Emergency contraception

Levonelle

Levonelle contains levonorgestrel, a synthetic version of the natural hormone progesterone. In a woman’s body, progesterone plays a role in ovulation and preparing the uterus for accepting a fertilised egg.

It’s not known exactly how Levonelle works, but it’s thought to work primarily by preventing or delaying ovulation. It does not interfere with your regular method of contraception.

ellaOne

ellaOne contains ulipristal acetate, which stops progesterone working normally. It prevents pregnancy mainly by preventing or delaying ovulation.`

Levonelle and ellaOne do not continue to protect you against pregnancy. This means that if you have unprotected sex at any time after taking the emergency pill you can become pregnant.

Even if you’re starting or continuing another method of hormonal contraception, it may not be effective immediately. You’ll need to use condoms or avoid sex until the contraception is working effectively. Your doctor or nurse will tell you when you can start hormonal contraception and how long you’ll need to take extra precautions to prevent pregnancy.

Levonelle and ellaOne are not intended to be used as a regular form of contraception. However, you can use emergency contraception more than once in a menstrual cycle if necessary.

After taking the emergency contraceptive pill, most women will have a normal period at the expected time. But you may have your period later or earlier than normal.

If your period is more than 7 days late, or is unusually light or short, contact your GP as soon as possible to check for pregnancy.

Most women can use the emergency contraceptive pill. This includes women who cannot usually use hormonal contraception, such as the combined pill and contraceptive patch. Girls aged under 16 years old can also use the emergency contraceptive pill.

The World Health Organisation (WHO) does not identify any medical condition that would mean a woman shouldn’t use Levonelle.

The manufacturer of ellaOne advises that it should not be used by women who:

• are allergic to any of the components of the drug
• have severe asthma that is treated with steroid tablets (glucocorticoids)
• have certain rare hereditary problems with lactose metabolism

ellaOne may not be effective in women who are taking liver enzyme-inducing medication.

Breastfeeding

Levonelle can be taken while breastfeeding. Although small amounts of the hormones contained in the pill may pass into your breast milk, it is not thought to be harmful to your baby.

The safety of ellaOne during breastfeeding is not yet known. The manufacturer recommends that you do not breastfeed for one week after taking this pill.

You may need to take the emergency pill if you either:

• forgot to take some of your regular contraceptive pills
• did not use your contraceptive patch or vaginal ring correctly
• were late having your contraceptive implant or contraceptive injection

Levonelle

You should take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking Levonelle.

You should then continue taking your regular contraceptive pill as normal.

You will need to use additional contraception, such as condoms, for:

• the next 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
• 9 days for the combined pill Qlaira
• the next 2 days if you use the progestogen-only pill

ellaOne

You’ll need to wait at least 5 days before taking your next contraceptive pill, applying a new patch or inserting a new ring if you’ve taken ellaOne.

You should use additional contraception, such as condoms, while waiting to restart your contraceptive method and then for:

• the next 7 days if you use the patch, ring, combined pill (except Qlaira), implant or injection
• 9 days for the combined pill Qlaira
• the next 2 days if you use the progestogen-only pill

Taking the emergency contraceptive pill has not been shown to cause any serious or long-term health problems. However, it can sometimes have side effects. Common side effects include:

• abdominal (tummy) pain
• headache
• irregular menstrual bleeding (spotting or heavy bleeding) before your next period is due
• feeling sick
• tiredness

Less common side effects include:

• breast tenderness
• dizziness
• headache
• vomiting

Get medical advice if you vomit within 2 hours of taking Levonelle, or 3 hours of taking ellaOne. You’ll need to take another dose or have an IUD fitted.

The emergency contraceptive pill may interact with other medicines. These include:

• the herbal medicine St John’s Wort
• some medicines used to treat epilepsy
• some medicines used to treat HIV
• some medicines used to treat tuberculosis (TB)
• medication such as omeprazole (an antacid) to make your stomach less acidic

ellaOne cannot be used if you are already taking one of these medicines, as it may not be effective.

Levonelle may still be used, but the dose may need to be increased. Your doctor or pharmacist can advise on this.

There should be no interaction between the emergency pill and most antibiotics. Two enzyme-inducing antibiotics (called rifampicin and rifabutin), used to treat or prevent meningitis or TB, may affect ellaOne while they’re being taken and for 28 days afterwards.

If you want to check that your medicines are safe to take with the emergency contraceptive pill, ask your GP or a pharmacist. You should also read the information leaflet that comes with your medicines.

You may be able to get the emergency contraceptive pill in advance of having unprotected sex if you:

• are worried about your contraceptive method failing
• are going on holiday
• cannot get hold of emergency contraception easily

Ask your GP or nurse for further information on getting advance emergency contraception.

Both Levonelle and ellaOne are effective only if taken before the release of an egg from the ovary (ovulation). The sooner you take Levonelle or ellaOne, the more effective it will be.

ellaOne has been slightly more effective than Levonelle in clinical trials.

If you vomit within 2 hours of taking Levonelle or 3 hours of taking ellaOne, get medical advice as you will need to take another dose or have an IUD fitted.

The intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised.

If you’ve had unprotected sex, the IUD can be inserted up to 5 days afterwards, or up to 5 days after the earliest time you could have ovulated to prevent pregnancy.

You can also choose to have the IUD left in as an ongoing method of contraception.

Most women can use an IUD, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUD is suitable for you.

You should not use an IUD if you have:

• an untreated STI or a pelvic infection
• certain abnormalities of the womb or cervix
• any unexplained bleeding from your vagina – for example, between periods or after sex

Women who have a heart condition should speak to their GP or cardiologist before having an IUD fitted.

Pregnancy and breastfeeding

The IUD should not be inserted if there is a risk that you may already be pregnant.

The IUD can be used safely if you’re breastfeeding, but the risk of complications during insertion is slightly higher.

Complications after having an IUD fitted are rare, but can include pain, infection, damage to the womb or expulsion (the IUD coming out of your womb). If you use the IUD as an ongoing method of regular contraception, it may make your periods longer, heavier or more painful.

The emergency IUD will not react with any other medication.

The IUD is more effective than the emergency pill at preventing pregnancy after unprotected sex.

Trials suggest the failure rate for the IUD as emergency contraception is lower than 1%. This means less than 1 woman in 100 using the IUD as emergency contraception will get pregnant.

The IUD must be fitted by a healthcare professional within 5 days (120 hours) of having unprotected sex or, if it’s possible to estimate when you ovulate, up to 5 days after you ovulate.