How does an emergency pill work

The morning-after pill / emergency contraception

In the event that contraceptive methods have failed (forgotten pill, torn condom, unprotected sexual intercourse) there is the so-called "morning-after pill". It is also known as emergency contraception and, if taken promptly, can prevent a high percentage of pregnancy. There are several Medicines each with a different active ingredient: either levonorgestrel (Pidana®) or ulipristal acetate (Ellaone®).

The morning-after pill is available in pharmacies without a prescription. Since Germany has ten thousand established gynecologists and ensures a medical on-call service around the clock, women can also contact a gynecologist directly in the event of a contraception failure. Girls and women can then also use the conversation with a gynecologist to find out about contraception, sexuality and sexually transmitted diseases.

Under certain conditions, the cost of the morning-after pill for girls and women is covered by health insurance. The prerequisite for this is that you have the morning-after pill prescribed by a doctor.
The rules for reimbursement of the morning-after pill:

  • for those under 18 years of age with statutory health insurance: free of charge
  • For those with statutory health insurance between the ages of 18 and 21: Cost of the prescription fee over five euros
  • For those with statutory health insurance from the age of 22: costs above the regular price
  • For those with private health insurance, the prescription is reimbursable afterwards, depending on the health insurance company: costs above the regular price

Effect of the morning-after pill

The effect of the two hormonal methods of the morning-after pill is to delay ovulation or delay the LH peak. The "LH peak" denotes the highest increase in LH concentration (LH = luteinizing hormone) 24 hours later leads to ovulation. The main difference between the two active ingredients lies in the window of action:

  • Ulipristal acetate works until shortly before ovulation, even on the woman's most fertile days, when the risk of pregnancy is highest.
  • "Afterwards pills" with levonorgestrel no longer work shortly before ovulation.

Ulipristal acetate can be taken up to 5 days after the period of contraception, levonorgestrel up to three days after (see product information).

Delayed ovulation then occurs about five days later. This delay is sufficient to close the fertile window, because sperm have an average survival time of 3-5 days. Both hormonal methods have no influence on the implantation of a fertilized egg cell. The morning-after pill therefore does not lead to an abortion. It cannot work if ovulation has already occurred (1).

If levonorgestrel or ulipristal acetate is administered after the LH peak, both active substances can no longer delay ovulation. For this reason, emergency hormonal contraceptives should always be administered as soon as possible to prevent ovulation. The rule is: the earlier the morning-after pill is taken, the more safely a pregnancy can be prevented! Affected girls and women should therefore not be afraid to visit their gynecologist the next morning or the on-call medical service at the weekend if the contraception fails.

After taking the pill, your period can come at the expected time, or three days earlier or later. This menstrual bleeding may be a bit heavier than usual. Since ovulation is postponed by taking the morning-after pill, the next menstrual bleeding can start later than usual. If the period is more than seven days overdue, a pregnancy test (by a gynecologist) is advisable to be on the safe side.

After taking the morning-after pill, there is no protection for the rest of the cycle, which is why a barrier method, e.g. a condom, should continue to be used.

Possible side effects of the morning-after pill

Side effects such as nausea, vomiting and headache are rare. After vomiting, another tablet should be taken within 3 hours. The best thing to do in this case is to talk to a gynecologist. Levonorgestrel and ulipristal acetate must not be taken together.

In addition, short-term hormone intake can lead to menstrual disorders and menstrual disorders as well as a delay in follicular maturation in the following cycle.

Information on the morning-after pill for overweight patients

Obese patients should know that as their body weight (BMI) increases, the contraceptive safety of the morning-after pill of both levonorgestrel and ulipristal acetate decreases. This effect is stronger with levonorgestrel. From a body weight of 70 kg, the effectiveness for levonorgestrel drops significantly, with ulipristal acetate a reduction in effectiveness only occurs from 95 kg.
For very overweight women (BMI> 35 kg / m²), the gynecologist may recommend an intrauterine device ("spiral after").

The morning-after pill is not a method of regular contraception!

The morning-after pill cannot replace other methods of contraception (pill, condom) because, on the one hand, it is not so safe and, on the other hand, it has more severe side effects. In addition, the effect decreases within a short period of time with frequent use. After using the morning-after pill, no further unprotected sexual intercourse should take place. Women who are prescribed the morning-after pill because of a mistake in taking their micropill can continue to take the pill, but should also, e.g. B. with a condom, use contraception.

Repeated emergency contraception
In individual situations, repeated delivery (even in the same cycle) may be necessary. On the one hand, if vomiting occurs within 3 hours of taking the morning-after pill, and on the other hand, if the contraceptive failure occurs again (in the same cycle). In the latter case there is a 4-fold increased risk of pregnancy (2). To reduce this risk, the morning-after pill should be recommended. When dispensing again, make sure that the same morning-after pill is used as the first time in order to rule out possible interactions (3).

If the contraception fails again within 24 hours, it is not necessary to take the morning-after pill again (4).