Emergency Contraception

Emergency contraception is one of the most important reproductive health tools available to women in the UK. It is safe, effective, and accessible through pharmacies without a prescription. Yet significant confusion still surrounds how it works, how many times it can be used, and what its limitations are. 

One of the most asked questions is whether it is safe to take the morning after pill more than once, either within the same cycle or across multiple occasions. The honest clinical answer is more nuanced than a simple yes or no, and understanding it properly helps women make informed decisions about their contraceptive health. 

What Is Emergency Contraception and How Does It Work? 

Emergency contraception refers to methods used after unprotected sexual intercourse to reduce the risk of unintended pregnancy. In the UK, two types of emergency contraceptive pill are available, alongside the copper intrauterine device as a highly effective non-hormonal option.

The two emergency contraceptive pills available in the UK are: 

  • Levonorgestrel (most commonly known as Levonelle), a progestogen-based pill that works primarily by delaying or inhibiting ovulation 

  • Ulipristal acetate (ellaOne), a selective progesterone receptor modulator that also works by delaying or inhibiting ovulation and may have additional effects on the endometrium

Neither pill is an abortifacient. Both work before implantation occurs and are not effective once a pregnancy has been established. This distinction is clinically and ethically important and is supported by the regulatory frameworks governing both products.

The copper IUD is the most effective form of emergency contraception available, with a failure rate of less than one percent when inserted within five days of unprotected intercourse. It can subsequently remain in place as ongoing contraception, making it a highly practical option for women seeking both immediate and long-term protection. 

Can You Take the Morning After Pill More Than Once? 

Yes. There is no medical evidence that taking emergency contraception on more than one occasion causes harm. Neither levonorgestrel nor ulipristal acetate accumulates in the body in a way that creates toxicity with repeated use, and neither has been shown to cause long-term fertility problems.

However, several important clinical points apply when emergency contraception is used more than once. 

Using Emergency Contraception More Than Once in the Same Cycle 

Taking two different emergency contraceptive pills within the same menstrual cycle is not recommended and is not clinically appropriate. The two pill types, levonorgestrel and ulipristal acetate, interact with each other in a way that reduces the effectiveness of both. They should not be taken together or within the same cycle.

If unprotected intercourse occurs again within the same cycle after taking emergency contraception, the appropriate course of action is to speak to a pharmacist or sexual health clinician rather than self-administering a second pill. A copper IUD may be the more appropriate option in this situation. 

Using Emergency Contraception Repeatedly Across Different Cycles 

Taking emergency contraception on multiple separate occasions across different cycles is medically safe. However, it is worth understanding that repeated reliance on emergency contraception as a primary contraceptive strategy is not clinically ideal for several reasons: 

  • Emergency contraception is significantly less effective than regular contraception used consistently. Levonorgestrel has an effectiveness of approximately 84 percent overall when taken within 72 hours, reducing with time. ellaOne is effective for up to 120 hours and maintains better efficacy across the full five-day window

  • Repeated hormonal disruption from frequent use can cause irregular menstrual cycles, unpredictable bleeding, and difficulty identifying cycle patterns 

  • It does not provide any protection against sexually transmitted infections 

A pharmacist providing emergency contraception is trained to discuss longer-term contraceptive options with every patient. This is not a judgement on the patient's choices but a clinical responsibility to ensure the most effective protection going forward. 

Emergency Contraception Effectiveness: What the Evidence Shows 

The effectiveness of emergency contraception depends on the method chosen and, for the pills, how quickly they are taken after unprotected intercourse. 

For levonorgestrel: 

  • Taken within 24 hours: reduces the risk of pregnancy by approximately 95 percent 

  • Taken between 24 and 48 hours: approximately 85 percent effective 

  • Taken between 48 and 72 hours: approximately 58 percent effective 

  • Not licensed for use beyond 72 hours after unprotected intercourse<sup>1</sup> 

For ulipristal acetate (ellaOne): 

  • Maintains consistent effectiveness across the full 120-hour window 

  • Evidence suggests it is more effective than levonorgestrel, particularly between 72 and 120 hours after unprotected intercourse 

  • May be less effective in women with a higher body weight, though the evidence on this remains under review

The copper IUD maintains above 99 percent effectiveness regardless of when within the five-day window it is inserted and is the most reliable option available for emergency contraception in all circumstances. 

Body weight is a clinical consideration for emergency contraceptive pill choice. Current guidance suggests that ulipristal acetate may be preferred over levonorgestrel in women with a higher body weight, though the evidence base continues to evolve. A pharmacist can advise on the most appropriate choice based on individual circumstances.

Emergency Contraception Side Effects 

Both emergency contraceptive pills are generally well tolerated. Side effects are usually mild and transient, resolving within a few days of taking the pill. 

Commonly reported side effects include: 

  • Nausea, which is more common with levonorgestrel than with ulipristal acetate 

  • Headache and dizziness 

  • Fatigue 

  • Breast tenderness 

  • Abdominal pain or discomfort 

  • Irregular bleeding or spotting before the next expected period 

If vomiting occurs within two hours of taking levonorgestrel or within three hours of taking ulipristal acetate, the dose may not have been fully absorbed, and a replacement dose or alternative method should be considered promptly. A pharmacist should be contacted in this situation.<sup>1</sup> 

The next menstrual period may be earlier or later than expected following emergency contraception use. If a period is more than seven days late, lighter than usual, or if pregnancy symptoms develop, a pregnancy test should be taken. 

When to Take Emergency Contraception 

The single most important factor in emergency contraceptive pill effectiveness is taking it as quickly as possible after unprotected intercourse. Every hour of delay reduces the window of opportunity before ovulation may occur. 

Emergency contraception should be considered following: 

  • Unprotected sexual intercourse 

  • Contraceptive failure including a split or slipped condom 

  • Missed contraceptive pills according to the relevant missed pill rules 

  • A delayed contraceptive injection beyond the recommended interval 

  • Sexual assault, in which case additional support and STI testing should also be sought promptly 

If there is any uncertainty about whether emergency contraception is needed, speaking to a pharmacist without delay is always the right approach. The pharmacist can assess the situation, advise on the most appropriate method, and provide the treatment or referral needed. 

Pharmacy Emergency Contraception in Wimbledon and Morden 

Emergency contraception is available directly from a pharmacist without a prescription and without a GP appointment. A brief confidential consultation is required before the medication is supplied, during which the pharmacist will confirm the clinical suitability of the chosen method and discuss longer-term contraceptive options. 

If you are looking for emergency contraception services in Wimbledon or emergency contraception treatment in Morden, Pearl Chemist Group provides discreet, non-judgemental, and clinically informed emergency contraception consultations across its South London branches. 

Speak to a pharmacist at Pearl Chemist Group as soon as possible after unprotected intercourse for the most effective outcome. 

References 

  1. National Institute for Health and Care Excellence. Emergency contraception. Clinical Knowledge Summary. NICE; updated 2023. https://cks.nice.org.uk/topics/contraception-emergency 

  1. Faculty of Sexual and Reproductive Healthcare. FSRH Guideline: Emergency Contraception. FSRH; 2017, updated 2020. https://www.fsrh.org/standards-and-guidance/documents/ceu-clinical-guidance-emergency-contraception-march-2017 

Frequently Asked Questions

Is it safe to take emergency contraception more than once in a lifetime? 

Yes. There is no medical evidence that taking emergency contraception on multiple separate occasions causes any long-term harm. Neither levonorgestrel nor ulipristal acetate accumulates in the body or causes lasting hormonal disruption. However, repeated reliance on emergency contraception as a primary contraceptive method is not recommended given its lower effectiveness compared to regular contraception used consistently. 

Can I take two morning after pills to make it more effective? 

No. Taking two doses does not increase effectiveness and is not clinically appropriate. The correct approach is to take a single dose of the most appropriate emergency contraceptive pill as quickly as possible after unprotected intercourse. If there are concerns about effectiveness, for example due to body weight or timing, a pharmacist can advise on whether ulipristal acetate or the copper IUD is a more suitable option. 

Does the morning after pill affect future fertility? 

No. Emergency contraception does not affect long-term fertility. Both levonorgestrel and ulipristal acetate work by delaying or inhibiting ovulation in the current cycle and do not have any lasting effect on the reproductive system. Fertility returns to normal immediately after use. 

How quickly does emergency contraception work? 

Both emergency contraceptive pills work by preventing or delaying ovulation. They are most effective when taken as soon as possible after unprotected intercourse. Levonorgestrel is effective within 72 hours. Ulipristal acetate maintains consistent effectiveness for up to 120 hours. The copper IUD is effective within five days of unprotected intercourse regardless of where in the cycle ovulation has occurred. 

Will the morning after pill affect my regular contraception? 

Ulipristal acetate can reduce the effectiveness of progestogen-based contraception including the progestogen-only pill, implant, and hormonal coil. After taking ellaOne, additional barrier contraception should be used for seven days. Levonorgestrel does not interact with hormonal contraception in the same way. A pharmacist will advise on what precautions are needed based on the specific method taken. 

Can I get emergency contraception from a pharmacy without a prescription? 

Yes. Both levonorgestrel and ulipristal acetate are available from a registered pharmacy without a prescription following a brief confidential consultation with the pharmacist. The consultation assesses clinical suitability, confirms the appropriate method, and provides an opportunity to discuss ongoing contraceptive options. There is no requirement to see a GP first. 

What should I do if my period does not come after taking emergency contraception? 

If your next period is more than seven days late, lighter than usual, or you experience symptoms that could indicate pregnancy, take a pregnancy test. Emergency contraception is not 100 percent effective, and a pregnancy test is the only way to confirm whether it has worked. If the test is positive, contact your GP or a sexual health clinic promptly to discuss your options and ensure appropriate care.