The morning-after pill is a type of emergency birth control (contraception). The purpose of emergency contraception is to prevent pregnancy after a woman has had unprotected sex or after her birth control method has failed.
The morning-after pill is intended for back-up contraception only, not as a primary method of birth control. Morning-after pills contain either levonorgestrel (Plan B One-Step) or ulipristal acetate (ella).
Plan B One-Step is available over-the-counter without a prescription; ulipristal is available only with a prescription from your doctor or health care provider.
Morning-after pills can help prevent pregnancy if you've had unprotected sex — whether you didn't use birth control, you missed a birth control pill, you were sexually assaulted or your method of birth control failed.
Morning-after pills do not end a pregnancy that has implanted. Depending on where you are in your menstrual cycle, morning-after pills may act by one or more of the following actions: delaying or preventing ovulation, blocking fertilization, or keeping a fertilized egg from implanting in the uterus. However, recent evidence strongly suggests that levonorgestrel doesn't keep a fertilized egg from implanting. It's not clear if the same is true for ella.
Keep in mind that the morning-after pill isn't the same as mifepristone (Mifeprex), also known as RU-486 or the abortion pill. This drug terminates an established pregnancy — one in which the fertilized egg has attached to the uterine wall and has already begun to develop.
Emergency contraception is an effective option for preventing pregnancy after unprotected sex, but it isn't as effective as other methods of contraception and isn't recommended for routine use. Also, the morning-after pill can fail even with correct use, and it offers no protection against sexually transmitted infections.
The morning-after pill isn't appropriate for everyone. Don't take a morning-after pill if:
- You're allergic to any component of the morning-after pill
- You're taking certain medications that may decrease the effectiveness of the morning-after pill, such as barbiturates or St. John's wort
- You know you're already pregnant
Also, if you're overweight or obese, there's some indication that the morning-after pill won't be as effective in preventing pregnancy as it is for normal-weight women.
In addition, make sure you're not pregnant before using ulipristal. The effects of ulipristal on a developing baby are unknown. However, if you're already pregnant when you take levonorgestrel, the treatment will simply be ineffective and won't harm the developing baby. Also, if you're breast-feeding, ulipristal isn't recommended.
Side effects of the morning-after pill typically last only a few days and may include:
- Nausea or vomiting
- Breast tenderness
- Bleeding between periods or heavier menstrual bleeding
- Lower abdominal pain or cramps
For maximum effectiveness, emergency contraception should be started as soon as possible after unprotected intercourse, and within 120 hours. You can take emergency contraceptive pills anytime during your menstrual cycle.
To use the morning-after pill:
- Follow the morning-after pill's instructions. If you use Plan B One-Step, take one Plan B One-Step pill as soon as possible and less than 72 hours after unprotected sex. If you use ella, take one ella pill as soon as possible and less than 120 hours after unprotected sex.
- If you vomit within two hours after taking the morning-after pill, contact your health care provider to discuss whether to repeat the dose.
- Don't have sex until you start another method of birth control. The morning-after pill doesn't offer lasting protection from pregnancy. If you have unprotected sex in the days and weeks after taking the morning-after pill, you're at risk of becoming pregnant. Be sure to begin using or resume use of birth control.
Using the morning-after pill may delay your period by up to one week after you normally expect it. If you don't get your period within three to four weeks of taking the morning-after pill, take a pregnancy test.
Normally, you don't need to follow up with your health care provider after using the morning-after pill. However, if you have bleeding or spotting that lasts longer than a week or develop severe lower abdominal pain three to five weeks after taking the morning-after pill, contact him or her. These may be signs or symptoms of a miscarriage or an ectopic pregnancy — when the fertilized egg implants outside the uterus, usually in a fallopian tube.
April 14, 2015
- Zieman M. Emergency contraception. http://www.uptodate.com/home. Accessed March 4, 2015.
- FDA approves Plan B One-Step emergency contraceptive for use without a prescription for all women of child-bearing potential. U.S. Food and Drug Administration. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm358082.htm. Accessed March 4, 2015.
- Shohel M, et al. A systematic review of effectiveness and safety of different regimens of levonorgestrel oral tablets for emergency contraception. BioMed Central Women's Health. 2014;14:54.
- Ella (prescribing information). Parsippany, N.J.: Watson Pharma Inc.; 2012. http://pi.watson.com/data_stream.asp?product_group=1699&p=pi&language=E. Accessed March 4, 2015.
- Plan B One-Step (prescribing information). Pomona, N.Y.: Duramed Pharmaceuticals Inc.; 2009. http://www.planbonestep.com/pdf/PlanBOneStepFullProductInformation.pdf. Accessed March 4, 2015.
- Koyama A, et al. Emerging options for emergency contraception. Clinical Medical Insights: Reproductive Health. 2013;7;23.