Emergency Contraception: Your Options, Timing and the Myths
A condom split, you missed pills, or you had sex you did not plan for. Here is how the copper IUD and the two emergency pills work, how long you have, what can make them less effective and where to get them.
TL;DR: There are three main emergency contraception options. The copper IUD is the most effective and works up to 5 days after sex. Levonorgestrel pills work up to 72 hours and ulipristal pills up to 120 hours, and both work best the sooner you take them. Weight and some medicines can make the pills less effective. Emergency contraception is not an abortion pill and does not affect your future fertility.
Maybe the condom split. Maybe you forgot your pill for a few days, or your injection is overdue, or sex happened that you did not choose. Whatever brought you here, take a breath. You have options, and you have some time, though not unlimited time. The sooner you act, the better your chances. This guide covers what each method is, how long it works for, what can get in its way, and where to get it in the UK, Nigeria and Kenya, without the judgement that too often comes with it.
What are the emergency contraception options?
There are three main options. According to the NHS, you can have a copper IUD fitted within 5 days (120 hours) of sex, take a levonorgestrel pill (sold as Levonelle and other brands) within 3 days (72 hours), or take an ulipristal acetate pill (ellaOne) within 5 days (120 hours). The sooner you use any of them, the more effective it usually is.
The copper IUD: the most effective option
The copper IUD (sometimes called the coil) is a small T-shaped device placed in the womb by a nurse or doctor. It is the most effective form of emergency contraception. UK clinical guidance from the Faculty of Sexual and Reproductive Healthcare (FSRH, now the College of Sexual and Reproductive Healthcare) reports a pregnancy rate of less than 0.1% when it is fitted within 5 days of sex (FSRH guideline). The WHO puts it at more than 99% effective.
The FSRH guideline also says the IUD can sometimes be fitted up to 5 days after your earliest likely ovulation date, even if sex was earlier than 5 days ago, so it is worth asking a clinic even if you think you have missed the window. A bonus: you can keep it as ongoing contraception for years, or have it removed whenever you like. Some people find the fitting uncomfortable, and periods may be heavier or more painful for the first few months (ACOG).
Levonorgestrel: the pill most people know
Levonorgestrel is a progestogen, a hormone also found in regular birth control. It works by stopping or delaying ovulation. The NHS says to take it within 72 hours of sex. It is the pill you are most likely to find on a pharmacy shelf in Lagos, Nairobi or London.
Ulipristal acetate: works for longer
Ulipristal acetate (ellaOne) also works by delaying ovulation, and it is licensed for up to 120 hours after sex. ACOG says that when taken as directed, ulipristal is more effective than levonorgestrel. The FSRH guideline notes that both pills are unlikely to work if you have already ovulated, which is another reason the copper IUD is worth considering.
If you take ulipristal and want to start or restart hormonal contraception like the pill, patch, ring, implant or injection, you need to wait 5 days, and use condoms or avoid sex until your contraception is working (ACOG). After levonorgestrel, you can start hormonal contraception straight away. If you vomit within 3 hours of taking either pill, you need another dose, so contact a pharmacist or clinic (FSRH).
Does weight affect emergency contraception?
It can. The FSRH guideline says levonorgestrel may be less effective if your BMI is over 26 or you weigh more than 70 kg. In that case, it recommends ulipristal or a double dose (3 mg) of levonorgestrel instead. Ulipristal may also be less effective with a BMI over 30 or weight over 85 kg, though the evidence is uncertain. The copper IUD works the same at any weight.
This is not about judgement. If it applies to you, tell the pharmacist your weight and ask which option and dose suit you.
Which medicines can make emergency pills less effective?
Some medicines speed up how fast your liver breaks down hormones. These are called enzyme-inducing drugs, and they can make both emergency pills less effective. Examples listed in the FSRH guideline include some epilepsy medicines (such as carbamazepine and phenytoin), the TB antibiotic rifampicin, St John's wort, and some HIV medicines.
If you have taken one of these in the last 28 days, the FSRH advises a copper IUD if possible, or a double dose of levonorgestrel. Ulipristal is not recommended in this situation. If you are on HIV or TB treatment, or any epilepsy medicine, mention it to the pharmacist or clinic. It is easy to overlook at a busy counter.
Is emergency contraception an abortion pill?
No. Emergency contraception prevents a pregnancy from starting, it does not end one. The WHO says emergency pills work by preventing or delaying ovulation, do not cause an abortion, and cannot interrupt an established pregnancy or harm a developing embryo. ACOG says the same: an abortion ends an existing pregnancy, while emergency contraception stops a pregnancy from happening.
Will emergency contraception affect my future fertility?
No. The WHO states that emergency contraception does not harm future fertility and there is no delay in your fertility returning after taking the pill. It also says repeated use carries no known health risks, though it can make your periods less regular. That said, emergency pills are less effective than regular contraception, so if you find yourself needing them often, it is worth finding a method that suits you. Our guide to contraception methods compared is a good place to start.
What to expect afterwards
Your next period may come a little earlier or later than usual. Some people feel sick or tired, or notice light spotting, which the WHO says is usually mild and passes without treatment. If your period is late, or unusually light or short, take a pregnancy test. The FSRH guideline recommends follow-up pregnancy testing after emergency contraception. It is also worth thinking about STI testing if the sex was unprotected, since emergency contraception does not protect against infections. Our guide to STI symptoms, prevention and treatment explains what to look out for.
If you were forced or pressured into sex, you deserve care and support, not just a pill. In the UK, sexual assault referral centres can help, and in Nigeria and Kenya, hospitals and gender-based violence centres offer post-rape care, which can include emergency contraception and HIV prevention medicine.
Where can I get emergency contraception?
In the UK, emergency contraception is free. The NHS says you can get it from most pharmacies, most GP surgeries, sexual health clinics, some NHS walk-in centres and some young people's services. You can also buy the pills from pharmacies. For a copper IUD, call a sexual health clinic and say it is for emergency contraception so they can fit you in quickly.
In Nigeria and Kenya, levonorgestrel pills are commonly sold in pharmacies without a prescription, often under several brand names. Ulipristal is less widely stocked, and a copper IUD needs a trained provider, so try a family planning clinic, a government health facility or a reproductive health NGO clinic. Prices and availability vary by area, so if your local chemist does not have what you need, ask where else to go, and do not let a pharmacist's personal views delay you.
Planning ahead
Many people keep a pack of emergency pills at home so they are not racing against the clock. Beyond that, the best protection is a regular method you are happy with. Asele can help you track your cycle and log symptoms like spotting or a late period, and Amara can answer your questions privately in Yoruba, Hausa, Igbo, Swahili, French or English. If you want to talk options through with a clinician, the Health Brief gives you a pre-visit summary of your cycle history to take along. Find us at Asele.
This post is education, not medical advice. If you need emergency contraception, speak to a pharmacist, nurse or doctor as soon as you can.
References
- NHS. Emergency contraception (morning after pill, IUD). nhs.uk
- Faculty of Sexual and Reproductive Healthcare. FSRH Guideline: Emergency Contraception (March 2017, amended). cosrh.org
- World Health Organization. Emergency contraception fact sheet. who.int
- American College of Obstetricians and Gynecologists. Emergency Contraception. acog.org
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