The morning after pill: 5 things you need to know

When it comes to the 'morning after' pill (MAP), there are still many misconceptions and myths surrounding it - despite the increase in press coverage about it as of late. Public interest has reached peak levels and it’s thrown into the spotlight how confusing the world of emergency contraception (EC) actually is. What are the facts that you need to know regarding its efficacy, the options available and its accessibility? Here are five facts that are worth having on your radar.

1. It’s not the most effective form of emergency contraception

There are two types of EC - the MAP (i.e. the ‘emergency contraceptive pill’ (ECP)) and the emergency IUD (i.e. the ‘emergency coil.’) While the ECP is the most common form of EC, the IUD is regarded as the better of the two due to its reliability and its ability to provide ongoing protection too. “Most patients do not realise that a copper IUD is much more effective for emergency contraception than either of the oral tablets,” Dr Anne Lashford, Vice President of the Faculty of Sexual and Reproductive Healthcare (FSRH) tells us. A T-shaped contraceptive made of plastic and copper, it requires insertion into the uterus by a trained healthcare professional.

When it comes to the ECP, there are two kinds, one containing ulipristal acetate (such as ellaOne) and one containing levonorgestrel (such as Levonelle). Before choosing, it’s recommended to weigh up your options by speaking to a healthcare professional first to see which one best fits your needs.

2. It works best if taken within 24 hours

Despite being called the 'morning after pill', ulipristal acetate containing EC pills can be taken within five days (120 hours) and levonorgestrel containing EC pills within 3 days (72 hours) of unprotected sex. However, the sooner they’re taken, the better - postponing it decreases its efficacy. “Oral emergency contraception works by delaying ovulation so it only works if it is taken prior to ovulation,” explains Dr Lashford. The more time that’s left to elapse, the greater the chance an egg may be released which in turn could be fertilised by a sperm waiting in the fallopian tubes. If you’ve already ovulated, it won’t work. However, the alternative form of EC offers a greater degree of certainty. “A copper IUD can however be inserted up to 5 days after ovulation,” says Dr Lashford, making it a better choice in this regard.

3. Accessibility is still an issue

With time being such a pivotal factor, wide-ranging and affordable availability is imperative. According to the NHS website , both Levonelle and ellaOne can be obtained free of charge from contraception clinics, Brook centres, certain pharmacies, most sexual health or GUM clinics, most NHS walk-in centres and minor injuries units, most GP surgeries and some A&E departments.

There is also the option to buy the ECP from certain pharmacies. However, price points are far from consistent. It’s an issue that’s received widespread press as of late with Boots having come under fire for charging significantly more than its counterparts due to fears that a lower price would lead to accusations of encouraging “inappropriate use.” As it stands at the moment, the pharmacy charges £28.25 for Levonelle and £26.75 for its generic levonorgestrel-based version, much more than Superdrug’s generic version for £13.49 and the £13.50 price tag of Levonelle at Tesco.

The price of ellaOne is sadly even more steep though, with it costing usually around £35. To help women better understand the options available, the brand has launched information on its website  regarding the online pharmacies that offer the service in an attempt to make the process of obtaining it as smooth as possible. However, it’s still an area that requires a great deal of improvement to provide better consistency across the board and accessibility to women of all incomes.

4. Your medications could stop it from working

If you’re taking any other drugs, ensure to disclose this to your health specialist in order to check that it doesn’t negate the ECP’s effects. “Both ellaOne and Levonelle, and in fact all oral contraceptive pills and the contraceptive implant, are metabolised more rapidly if the patient is also taking drugs which induce liver enzymes,” cautions Dr Lashford. “Some of the older anti-epileptic medicines such as phenytoin and carbamazepine, an antibiotic used to treat TB and for meningitis contacts called rifampicin and many of the antiretroviral drugs used to treat HIV are in this class,” she adds. “There is also some evidence that drugs that alter the acidity of stomach such as omeprazole and ranitidine may make ellaOne less effective.”

Certain supplements can also interfere with its effectiveness too. “The most commonly encountered enzyme inducing drug is St John’s Wort which can be brought from health food shops and is used by many people to treat low mood,” highlights Dr Lashford. “Women on any of these drugs would be best advised to consider a copper IUD rather than oral EC,” she recommends.

5. Bear your BMI in mind

Can weight affect the ECP’s efficacy? Yes. Revised guidelines from the FSRH  advise that women be warned by their health professionals of the possible impact their BMI could potentially have. “Oral emergency contraception – particularly Levonelle -  may be less effective in women weighing over 70kg or if their BMI is over 26,” explains Dr Lashford. “The insertion of a copper IUD would be a much more effective option,” she recommends.

“However, if oral treatment is wanted, ellaOne is generally more effective but if Levonelle is used, they should take a double dose.” Are there any risks associated with upping the amount ingested in this situation? According Dr Lashford, no. “Oral emergency contraception is extremely safe,” she tells us. “There are no concerns regarding taking a double dose.”