Emergency Contraception

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Emergency Contraception

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Please read all the information about your options below before starting an assessment.

There are three types of emergency contraception available which include:

* Levonelle tablet (levonorgestrel)

* ellaOne tablet (Ulipristal acetate)

* The Coil (Intra-uterine contraceptive device- IUCD)

The most effective form of emergency contraception is the IUCD, it is more effective than the emergency pill, and this should always be considered. If you use the IUCD for emergency contraception, it can be left in and used as your regular contraceptive.

Evidence has shown that ellaOne has been demonstrated to be more effective than Levonelle.

The emergency pills are not effective if taken after ovulation has occurred.

Emergency contraception should only be used as an occasional method when your regular contraception fails. It should not replace a regular contraceptive method.

Emergency contraception does not prevent pregnancy in every instance.

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Common Symptoms

 

  • Unprotected sexual intercourse within the last 5 days 
Common Treatments

It is vital that you read the Patient Information Leaflet for important information about your pill before taking it. Please click on the link below for further information about both emergency pills.

Treatments we prescribe if clinically appropriate:

  • Levonelle 1500 take as an immediate single dose - £5.20*
  • ella One 30mg take as immediate single dose - £14.05*

*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

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Levonelle

Levonelle contains levonorgestrel which is a synthetic version of the progestogen hormone. The usual dose is 1.5mg. Some women may require a higher dose. 

It is thought to work by preventing or delaying the egg being released by the ovary. If the embryo has already implanted, then it does not affect this. It will therefore not terminate a pregnancy if it has already occurred. 

Studies have shown if 1,000 women had unprotected sex once, about 60 to 80 would become pregnant. If all those women had taken Levonelle then only around 11 to 26 would have become pregnant.

If ovulation has already taken place, then it will not be effective. If you have a 28-day cycle, then you are likely to ovulate after 14 days from the first day of your period. Ovulation and menstrual cycles can be unpredictable so it may be difficult to work out your day of ovulation. 

If you think you may have already ovulated, then you should consider the IUCD. Contact your GP surgery or family planning clinic to arrange this as soon as possible. You can also contact NHS 111 for further advice.

If you have unprotected sex at any time after taking the emergency pill, you can become pregnant. It does not continue to protect you against pregnancy after you have taken it.

Using emergency contraception does not replace the necessary precautions required to prevent sexually transmitted diseases.

Who is Levonelle unsuitable for?

Certain conditions and medications make Levonelle ineffective. 

Levonelle is unsuitable if you have a history of any of the following conditions:

  • porphyria
  • previous ectopic or molar pregnancy
  • very severe gut disease (such as Crohn's disease)
  • lactose intolerance (rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption)

If you take any of the following medications then Levonelle may be unsuitable for you:

  • Anti-epileptics: phenytoin, carbamazepine
  • Rifampicin and rifabutin (antibiotics used to treat TB)
  • St Johns Wort (herbal remedy for anxiety/ depression)
  • Anti-virals (ritonavir)
  • Selegiline
  • Ciclosporin
  • Tizanidine

If you have any of the above, then please speak to your doctor or nurse for further advice. 

If the Levonelle did not work and you became pregnant, there is no evidence that taking the emergency progestogen pill is harmful to the baby.

How to take Levonelle

Take the pill as soon as possible after unprotected sex, preferably within 12 hours. The earlier it is taken, the more effective it is as preventing pregnancy.

Levonelle should be taken within 72 hours (3 days) from unprotected sex. 

If you vomit within 3 hours of taking the pill, then you should either take another pill straight away.  You can see your pharmacist or contact us for another prescription. Alternatively, contact your family planning clinic or GP surgery to have the IUCD fitted. 

Side effects from Levonelle

Side effects are generally uncommon. Mild side effects usually only occur for a short time and may include:

  • nausea (less likely to occur if you take the pill with food)
  • vomiting (another pill will need to be taken within 3 hours)
  • diarrhoea
  • abdominal pain
  • a headache
  • fatigue
  • dizziness
  • breast tenderness
  • changes to your period (erratic bleeding, period may be early or late)

Most women will have their period within 5-7 days of their expected date.

If any of the side effects become bothersome, then speak to your pharmacist, doctor or nurse for further advice.

After taking Levonelle

If you are not using regular contraception then we advise you to make an appointment with your local family planning clinic or GP surgery.

There is an increased risk of pregnancy with further unprotected sex after the emergency pill has been taken within that menstrual cycle. It is therefore advisable to start regular contraception to help prevent this.

You should do a pregnancy test 3 weeks after using emergency contraception. 

Your regular method of contraception should be continued as normal. If emergency contraception is used because of missed oral contraceptive pills, then resume your normal pill-taking regime within 12 hours of taking Levonelle.

Use additional barrier contraception, such as condoms, for:

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

If in doubt speak to your nurse, GP or pharmacist for further advice.

If pregnancy occurs after treatment with Levonelle, then the possibility of an ectopic pregnancy should be considered. See your GP for further advice. 

When to seek medical advice after taking Levonelle

If you develop any of the following symptoms listed below 2 to 6 weeks after taking Levonelle, then you must seek urgent medical advice (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance or go to A&E if the symptoms are severe. These may be signs of an ectopic pregnancy.

  • abdominal pain
  • abnormal bleeding
  • feeling faint or dizzy

Please note that i-GP does not treat medical emergencies.

ellaOne

ellaOne contains 30mg Ulipristal acetate. 

It is thought to work by preventing or delaying the egg being released by the ovary. If the embryo has already implanted, then it does not affect this. It will therefore not terminate a pregnancy if it has already occurred. 

Studies have shown if 1,000 women had unprotected sex once, about 60 to 80 would become pregnant. If all those women had taken ulipristal acetate, about 9 to 18 would have become pregnant. It will, however, depend on when in the cycle it was taken.

If ovulation has already taken place, then it will not be effective. If you have a 28-day cycle, then you are likely to ovulate after 14 days from the first day of your period. Ovulation and menstrual cycles can be unpredictable so it may be difficult to work out your day of ovulation. 

If you think you may have already ovulated, then you should consider the IUCD. Contact your GP surgery or family planning clinic to arrange this as soon as possible. You can also contact NHS 111 for further advice.

If you have unprotected sex at any time after taking the emergency pill, you can become pregnant. It does not continue to protect you against pregnancy after you have taken it.

Using emergency contraception does not replace the necessary precautions required to prevent sexually transmitted diseases.

Who is ellaOne unsuitable for?

 EllaOne is unsuitable if you have a history of any of the following conditions:

  • severe asthma
  • severe liver disease

If you take any of the following medications then ellaOne maybe unsuitable for you:

  • Anti-reflux medication such as antacids, ranitidine, omeprazole
  • Anti-epileptics: phenytoin, carbamazepine
  • Rifampicin and rifabutin (antibiotics used to treat TB)
  • St Johns Wort (herbal remedy for anxiety/ depression)
  • Anti-virals (ritonavir)

If you have missed your Progestogen-only pills or Combined oral contraceptive pill then ellaOne may not be the best choice of emergency contraception for you. You should consider the IUCD or Levonelle instead.

You should not breastfeed for one week after taking this tablet.

How to take ellaOne

Take the pill as soon as possible after unprotected sex, preferably within 12 hours. The earlier it is taken, the more effective it is as preventing pregnancy.

EllaOne should be taken within 120 hours (5 days) from unprotected sex. 

If you vomit within 3 hours of taking the pill, then you should either take another pill straight away.  You can see your pharmacist or contact us for another prescription. Alternatively, contact your family planning clinic or GP surgery to have the IUCD fitted. 

Possible side effects of ellaOne

Side effects are generally uncommon. Mild side effects usually only occur for a short time and may include:

  • nausea (less likely to occur if you take the pill with food)
  • vomiting (another pill will need to be taken within 3 hours)
  • abdominal pain
  • a headache
  • dizziness
  • muscle pains
  • changes to your period (erratic bleeding, period may be early or late)

Most women will have their period within 5-7 days of their expected date.

If any of the side effects become bothersome, then speak to your pharmacist, doctor or nurse for further advice.

After taking ellaOne

 

If you are not using regular contraception then we advise you to make an appointment with your local family planning clinic or GP surgery.

There is an increased risk of pregnancy with further unprotected sex after the emergency pill has been taken within that menstrual cycle.

You should do a pregnancy test 3 weeks after using emergency contraception. 

Wait at least 5 days before taking your next contraceptive pill, applying a new patch or inserting a new ring. You will also need to use additional barrier contraception such as condoms until you restart your contraception and for a further:

  • 2 days if on the POCP.
  • 7 days if on the COCP (apart from Qlaira)
  • 7 days if on the contraceptive ring or contraceptive patch.
  • 7 days if using the progestogen-only implant or progestogen-only injection
  • 9 days if on Qlaira

This is the advice given by the Faculty of Sexual and Reproductive Healthcare (FSRH) in their guideline for Emergency Contraception, December 2017.

If in doubt speak to your nurse, GP or pharmacist for further advice.

The Coil (IUCD)

The IUCD (intrauterine contraceptive device) is the most effective form of emergency contraception. It is inserted into the uterus by a doctor or nurse. It is thought to work by releasing copper to prevent fertilisation and if the egg is already fertilised then by preventing the egg implanting into the uterus. It can be inserted up to 5 days after unprotected sex, or up to five days after the earliest likely date of ovulation (whichever is later).

An IUCD can be used even if the emergency pill has been taken. It can also be used for ongoing contraception. 

Side effects are uncommon and include, pain, infection, damage to the uterus, it coming out of the uterus, changes to your periods if you continue to use as it a contraceptive (heavier, more painful or longer periods).

The IUCD may be unsuitable for women with the following:

  • current pelvic inflammatory disease
  • an active chlamydia or gonorrhea infection
  • history of copper allergy or Wilson's disease,
  • distorted uterus,
  • gestational trophoblastic disease
  • postpartum sepsis
  • cervical or endometrial cancer
Where else can you get emergency contraception?

Emergency contraception can be obtained free on the NHS.

  • Contraception clinics or sexual health clinics
  • Your GP surgery
  • Some pharmacies

You can also buy it from most pharmacies after having a consultation with the pharmacist to assess it's suitability. It will generally cost around £25 to £35 as listed on NHS Choices. However, it is best to contact your pharmacy to find out the exact cost as it can vary.

Contraceptive Advice

For further advice on all the different forms of contraception available, please see the NHS Choices: Your Contraceptive Guide

Long-acting reversible contraceptives (LARC) are very effective. They allow you to avoid having to remember to take your contraceptive pill every day. There are four types of LARC available. These include:

  • Contraceptive Implant
  • Contraceptive Injection
  • IUCD (Intrauterine contraceptive device) also known as the 'coil.'
  • IUS (Intrauterine contraceptive system)

Implant

A small rod-shaped implant is inserted under the skin of the upper arm and releases the hormone progesterone. This provides contraception for three years.

Injection

An injection of the progesterone hormone is given into the muscle. This lasts between two to three months depending on the brand.

IUCD

This small device is inserted into the uterus. It lasts up to 10 years.

IUS

This is a type of IUCD which contains the hormone progesterone. This can last up to five years.

Please click on the links above for further information about each type of LARC.

You can get contraception free of charge from:

  • contraception clinics
  • sexual health/ GUM clinics
  • your GP surgery
Safe sex

The emergency pill does not protect you against sexually transmitted infections. If you are worried that you may have an STI, go for a check-up at a sexual health clinic as soon as you can. Help protect yourself from catching or passing on an STI  by always using condoms.

Please use the following links to find your nearest Sexual Health/ GUM clinic.

You can call the national sexual health helpline free on 0300 123 7123 for further advice if you are worried.

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We could send you a treatment plan with a prescription, if appropriate, within an hour and you can collect your medication from your local pharmacy.