective it is#

• The copper IUD is more than 99% effective and can provide ongoing contraception for up to 5 to 10 years.
• Emergency contraceptive pills are approximately 85% effective. Ulipristal acetate is more effective than levonorgestrel.

Emergency contraceptive pills may be less effective if you:

• are late taking them
• vomit within 3 hours of taking them
• weigh over 70 kg or have a body mass index (BMI) over 26 kg/m2
• are taking certain medications, including some other contraceptives

A double dose of the levonorgestrel pill is recommended for people who weigh more than 70 kg or have a BMI greater than 26 kg/m2. A pharmacist may ask a few questions, such as your weight or BMI, whether you are breastfeeding, and what medications you take, to help work out the best option for you.

How emergency contraception works#

• The copper IUD stops sperm from reaching and fertilizing an egg. It also changes the lining of the uterus so a fertilized egg will not stay there and start a pregnancy.
• The emergency contraceptive pill prevents or delays the ovaries releasing an egg.

Where to get it#

• Copper IUD: talk to a doctor or nurse and make an appointment to have it inserted.
• Emergency contraceptive pills: you can buy them at a pharmacy without a prescription, or see a doctor or nurse. Ask the pharmacist whether the pill is a suitable option for you.

Cost#

The cost of emergency contraception varies depending on the type, the brand, and where you buy it. Some pharmacies are cheaper than others. If you have a copper IUD inserted, or see a doctor for emergency contraceptive pills, you may also need to pay for the medical appointment, and these costs can vary between clinics.

Possible side effects#

Copper IUD: in the first few weeks after insertion you may experience abdominal pain, irregular bleeding between periods, heavier periods, or more painful periods. Because it contains no hormones, there are no hormonal side effects.

Emergency contraceptive pills: these may make your period late or early, or change the amount of bleeding for your next period. For a small number of people, other effects can include nausea, headaches, bloating, and sore or tender breasts. If your period is more than 7 days late, lighter than usual, or unusual in any other way, take a pregnancy test.

Potential risks#

As with all medications, there are potential risks:

• Copper IUD: there is a small risk of perforation (the IUD making a hole in the wall of the uterus when it is put in) and of infection around the time it is inserted and for the first 3 weeks afterwards.
• Emergency contraceptive pills: there are no known serious risks from taking them.

A doctor, nurse or pharmacist will recommend the best type of emergency contraception for your circumstances.

Starting other contraception afterwards#

After taking the levonorgestrel pill, you can start the pill, implant, vaginal ring or injection straight away.

Other forms of contraception, such as the pill, implant, vaginal ring and injections, can make ulipristal acetate less effective. Do not start them until 5 days after taking the ulipristal acetate pill. If you do start them within the next 3 weeks, you will need a pregnancy test 3 to 4 weeks after taking the emergency contraception.

The copper IUD can remain in place and provide very effective ongoing contraception for up to 10 years.

If you become pregnant#

• Copper IUD: see a doctor or nurse to have the IUD removed promptly. They will also need to rule out a pregnancy in the fallopian tubes. Removing the IUD will not harm the pregnancy, and you can then weigh up your options. If the IUD cannot be removed and you continue the pregnancy, there is a high risk of miscarriage or premature delivery.
• Emergency contraceptive pill: it is safe either to continue the pregnancy or to end it with a medical or surgical abortion.

After having a baby#

• The copper IUD can usually be inserted once your baby is 4 weeks old, and in some circumstances soon after giving birth. Your doctor or nurse will advise on the best timing for you.
• Emergency contraceptive pills are safe to take at any stage after having a baby.

Breastfeeding#

The copper IUD and the levonorgestrel pill are safe to use while breastfeeding; your breastmilk will not be affected. The ulipristal acetate pill is also generally thought to be safe, although it has not been well studied during breastfeeding. Ask your doctor, nurse or pharmacist whether you should express and throw out your breastmilk for 24 hours after taking ulipristal acetate.

Key points#

• The emergency contraceptive pill prevents or delays the ovaries releasing an egg.
• As with all medications, there are potential risks.
• There is a small risk of perforation, when the IUD makes a hole in the wall of the uterus as it is put in.
• There are no known serious risks from taking emergency contraceptive pills.
• The copper IUD can remain in place and provide very effective ongoing contraception for up to 10 years.

Where to get help#