Let's Talk About Emergency Contraception

Using emergency contraception is nothing to be ashamed of, so why is it so stigmatised? VP Wellbeing & Diversity Henn Warwick goes through the different types of emergency contraception, and how to use them.

Emergency contraception is used to prevent pregnancy after unprotected sex. If your condom breaks or you realise that you forgot to take the pill before you had sex, then you could find yourself in need of some emergency contraception.

Using emergency contraception is not the same as having an abortion. An abortion can only take place after a fertilised egg has implanted in the uterus, emergency contraception attempts to prevent ovulation (an egg being released), fertilisation, or a fertilised egg from implanting in the uterus (womb).

Sometimes, even the best-laid plans go to waste, and that’s where the two methods of emergency contraception can help to give you peace of mind.

Methods of emergency contraception

  • The emergency contraceptive pill – Levonelle or ellaOne (the "morning-after" pill)
  • The intrauterine device (IUD or coil)

Going back to basics

During the menstrual cycle, lots of hormones are released - starting a chain reaction.

  1. The pituitary gland sometimes referred to as the 'master gland' in the brain releases follicle-stimulating hormones
  2. These hormones stimulate the growth of the follicles and stimulate a premature egg in the ovaries
  3. These follicles then release oestrogen which helps prepare the uterus lining and triggers the brain to release luteinizing hormone
  4. The luteinizing hormone then triggers ovulation in which the egg is released into the fallopian tubes where it spends around 12 to 24 hours waiting to be fertilised
  5. If the egg isn’t fertilised in this time it begins to dissolve and his shed away with the uterus lining during menstruation

Why am I taking back to primary school PSHE class? Bear with me, it's important to understand how emergency contraception is different to other contraception.

So regular contraception, let's say for example the pill, modifies hormone levels tricking the body into thinking it has already released an egg or is already pregnant. This is done by increasing progestin levels which effectively decreases the release of follicle-stimulating hormones and luteinizing hormones - thus breaking the cycle.

The emergency contraceptive pill causes different mechanisms to take place. Following unprotected sex, fertilisation isn't immediate. The sperm that survive undergo some biological changes first, which take place within the fallopian tubes. These biological changes take time, and this allows for around 72 hours/three days for someone who has had unprotected sex to use the morning after pill containing levonorgestrel. Sperm can survive for up to five days which is why the ellaOne pill containing the active ingredient ulipristal acetate, or the copper IUD is used.

All methods of emergency contraception are most effective if taken as soon as possible. If the emergency contraceptive pill is taken during the first half of the menstrual cycle, it works specifically to prevent ovulation – even if the egg is mature and ready to be released, it will not be, meaning the sperm cannot fertilise it.

In cases where it’s too late to prevent ovulation, meaning the mature egg has already been released, the emergency contraceptive pill is believed to thicken cervical mucus and trap sperm. It may also directly inhibit fertilization between sperm and egg. The copper IUD can prevent fertilisation by releasing copper to stop the egg from implanting in the womb or being fertilised.

Let’s break things down and talk about the emergency contraceptive pill and the IUD.

The Emergency Contraceptive Pill

Levonelle

What is it?

Levonelle is a pill that contains a hormone called levonorgestrel. This is a type of progestogen hormone, similar to the natural progesterone produced by the ovaries. Taking it is thought to stop or delay the release of an egg. It should be taken within three days of unprotected sex to prevent pregnancy.

Who can use it?

Most people can use pills with levonorgestrel. However, there are some factors that would require the dose of levonorgestrel to be altered, such as taking certain prescribed medicines, complementary medicines, weighing over 70kg, or having a BMI (body mass index) higher than 26. In some instances, the emergency IUD may be preferred. You can use Levonelle after five days of a miscarriage or abortion. The Levonelle pill is suitable for people who have recently given birth after 21 days.

Effect on periods

Taking the pill can sometimes alter your next period, it can sometimes come earlier or later than expected. If you don’t have a period within about a week of the expected time, then it is your best bet to take a pregnancy test just in case.

Disadvantages

Although there are no serious long-term side effects, some people may feel sick or may get headaches or a painful period. It is rare, but possible that taking the pill can make you be sick. Any side effects should go away within a few days, if they persevere it is recommended to call your GP or pharmacist.

Taking Levonelle with other contraception

If you require emergency contraception as a result of using a patch or vaginal ring incorrectly, you can insert a new vaginal ring or apply a new patch just after 12 hours. It is recommended to use other contraception such as condoms for pregnancy protection for seven days after using Levonelle.

Can levonorgestrel fail?

As with any medication, there is always a chance it may not work. Some people still become pregnant even though they took levonorgestrel correctly. Equally, delays in taking the pill can make it less effective. If you experience sickness or diarrhoea when taking the pills this can interfere with its effectiveness, it’s best to call your doctor or pharmacist so they can advise you on what to do next if this happens. They may recommend taking a further dose or suggest fitting an IUD. If you are sick after three hours, levonorgestrel will have been absorbed into your body and another dose won’t be needed.

ellaOne

What is it?

ellaOne is a pill with the active ingredient ulipristal acetate (UPA). ellaOne is currently the only brand available containing UPA in the UK. This pill works by stopping progesterone from functioning normally and by stopping or delaying the release of an egg. It must be taken within five days of unprotected sex to prevent pregnancy. This form of emergency contraception is more effective at preventing pregnancy than a pill with levonorgestrel.

Who can use it?

Most people can use pills containing UPA. Some factors, such as having severe asthma, or being on certain prescribed medicines or complementary medicines may mean an emergency IUD is more suitable. The effectiveness of the ellaOne pill can be weakened if a form of hormonal contraceptive was used the week before taken. ellaOne can be taken 21 days after giving birth, but it’s best to avoid breastfeeding for at least a week after taking it. During this week breastmilk should still be expressed but discarded. ellaOne can also be used five days after a miscarriage or abortion.

Effect on periods

Taking ellaOne may alter your next period, it could come earlier or later than expected. If you don’t have a period within about a week of the expected time, then it is your best bet to take a pregnancy test just in case.

Disadvantages

ellaOne is not known to have any long-term side effects, although some people report feeling sick or getting a headache or a painful period. It is rare, but possible that taking the pill can make you be sick. Any side effects should go away within a few days, if they persevere it is recommended to call your GP or pharmacist.

Taking ellaOne with other contraception

If you require emergency contraception as a result of forgetting your pill or using a patch or vaginal ring incorrectly it is recommended to wait for five days after taking emergency contraception before returning to your usual contraception. During these five days, it is recommended to use condoms for pregnancy protection.

Can ellaOne Fail?

As with any medication, there is always a chance it may not work. Some people still become pregnant even though they took the pill correctly. Equally, delays in taking the pill can make it less effective. If you experience sickness or diarrhoea are taking the pills this can interfere with its effectiveness, it’s best to call your doctor or pharmacist so they can advise you on what to do next if this happens. They may recommend taking a further dose or suggest fitting an IUD. 

The emergency intrauterine device (IUD).

What is it?

The IUD is a small plastic and copper device that's fitted in your uterus up to five days after unprotected sex or within five days of the earliest time you could've released an egg. Unlike regular contraceptive pills, the IUD does not contain any hormones, it works by releasing copper to stop the egg implanting in your womb or being fertilised.

The IUD is the most effective method of emergency contraception. A benefit of using an IUD is that you can choose to leave it in as it can be used as an ongoing method of contraception. If you are unable to access an IUD fitting immediately you may be advised to take an emergency contraceptive pill.

Who can use it?

Most people can use an emergency IUD, including those who’ve never been pregnant.

An emergency IUD can be used from day five after a miscarriage or abortion as long as there were no complications. If you had complications, you would need to seek advice from a doctor or nurse.

An IUD may not be suitable if you have an untreated STI or pelvic infection, problems with your womb or cervix, or unexplained bleeding between periods or after sex. It’s not normally recommended before the 28 days after giving birth. If you need to, you can use an emergency pill from 21 days after giving birth.

Effect on periods

Your period should still come at around the same time that you would normally expect it, however, it may be heavier than usual. If you don’t have a period within about a week of the expected time, then it is your best bet to take a pregnancy test just in case.

Disadvantages

The procedure to fit the IUD can be uncomfortable and potentially painful, it also carries a risk of infection. Some people experience stomach cramps and spotting after the procedure. It can also lead to heavier, longer or more painful periods if you continue to use it as a regular method of contraception. It is very rare, but not impossible for the IUD to become displaced or perforate (go through) the womb.

Can an emergency IUD fail?

About 1 in 1,000 women will become pregnant after having an emergency IUD fitted. The IUD has treads that can be felt by inserting a finger inside the vagina, the treads should be at your cervix (neck of the womb, at the top of your vagina). If you are unable to feel the threads the IUD may be in the wrong place meaning it will be unable to protect against pregnancy, it is recommended your call your GP or call a sexual health clinic straight away and use extra protection such as condoms to prevent pregnancy. Equally, it would be best to call your GP as soon as possible if you experience any unexpected bleeding or sudden or unusual pain in your lower abdomen.  

Accessing emergency contraception

Accessing emergency contraception is easier than ever before in the UK. The contraceptive bill is available to buy in high street pharmacies such as Superdrug and Boots. You can access emergency contraception for free on the NHS as well.

Accessing The Emergency Contraceptive Pill

You can get both Levonelle and ellaOne for FREE from:

  • Jays Pharmacy – the service at Jay’s is very quick and discreet. Emergency contraception is offered free of charge for anyone up to 25 years old
  • A Sexual Health Clinic – find one here
  • Most NHS walk-in-centres
  • Most GP Surgeries, it’s best to call and ask if they provide this service
  • Some Accident and Emergency (A&E) departments

You can also buy Levonelle and ellaOne from most pharmacies, and from some organisations such as BPAS or Marie Stopes

  • 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. Prices vary, but it's likely to cost around £25.
  • 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. Prices vary, but it's likely to cost around £35.

Can I buy the morning after pill in advance?

Some people may decide that they want to purchase a morning-after pill in advance, just in case they ever find themselves in need of emergency contraception, and it’s absolutely possible.

Accessing The Emergency IUD

Unlike emergency contraceptive pills, you cannot get an IUD from your pharmacist as it needs to be fitted by a medical professional. If you’re unsure where to go, your pharmacist should be able to signpost you to the closest service such as:

  • A Sexual Health Clinic – find one here
  • Most NHS walk-in-centres
  • Most GP Surgeries, it’s best to call and ask if they provide this service
  • Some Accident and Emergency (A&E) departments.

Using emergency contraception is nothing to be ashamed of, so why is it so stigmatised?

Recent research by the brand ellaOne on nearly 1,000 women between 18 and 35 years old, found that 57% feel awkward and embarrassed when making the purchase, while just 10% feel confident.

In another survey, three-quarters of women admitted to not seeking emergency contraception after having unprotected sex, due partly to embarrassment and factors such as misinformation (only 17% of women learn about it in school). 

For best sexual practice, emergency contraception should not be your go-to contraception and should only be used as a last resort when other contraception fails.

Emergency contraceptive pills are unable to provide you with continuous protection from pregnancy. So, for best protection against pregnancy, using a regular method of contraception is advised.