Ask a lot of women in their 20s and 30s when they first took the morning-after pill, and it’ll be as distant a memory as losing their virginity.
“The first time I took the morning-after pill was the first time I had sex, at 16,” says Lauren, 30 and from south London. “I remember I put the empty pill packet in the bin in my bedroom after and my dog turned the bin over. My mum was clearing it up and found the empty packet and was so furious that a) I’d had sex and b) I hadn’t used protection. That didn’t put me off though, clearly, because I’ve taken it about 10 times since.”
Marianne, 25, from Yorkshire says much the same: “I used it from 15 to 17 a couple of times, when condoms split or I wasn’t certain that I’d used one properly... basically until I was brave enough to tell my parents I was having sex so I could go on the pill.” After that, she was on the contraceptive pill for a while but came off when she started dating girls as well as boys. She estimates that the number of times she’s had sex without any protection and taken the morning-after pill as a precaution is around 20.
For Faye, 24, from Sussex, the last time she took it was the sixth in 10 years. “I slept with the boy I was dating and we got carried away and had unprotected sex. That was about three months ago, and a rare one-off for me these days.” It’s never tricky to get hold of, she says: “I got it from an independent pharmacy near my house and I didn't pay because I specifically looked up where I could get it for free in my local area. The chemist looked at me disapprovingly but I just ignored him.”
Like Lauren, Marianne and Faye, I first took the morning-after pill when I was in my mid-teens and it’s been a recurring staple of my sex life ever since. I’m now 25. A quick survey of my female friends suggests most have taken it, and the statistics back this up: 61% of UK women are thought to have accessed emergency contraception – a higher rate than any country in the European Union, according to the Independent. Women are likely to use it more frequently in their 20s than at any other age.
There are no accurate, collated statistics of how much emergency contraception is taken each year from GP surgeries, pharmacies and Sexual Reproductive Health (SRH) services, but how often we access the morning-after pill or emergency coil in the UK does seem to be falling. From 2015-16, the women of Britain accessed emergency contraception from SRH services roughly 300,000 times. A decade earlier, between 2005 and 2006, the number was closer to 500,000.
Over the course of 10 years, then, our use of emergency contraception as accessed from specific sexual health centres has gone down 40%. This could be because we’re getting it elsewhere – it’s now available online, while pharmacies are increasingly popular places to pick up the morning-after pill, since it became available over-the-counter in 2001. But it could also be due to the rise of alternative measures such as LARCs – Long-Acting Reversible Contraceptives such as contraceptive injections, intrauterine devices (IUD) like the copper coil, and intrauterine systems (IUS) like the Mirena – as well as better awareness around safe sex.
For future generations, we may see usage of emergency contraception fall even further. As of this week, sex education has been made compulsory in UK schools, which may affect the number of emergencies women are having. Hopefully, it may also improve women’s understanding of emergency contraception and what it does – research from the Family Planning Association in 2014 found that the majority (59%) of 16-54-year-old UK women said they knew only “a little” about it.
Lauren admits minimal knowledge; “I know it’s a last resort. I don’t know anything about the health risks though,” she says. That’s despite the fact that she once took it four times in a week. “I had gone on a debauched ski trip with a group of newly single girls. We all ended up hooking up with people on the same night (I took the boot room) and the next morning sheepishly lined up at the one lodge pharmacy to get the morning-after pill. I carried on in that vein.”
Without googling, Faye said she couldn’t be totally sure how it works or what the risks are, either. “My guess would be that it prevents an egg from being released. And immediately starts a shedding of the womb so that if there is a fertilised egg it can't embed. But short answer, no, I don’t know,” she says. She also doesn’t know how often is too often to take it, but thinks “too many times could make you infertile.”
The lack of information about emergency contraception may be due to the persisting stigma of taking it; the FPA found that “one-third (39%) of [2,509] women surveyed thought asking for emergency contraception can be embarrassing.” This went up to more than half of 16-24-year-olds.
While our use of it may be falling, then, anecdotal evidence suggests we’re still relying on the morning-after pill or emergency coil well into our 20s and beyond, while failing to educate ourselves on what it is, what it does to us and what better, alternative options there might be. The morning-after pill, essentially, is shrouded in myth.
If, like me, Lauren, Marianne and Faye, you don’t know much about emergency contraception and you’re too embarrassed to ask (especially if you’ve already taken it more than 20 times over the last 10 years – oops), relax and scroll on for more information from the NHS, as well as advice from Karin O’Sullivan, clinical lead at the Family Planning Association.
It’s not just a pill
Emergency contraception doesn’t just refer to oral pills, says the FPA, but also includes the emergency IUD (copper coil) which, according to Karin O’Sullivan, is “the most effective method [of emergency contraception] as this can stop a fertilised egg from implanting in your uterus (womb).”
The IUD is basically a small, T-shaped plastic and copper device. It’s inserted into the uterus by a trained nurse or doctor and stops the fertilised egg from surviving in the fallopian tube or womb.
The good thing about the IUD is “you can also keep [it] as your regular method if you want to” afterwards, says Karin. So you’re remedying the “emergency” and protecting yourself going forwards.
As for the pills, “there are two different types of emergency pill” says Karin. There’s Levonelle and ellaOne; the former works for up to 72 hours after unprotected sex, the latter five days. Both prevent or delay ovulation (although experts don’t 100% know how Levonelle works, so you don’t have to feel bad for not knowing, either).
“You can take the same type of pill more than once in any menstrual cycle if you need to, but it may not be possible to take a different type of pill in the same cycle,” points out Karin. The sooner you take the pills after unprotected sex, the better they work.
It’s not the same as an abortion
Despite what some religious groups might have you believe, the morning-after pill or emergency coil is not the same as an abortion because it prevents pregnancy from occurring in the first place. Pregnancy happens when a fertilised egg implants in the uterus, which takes five to seven days from when sperm fertilises the egg. Emergency contraception intervenes in the interim.
“How effective emergency contraceptive pills are will depend where you are in your menstrual cycle. The pills work by stopping you ovulating (releasing an egg),” says Karin. “If you’ve already released an egg when you take the pill, you’re at greater risk of pregnancy.” If that is the case, you’ll need to take a pregnancy test.
You don’t have to pay for it
Although most pharmacies in the UK will charge you for the morning-after pill (you can’t get the IUD at pharmacies since it has to be fitted by a professional), there are some that don’t charge if you live in the local area. You can look this up online.
GPs, NHS-funded Brook centres, local sexual health services and NHS walk-in centres should give it to you for free, and will probably hand you a bunch of condoms while you’re at it. If you’re under 16, you can now get it at pharmacies – pre-2015, they were advised only to give out to over-16s.
If you are going to pay at a pharmacy (I recall doing this because I’ve left it to the last minute more than once and couldn’t access anywhere free), beware that Levonorgestrel (known as Levonelle) generally costs £20-28 and Ulipristal (that’s ellaOne) can cost up to £48.
According to the Independent, the pill is five times more expensive in the UK than other countries in Europe, like France, where Levonelle can cost just £5.50. “We’d like all women who need it to have easy and free access to all types of emergency contraception,” says Karin, but it’s not a reality just yet.
You can buy it online
“Buying online, as long as it’s from a trusted pharmacist, is a helpful option for women who don’t have easy access,” says Karin. The morning-after pill has been available online since 2001, with Superdrug the first company to offer the service in the UK. You generally have to fill out a form about your medical health, and pay with a credit or debit card to prove you’re over 16.
Buying online can actually be cheaper than buying in a pharmacy, as competitive pricing takes hold. Levonelle can be as cheap as around £12 and ellaOne £24. Of course, you’ll still need to wait for it to be delivered – remember, there’s only a 72-hour window after unprotected sex in which you can take Levonelle. Luckily, most sites do 24-hour delivery services...
Taking it frequently is not actually bad for you
“When I first heard about the morning-after pill, I was told by friends and parents that you can only take it once or twice in a lifetime or it makes you infertile,” says Rose, 26, from London. Marianne and Faye heard the same. In reality, however, there are no proven long-term effects on your fertility.
While there are very few comprehensive clinical trials on the topic, it’s believed that the myth of long-term danger to your fertility actually comes from the fact that unprotected sex could lead to contracting STIs like chlamydia which, in turn, can be damaging to fertility if it goes untreated.
In a very small proportion of women – those with a genetic predisposition to blood-clotting – emergency oral contraceptives can increase the risk of blood clots to the brain. It can also cause a heightened incidence of ectopic pregnancies, which is when the embryo lodges in the fallopian tube rather than the womb. But that’s also rare.
Overall, it’s extremely safe to take multiple times. “Although there’s no evidence to show that taking emergency pills frequently will harm you, a regular method of contraception is much more effective at preventing pregnancy,” advises Karin.
There might be side effects
“When I took Levonelle I didn’t have normal periods for about six months afterwards,” says Rose. “I instantly got a really heavy period, and then it would come at random times for four months.”
Faye has also experienced side effects: “Once I took it and felt super-nauseous and then threw it up,” she says. “It probably didn’t help that I was hungover. Anyway, I had to go back to the clinic, which was annoying, but they say if you throw it up, you have to take it again.”
According to the NHS, some of the side effects regularly experienced by women who take emergency contraception orally include abdominal pains, dizziness, tiredness, nausea and irregular bleeding. And be prepared that your next period might be heavier than usual.
It’s not foolproof
For Jessica, Marianne, Faye and myself, taking the morning-after pill has always 'worked' insofar as it’s effectively prevented pregnancy. However, Levonelle is only 95% effective if taken in the first 24 hours, and effectiveness falls as time passes. ellaOne is thought to be 95% effective between 48 hours and five days after sex.
“Emergency contraceptive pills are very safe, but they’re not as effective as regular contraception at preventing pregnancy and won’t protect you from sexually transmitted infections,” explains Karin. For that reason, you should still use a condom if you and your partner have not been checked for STIs.
There are other, better options
Karin reminds us that: “If you need to take emergency pills often, because your current method isn’t working for you – for example if you can’t remember your pill or have trouble using condoms – then speak to a doctor, nurse or pharmacist about finding a method that suits you.”
For Marianne, taking the emergency contraceptive pill has been a better option than regular contraceptive pills because she kept forgetting to take them every day. Although she’s not worried about the dangers of taking the morning-after pill, she is now considering having an IUD fitted, mostly for convenience.
Lauren says that going on the contraceptive pill Microgynon helped her relax about unprotected sex (although she hasn’t had unprotected sex four times in one week lately, and has been having sex with a regular partner). It beats paying for the morning-after pill when you’re on holiday, too, she adds.
If you’re unsure of the best contraception for you, FPA’s My Contraception Tool can help you consider your options, says Karin. “Long-acting reversible contraception such as the IUD (copper coil), IUS (progesterone-only coil) and implant are all highly effective at preventing pregnancy and don’t rely on you remembering to use them, so... you won’t need emergency contraception.”
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