• Emergency contraceptive pill - There are two kinds of emergency contraceptive pill (‘Morning-after’ pill). o Levonelle has to be taken within 72 hours (three days) of the first episode of unprotected sex o ellaOne has to be taken within 120 hours (five days) of the first episode of unprotected sex. Both work by preventing or delaying ovulation (release of an egg). • The IUD can be inserted into your uterus up to five days after unprotected sex, or up to five days after the earliest time you could have ovulated. It may stop an egg from being fertilised or implanting in your womb. IMPORTANT: Emergency contraception does not protect against sexually transmitted infections (STIs). The emergency contraceptive pill does NOT provide ongoing contraception.

• There are no serious side effects of using emergency contraception. • Levonelle or ellaOne can make you feel sick, dizzy or tired, or give you a headache, tender breasts or abdominal pain. • Levonelle or ellaOne can make your period earlier or later than usual. • If you use the IUD as a regular method of contraception, it can make your periods longer, heavier or more painful. • You may feel some discomfort when the IUD is put in – painkillers can help to relieve this. • If you use the IUD as emergency contraception, it can be left in as your regular contraceptive method. • The emergency contraceptive pill does not provide ongoing contraception. You can start hormonal contraception straight away after taking Levonelle although you need to check in the information that comes with the medication how long it takes to become effective. • You must wait 5 days after taking EllaOne before starting or continuing hormonal contraception otherwise it may stop EllaOne working.

Note: Emergency contraception does not cause an abortion. It prevents pregnancy before it happens. Levonelle and Ella One are thought to delay ovulation. As sperm can only survive inside the female body for 5 days, delaying ovulation aims to keep the egg ‘out of the way’ until the sperm have died off. However, as you may ovulate later on in your cycle, further episodes of uprotected sex put you at risk of pregnancy again. The copper IUD works by preventing a fertilised egg from implanting into the uterus. Pregnancy is defined as beginning from the time the fertilised egg implants in the lining of the womb, so copper IUDs prevent pregnancy. If you are already taking hormonal contraception or wish to start, Levonelle won’t interfere with it and you can continue to take it/start straight away. However, EllaOne will. You need to wait 5 days after taking EllaOne before starting or continuing any hormonal contraception. Even if you are starting or continuing another method of hormonal contraception, it may not be effective immediately. You will need to use condoms or avoid sex until the contraception is working effectively. The time it takes for contraception to become effective depends on the emergency contraceptive pill and the method of hormonal contraception being started. Your doctor or nurse will tell you when you can start hormonal contraception and how long you will need to take additional precautions to prevent an unintended pregnancy. Levonelle and ellaOne are not intended to be used as a regular form of contraception. However, you can use emergency contraception more than once in a menstrual cycle if necessary but you should speak to a doctor or pharmacist for advice if you need to.

period at the expected time. However, you may have your period later or earlier than normal. If your period is more than seven days late, or is unusually light or short, you should do a pregnancy test to check for pregnancy.

Most women can use the emergency contraceptive pill. This includes women who cannot usually use hormonal contraception, such as the combined pill and contraceptive patch. Girls aged under 16 years old can also use the emergency contraceptive pill. Levonelle The World Health Organisation does not identify any medical condition that would mean a woman shouldn’t use Levonelle. ellaOne The manufacturer of ellaOne advises that it should not be used by women who: • are allergic to any of the components of the drug • have severe asthma that is treated with glucocorticoids (steroid) tablets • have certain rare hereditary problems with lactose metabolism ellaOne may not be effective in women who are taking liver enzyme-inducing medication. (see below)

If you are already using the pill, patch, vaginal ring or contraceptive injection you may need to take the emergency pill if you: • forgot to take some of your regular contraceptive pills, or • did not use your contraceptive patch or vaginal ring correctly, or • were late having your contraceptive implant or contraceptive injection

If you have taken Levonelle, then you should: • take your next contraceptive pill, apply a new patch or insert a new ring within 12 hours of taking the emergency pill • You should then continue taking your regular contraceptive pill as normal. You will need to use additional contraception, such as condoms, for: • the next seven days if you use the patch, ring, combined pill (except Qlaira), implant or injection • nine days for the combined pill Qlaira • the next two days if you use the progestogen-only pill If you have taken ellaOne, you will need to wait at least five days before taking your next contraceptive pill, applying a new patch or inserting a new ring. You should then use additional contraception, such as condoms, while waiting to restart your contraceptive method and then for: • the next seven days if you use the patch, ring, combined pill (except Qlaira), implant or injection • nine days for the combined pill Qlaira • the next two days if you use the progestogen-only pill

• you think you might be pregnant • your next period is more than seven days late • your period is shorter or lighter than usual • you have any sudden or unusual pain in your lower abdomen (this could be a sign of an ectopic pregnancy, where a fertilised egg implants outside the womb – this is rare but serious, and needs immediate medical attention)

The emergency pill and other medicines The emergency contraceptive pill may interact with other medicines. These include: • the herbal medicine St John’s Wort • some medicines used to treat epilepsy • some medicines used to treat HIV • some medicines used to treat tuberculosis (TB) • medication such as omeprazole (an antacid) to make your stomach less acidic ellaOne cannot be used if you are already taking one of these medicines, as it may not be effective. Levonelle may still be used, but the dose may need to be increased – your doctor or pharmacist can advise on this. There should be no interaction between the emergency pill and most antibiotics. Two enzyme-inducing antibiotics (called rifampicin and rifabutin), used to treat or prevent meningitis or TB, may affect ellaOne while they’re being taken and for 28 days afterwards. If you want to check that your medicines are safe to take with the emergency contraceptive pill, ask your pharmacist or book an appointment to speak to one of our doctors [here]. You should also read the patient information leaflet that comes with your medicines.

An alternative to the morning-after pill is the intrauterine device. It needs to be fitted by a trained professional in a GP surgery or sexual health clinic. How the IUD works : The intrauterine device (IUD) is a small, T-shaped contraceptive device made from plastic and copper. It’s inserted into the uterus by a trained health professional. It may prevent an egg from implanting in your womb or being fertilised. If you’ve had unprotected sex, the IUD can be inserted up to five days afterwards, or up to five days after the earliest time you could have ovulated, to prevent pregnancy. It’s more effective at preventing pregnancy than the emergency pill, and it does not interact with any other medication. You can also choose to have the IUD left in as an ongoing method of contraception. How effective is the IUD at preventing pregnancy? There are several types of IUD. Newer ones have more copper and are more than 99% effective. Fewer than two women in 100 who use a newer IUD over five years will get pregnant. IUDs with less copper in them are less effective than this, but are still effective. The IUD is more effective than the emergency pill at preventing pregnancy after unprotected sex. Who can use the IUD? Most women can use an IUD, including women who have never been pregnant and those who are HIV positive. Your GP or clinician will ask about your medical history to check if an IUD is suitable for you. You should not use an IUD if you have: • an untreated STI or a pelvic infection • certain abnormalities of the womb or cervix • any unexplained bleeding from your vagina – for example, between periods or after sex Women who have a heart condition should consult their GP or cardiologist before having an IUD fitted. Pregnancy and breastfeeding The IUD should not be inserted if there is a risk that you may already be pregnant. The IUD can be used safely if you’re breastfeeding, but the risk of complications during insertion is slightly higher. What are the side effects of the IUD? Complications after having an IUD fitted are rare, but can include pain, infection, damage to the womb or expulsion (the IUD coming out of your womb). If you use the IUD as an ongoing method of regular contraception, it may make your periods longer, heavier or more painful. The IUD and other medicines The emergency IUD will not react with any other medication. Where can I get the IUD fitted? Because it needs to be fitted by a trained professional, you can get the IUD from • a GP surgery that provides contraception (some GP surgeries may not provide the IUD) • a contraception clinic • a sexual health clinic (find sexual health services near you) • some genitourinary medicine (GUM) clinics • some young people's clinics (call 0300 123 7123) • Bear in mind if you are planning to have the IUD fitted it can still be advisable to take the morning-after pill if it is safe for you to do so, in case you cannot get an IUD fitted in time.

If you're not using a regular method of contraception, you might consider doing so in order to lower the risk of unintended pregnancy. Regular hormonal contraception includes • contraceptive pills • contraceptive patches • the contraceptive ring Long-acting reversible contraception (LARC) offers the most reliable protection against pregnancy, and you don't have to think about it every day or each time you have sex. LARC methods are the: • Contraceptive injection • Contraceptive implant • Intrauterine System (Mirena coil or Jaydess) • Intrauterine Device (copper coil)

Family Planning Association: 0300 123 7123 British Pregnancy Advisory Service: 03457 30 40 30 Marie Stopes: 0345 300 8090 (NHS Funded) / 0345 300 1202 (Private)