Emergency pill (morning-after pill)
What is the emergency pill?
The emergency pill is technically called 'progestogen-only emergency contraception' (POEC). Progestogen is a hormone. POEC is an oral hormonal method of emergency contraception. POEC is what people mean when they talk about the emergency contraceptive pill or the morning-after pill. POEC containing a progestogen called levonorgestrel has been licensed in the UK since 1999. The combined oestrogen-progestogen hormonal method – the Yuzpe regimen – used to be available in the UK but isn’t anymore. It’s still used in some other countries.
What is the emergency pill called in the UK/
In pharmacies the generic name for POEC is Levonelle One Step. The POEC prescribed by doctors and nurses used to be called Levonelle-2, but since November 2005 most people are prescribed Levonelle 1500. Levonelle One Step and Levonelle 1500 comprise of a single 1.5 mg tablet. Levonelle-2 comprises 2 tablets, each of 0.75mg.
How does POEC work?
How POEC works isn’t completely understood, though it seems that POEC works primarily by delaying ovulation. POEC may also stop a fertilised egg implanting in the womb. There is limited data on how POEC works if a woman has already ovulated.
How effective is POEC if I take it within 72 hours of unprotected sex?
POEC is not as effective as the other method of emergency contraception, the emergency IUD. Nor is POEC as effective as using ongoing contraception. That said, it’s still effective and often more convenient than an IUD: it’s clearly not practical for all women to who’ve had unprotected sex to have an IUD inserted. At the same time some women using a regular form of contraception don’t always comply with their required regime. As a result POEC is a practical and effective alternative means of preventing many unplanned pregnancies. The general view is that POEC is more effective the sooner you take it after unprotected sex. A trial suggested that POEC stops 95% of pregnancies that would otherwise occur if you take it within 24 hours of unprotected sex. If you take POEC between 25-48 hours after sex, POEC should stop 85% of pregnancies that would otherwise occur. If you wait 49-72 hours after sex before you take it, POEC should stop 58% of pregnancies that would otherwise occur. Another way to look at this is the POEC failure-rate seems to triple (5% to 15%) if you wait between 25-48 hours before taking it. The failure rate goes up by a factor of eight (5% to 42%) if you wait 49-72 hours.
What happens if I take POEC later than 72 hours after unprotected sex?
A trial conducted by the World Health Organisation added weight to the view that POEC continues to reduce the chances of pregnancy even if taken 73-120 hours after unprotected sexual intercourse. Nevertheless data to support the view that POEC continues to work from 73-120 hours is not conclusive and if you take POEC after 72 hours then you are using POEC outside the product license (i.e. POEC has not been approved by regulators for use after 73hrs even if it does work after this time). Women seeking to use emergency contraception from 73-120 hours after unprotected sex should consider whether an emergency IUD would be more appropriate.
Why would I choose to use POEC rather than an emergency IUD?
You might choose to use POEC because it’s generally easier to get hold of than visiting a doctor or nurse to have an emergency IUD fitted – indeed POEC is available online from this website. If you already know that you don’t want to use an IUD as your ongoing contraceptive method you may decide that you simply don’t want to go through the process of having an IUD fitted and then removed.
What are the disadvantages of taking POEC?
There are no serious side-effects of using POEC. Some women who take POEC may experience passing side-effects that include nausea, vomiting, headaches, breast tenderness and abdominal pain. POEC does not protect you from sexually transmitted infections (STIs/STDs). A woman who takes POEC should consider getting tested for STIs. Some STIs show no symptoms yet can cause long term damage to your health. There is little evidence to support the view that taking POEC increases a woman’s chances of having an ectopic pregnancy. An ectopic pregnancy occurs when the foetus grows outside the womb – usually in the fallopian tube.
What happens if I vomit after taking POEC?
If you vomit within 2 hours of taking POEC you need to take another dose as quickly as possible. If you vomit again with this second dose you may have to have an emergency IUD fitted. Only about 1% of women vomit after taking POEC, so it’s not common. That said, about 14% of women feel nauseous after taking it and there may be other reasons why you’d vomit, particularly if you’re travelling abroad.
Will taking POEC affect my period?
POEC frequently affects a women’s period. Around 50% of women taking POEC find that their period is a few days early or a few days late. Around 16% of women taking POEC experience bleeding that is nothing to do with their expected period in the 7 days after taking POEC. After taking POEC, 80% of women have their period before or within 2 days after their expected date. 95% of women have their period before or within 7 days after their expected date. If you’re period is more than 7 days late you should have a pregnancy test.
Can I use POEC more than once in a cycle?
You can use POEC more than once in a cycle. If you have further unprotected sex within 12 hours of taking POEC the view is that there’s no need to take a further dose of POEC but as unprotected sex can expose you to STI’s you shouldn’t rely on POEC to be your routine contraception even in the 12 hours after you’ve taken it.
Does POEC provide contraceptive cover for the remainder of my cycle?
POEC does not provide contraceptive cover for the remainder of a woman’s cycle. Therefore women who missed a pill should resume their hormonal contraception within 12 hours of taking POEC. Likewise if you didn’t use the contraceptive patch properly – you should apply a new patch within 12 hours of taking POEC. In addition, you should use condoms for 7 days after resuming the patch and the combined pill and for 2 days if you use the progestogen-only pill.
Are there any women for whom POEC would not be appropriate?
Women should always seek medical guidance before taking POEC as a number of medical conditions may make it inappropriate to take POEC. If you are in any doubt as to whether POEC is appropriate for your particular situation, it’s best to seek guidance from a doctor. Women with a hypersensitivity to levonorgestrel, lactose or any of the components of POEC should take POEC with caution. Women with hepatic dysfunction, hereditary problems of galactose intolerance, the Lapp lactose deficiency or glucose-galactose malabsorption should take POEC with caution. Women with severe malabsorption syndromes, such as Crohn’s disease, should also be cautious, as their condition may make POEC less effective. Liver enzyme-inducing drugs – including the herbal remedy St John’s Wort – may make POEC less effective. A doctor may advise women taking such drugs to consider using an emergency IUD rather than POEC. If a woman taking enzyme-inducing drugs is prescribed POEC, it’s usual for a doctor to recommend double the usual dose of POEC to counterbalance the effect of the enzyme-inducing drugs. Advising a woman taking enzyme-inducing drugs to take double the dose is judged to be good medical practice but is outside the produce license. Women using non-liver enzyme-inducing antibiotics should take the normal POEC dose. Women taking anticoagulant drugs such as phenindione and warfarin should be cautions about taking POEC as there may be an interaction between the anticoagulants and the POEC.
Why is POEC supplied in advance of need?
Women who rely upon barrier methods such as the male condom or women going travelling are regularly supplied with POEC in advance of need. When such women actually need POEC they may not be able to get it, so it makes good sense to supply it in advance of need. Trials have shown that prescribing POEC in advance of need is safe and effective. Studies suggest that prescribing POEC in advance of need increases use of POEC without effecting use of ongoing contraceptive methods, rates of STI infection or sexual behaviour. The ability to prescribe POEC in advance of need is implicit within the POEC product license. What this means is that when the regulator approved POEC for use, they implied that doctors were allowed to prescribe POEC in advance of need.
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