What is the morning-after pill?
It is a form of emergency contraception. Its purpose is to prevent pregnancy after sex without protection or with failed protection. Of course, it does not protect against sexually transmitted infections.
There are two products: Norlevo (levonorgestrel 1.5 mg/tablet) and EllaOne (ulipristal acetate 30 mg/tablet).
When can a woman take it?
She can take it right after sex, or even in advance if, for example, she is anxious or on vacation.
Within how many hours can it be taken?
Norlevo can be taken within 72 hours after sex, while EllaOne can be taken within 120 hours. The sooner it is taken, the more effective it is, ideally within the first 24 hours and preferably with food.
How exactly does the pill work?
The pill can prevent a pregnancy because conception does not happen immediately after sex; it can occur even a few days later. It works by delaying or inhibiting ovulation and it blocks fertilization of the egg.
How effective is it? Is pregnancy still possible after taking the pill?
No method of contraception is 100% effective. However, the pill is 95% effective if taken within 24 hours, 85% from 25 to 48 hours and 58% from 49 to 72 hours.
Is the morning-after pill a method of contraception?
No. First, it does not protect a woman for her entire cycle, and second, taking it repeatedly disrupts the normal cycle. There are clearly other, more effective contraceptive methods to follow. Also, in terms of cost (even though it is not particularly expensive), it is not recommended for routine use.
Is it true that it must not be taken twice in the same month, and why?
Norlevo can safely be taken more than once in the same month. The same does not apply to EllaOne, because it can affect other types of contraception for a week.
How many times can I take the morning-after pill?
There is no limit on this.
If a woman vomits, does she need to take the pill again?
If she vomits within 2 hours of taking Norlevo or within 3 hours of taking EllaOne, the woman should repeat the dose.
How safe is it? Is it true that it is dangerous?
It is a myth that it is dangerous. Millions of women around the world have used it safely, and its use is recommended.
Are there side effects?
They can occur, but they are not serious or long-lasting (they stop within 1 to 2 days). The most common are malaise, fatigue, abdominal pain, nausea, headache and bleeding before the expected period. Less common ones are dizziness, breast tenderness and vomiting.
Can a woman be allergic to the morning-after pill?
Rarely, but it does happen. If a woman has had an allergy to any of the ingredients in the past, she should tell her doctor.
Norlevo should be avoided in severe liver disease or porphyria, while EllaOne should be avoided in possible pregnancy, severe asthma or hereditary problems with lactose metabolism.
How long does the morning-after pill delay your period?
Usually your period comes on time, but it may come a little earlier or later. Sometimes the bleeding is heavier. If it is more than a week late, pregnancy is suspected and the woman should see her doctor.
Is the morning-after pill different from the abortion pill?
Of course. The morning-after pill does not cause an abortion like Ru-486 (mifepristone) does; it prevents conception.
Can a breastfeeding woman use it?
Norlevo can be used safely, while after taking EllaOne the woman should avoid breastfeeding for 36 hours.
What can affect how the pill works?
If a woman is overweight, the pill may be less effective. Also, if she takes other medications, she should contact her doctor. It does not interact with most antibiotics. Alcohol does not affect how the pill works, and it can be given if an anti-nausea medication has not already been administered.
Do you need a prescription for the morning-after pill?
No prescription is needed. A woman can buy it freely at the pharmacy.
So, yes or no to the morning-after pill?
Definitely yes, but in moderation. It is a method for emergencies and should be treated as such.
How much does the morning-after pill cost? Is it affordable?
The morning-after pill is affordable and fairly easy to find. For more information, contact your gynecologist or pharmacist.
https://www.youtube.com/watch?v=zN8fEakox5I
Morning-after pill brands
Two types of morning-after pill are available in Greece, each with a different active ingredient:
- Levonorgestrel 1.5 mg: the best-known brand is Norlevo, and there are also generics with the same ingredient. It is taken as soon as possible and up to 72 hours after sex.
- Ulipristal 30 mg: sold as ellaOne. It is effective up to 120 hours (5 days) and keeps working better close to ovulation.
Both are available from the pharmacy without a prescription. The choice depends on the time since sex, your weight and whether you are breastfeeding. The most effective method of emergency contraception remains the copper IUD, if it is inserted within 5 days. Afterward, you need regular contraception, such as contraceptive pills.
The morning-after pill prevents pregnancy and does not end a pregnancy that is already established. Ending a pregnancy involves other procedures, described in the article on abortion.
Ovulation and the fertile window: why every hour counts
Sperm can survive in a woman's reproductive tract for up to five days. The egg, by contrast, lives about 12 to 24 hours after it is released. This means that unprotected sex can lead to pregnancy even if ovulation occurs a few days later.
The morning-after pill works mainly by delaying ovulation. But if ovulation has already happened, the hormone cannot “undo” it. This is why effectiveness drops as time passes and as you get closer to the middle of the cycle.
- Levonorgestrel: works best when taken several days before the LH hormone surge. Just before ovulation, it loses much of its effect.
- Ulipristal: can delay ovulation even when LH has started to rise, which is why it is considered the better choice when sex took place close to the fertile days.
- Copper IUD: does not depend on the phase of the cycle, because it prevents fertilization and implantation. Its effectiveness exceeds 99%.
In practice: if you do not know which phase of your cycle you are in, do not wait to “see what happens”. Take the pill as soon as possible.
When you need emergency contraception: common scenarios
The need does not arise only after sex with no protection at all. There are everyday situations in which the method you use may have failed without you realizing it right away.
- A condom that tore, slipped off or was put on late.
- Missed contraceptive pills, especially two or more in the first week of the pack, if there was unprotected sex during the pill-free days or the first days of the new blister pack.
- A progestogen-only pill taken later than the allowed window for that specific product.
- A vaginal ring or contraceptive patch that was removed or came off for longer than the package leaflet allows.
- A late repeat contraceptive injection.
- Severe vomiting or diarrhea for more than 24 hours while taking the contraceptive pill.
- Non-consensual sex. In this case, you also need a medical assessment for infections and support.
Body weight, medications and choosing the dose
Some medications speed up the breakdown of hormones in the liver and lower blood levels of the active ingredient. They are called enzyme inducers. This group includes rifampicin, certain antiepileptics such as carbamazepine and phenytoin, some antiretroviral drugs and the herbal remedy St John’s wort.
If you have taken such a medication in the last four weeks, UK guidelines (FSRH) recommend the copper IUD as the first choice. If this is not possible, the doctor may recommend a double dose of levonorgestrel. Ulipristal is not recommended in this case.
For women with a body mass index above 26 or a weight above 70 kg, the same guidelines state that ulipristal or a double dose of levonorgestrel may be preferred, always after talking with a doctor or pharmacist. Do not double the dose on your own without guidance.
Contraception after the pill: what to do in the following days
The morning-after pill only protects against sex that has already happened. It does not cover the following days of the cycle. In fact, because it delays ovulation, new unprotected sex a few days later may fall right in the fertile window.
After levonorgestrel
You can start or continue hormonal contraception right away. Also use condoms for seven days with the combined pill, the ring or the patch, and for two days with the progestogen-only pill.
After ulipristal
Here you need to wait. Progestogen hormones reduce the effect of ulipristal, so it is recommended to wait five days before starting hormonal contraception. After starting, use condoms for seven days (two days for the progestogen-only pill). In total, that means about 12 days of protection with condoms.
Pregnancy tests and warning signs to watch for
A urine pregnancy test becomes reliable about three weeks after the last unprotected sex. Before that, it may give a false negative result. Take a test if:
- your period is more than seven days late,
- the bleeding you had was much lighter or shorter than usual,
- you started hormonal contraception right after the pill, because bleeding from the method can be mistaken for a period.
The pill does not increase the risk of ectopic pregnancy. But if it fails, the pregnancy can be anywhere, as in any other case. Severe pain on one side of the abdomen, dizziness, feeling faint or shoulder pain together with a positive test need immediate assessment for ectopic pregnancy.
Sexually transmitted infections after unprotected sex
Emergency contraception only deals with the risk of unwanted pregnancy. If the sex was with a new or casual partner, also consider testing for infections.
- Chlamydia and gonorrhea: testing is reliable about two weeks after sex. Infections with chlamydia often cause no symptoms at all.
- HIV, syphilis, hepatitis B: blood tests at time intervals set by your doctor.
- Post-exposure prophylaxis for HIV (PEP): if there is a real risk, it must be started within 72 hours. Go to a hospital immediately.
Myths and facts about emergency contraception
- “It causes infertility.” No. The hormone is cleared from the body within a few days, and fertility returns immediately.
- “If I take the pill, I am protected for the whole month.” No. It only covers sex that has already happened.
- “It only works the morning after.” No. The name is misleading. It works for up to 72 or 120 hours, depending on the product, but the sooner the better.
- “If I was already pregnant, it will harm the fetus.” Available data show no increased risk of birth defects after levonorgestrel. For ulipristal the data are more limited but reassuring.
- “Only young women need it.” Women in perimenopause can also get pregnant and may need emergency contraception.
Frequently Asked Questions
What brands of morning-after pill are available?
Norlevo and generics with levonorgestrel, which work up to 72 hours after sex, and ellaOne with ulipristal, which works up to 120 hours. Both are sold without a prescription.
Can I take Norlevo and EllaOne in the same cycle?
It is not recommended to combine them within a few days. If you have taken ulipristal (EllaOne), levonorgestrel is not recommended for the next five days, because it may reduce its effect. If you took levonorgestrel in the last week, ulipristal may be less effective. For new sex in the same cycle, choose the same product you took the first time and ask a doctor or pharmacist for advice.
If my period came after the pill, am I definitely in the clear?
If the bleeding is normal in amount and duration, pregnancy is very unlikely. But if it was very light, very short or looked more like spotting, take a pregnancy test three weeks after sex. Light bleeding a few days after taking the pill is usually a side effect of the hormone and not a real period.
Does the morning-after pill affect future fertility?
No. The hormone is metabolized and cleared within a few days, with no permanent effect on the ovaries or uterus. Fertility returns as early as the next cycle. Frequent use does not cause infertility; it is simply less reliable than a regular method and can disrupt your cycle.
Can I take the pill if I am already on birth control?
Yes, if there was a real mistake in taking them, for example missed pills at a critical point in the pack. After levonorgestrel, continue your contraceptive pills as usual and use condoms as well for seven days. After ulipristal, wait five days before restarting them. If you are not sure whether you need emergency contraception, ask your pharmacist with the package leaflet in hand.
For a personalized assessment of your case, book an appointment with Dr. Panagiotis Polyzos at his office in Athens or Volos.
