Emergency contraception: what you need to know about the “morning after” pill

The “morning after” pill is a hormonal emergency contraceptive that women can take after a contraception mishap or unprotected sex to avoid an unwanted pregnancy.

The “morning after” pill can be obtained from any pharmacy without a prescription. It is usually dispensed just once, in person to the woman concerned. At night, during the weekend or on bank holidays, the emergency pharmacies can be used. 

Products with the active agent levonorgestrel and the agent ulipristal acetate are approved in Germany. In the case of both substances, the earlier they are taken after a contraception mishap or unprotected sex, the more effective they are. 

Depending on the active agent, the “morning after” pill costs between 18 and 35 euros.

When women get the “morning after” pill prescribed by a doctor before their 22nd birthday, the statutory health insurance will assume the costs. However, a contribution is required after the woman’s 18th birthday.

Girls below the age of 14 usually have to get their parents’ consent to them taking the “morning after” pill. If the girls concerned are between 14 and 18 years old, the pharmacist decides whether they are given the product.

Products with the active agent levonorgestrel prevent the formation of a hormone that causes the egg cell to mature. This prevents ovulation. Products with the active agent ulipristal acetate prevent or postpone ovulation.

The probability of getting pregnant is greatest 1 to 2 days before ovulation. Taking the “morning after” pill can push this point back by up to 5 days so that the sperm are no longer capable of fertilization. However, if ovulation has already taken place or if it is imminent, the “morning after” pill with the agent levonorgestrel is no longer effective. In contrast, products with the agent ulipristal acetate are effective until just before ovulation.

In general terms, the earlier it is taken after the contraception mishap or the unprotected sex, the better.

Depending on the product, the time window for taking the “morning after” pill effectively is a maximum of 3 to 5 days.

Should vomiting occur within the first 4 hours after taking it, a new “morning after” pill should be taken as soon as possible.

Women who usually take hormonal contraception and take the “morning after” pill with the agent levonorgestrel should continue their hormonal contraception within 24 hours. They should also use a second contraception method for the next 7 days, for example use condoms or not have sex. Someone who takes the “morning after” pill with the agent ulipristal acetate can resume hormonal contraception after 5 days. They should also use a second contraception method before that and for up to 14 days afterwards.

For breast-feeding women, it should be noted that the agents in the “morning after” pill pass into the breast milk. So they should stop breast-feeding for between 8 hours and a week, depending on the product taken. Doctors recommend pumping the milk out in order to maintain lactation. However the baby should not drink it.

Taking the “morning after” pill can cause the menstrual period to be delayed. Spotting or heavier irregular bleeding are also possible.

The more common side effects also include:

• dizziness
• headaches and abdominal pain
• chest tightness
• nausea and vomiting 
• muscle and back pain
• fatigue
• mood swings

Doctors advise women with bad asthma who are taking glucocorticoids such as cortisone in tablet form against taking the “morning after” pill. This also applies to women very susceptible to thromboses and women with severe disorders of the liver function. Women who are very overweight will benefit from inserting an “emergency” copper coil, as the “morning after” pill may not work.

Simultaneously taking certain medications can also cause the “morning after” pill to be ineffective. So tell the pharmacist which medications you are taking.

Moreover, if you are pregnant or suspect you are pregnant, taking the “morning after” pill is not an option.

If condoms tear, slide off or remain stuck in the woman’s vagina it is often because they are the wrong size, i.e. the condom is too small or too large.

To find out how to select the right size, go to the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung – BZgA) website.

Proper use also involves getting the air out of the reservoir by squeezing with the fingertips when slipping the condom on. The condom should also be put on before penetrating the vagina, and only taken off when the penis has been fully withdrawn from the vagina.

Anyone who uses the hormonal pill as contraception should be careful to always take the pill at the same time of day. If you find it difficult to remember the time to take it, the best idea is to save it on your smartphone. Time differences need to be taken into account, for example while on holiday or a business trip. It should also be noted that taking certain medications simultaneously, nausea and vomiting can make the pill less effective. If you are in any doubt, use an additional contraception method until you have finished the pack of pills, condoms for example.

A woman using a vaginal ring, diaphragm or coil should always check that everything is sitting correctly. With a diaphragm, for example, it is important that it lies precisely at the entrance to the womb. In this case, the spermicide gel is always an issue too – even if the diaphragm sits perfectly it is useless without the gel. Moreover, the diaphragm should not be inserted more than 2 hours before having sex, and it should only be removed 8 to 12 hours afterwards.

A gynecologist can check that a contraceptive coil is positioned correctly.

If emergency contraception using the “morning after” pill is unsuitable, for example because there is a fear of adverse side effects, or if the woman concerned is very overweight, an emergency coil or copper chain are suitable alternatives.

The copper in the coil and the chain changes the environment in the uterus and the fallopian tubes in such a way that the fertilization capability of the sperm is restricted and the fertilized egg cell is unable to nest.

Both the emergency coil and the copper chain need to be inserted into the uterus by a gynecologist. This should be done as quickly as possible but by the fifth day, at most, after the contraception mishap or the unprotected sex.

According to experts, this non-hormonal, weight-independent emergency contraception is the most effective. It should be recommended to women who are obese.

The emergency coil costs between 120 and 300 euros. It costs between 200 and 350 euros to insert a copper chain. Women covered by statutory health insurance have their costs covered by health insurance providers until their 22nd birthday.

If you have any questions about emergency contraception you can consult your gynecologist.

You can also get information on the subject from the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung – BZgA), advice centers such as pro familia, or specialist portals such as Frauenärzte im Netz (Gynecologists Online) (in German).