The morning-after pill: intake and side effects

The morning-after pill: intake and side effects

Nobody is immune to a contraceptive failure: the contraceptive pill was forgotten, the condom broke, the diaphragm slipped. Or love and desire were so overwhelming that no contraception was used at all. With the so-called “morning after pill”, pregnancy can be prevented in such exceptional situations. The morning-after pill is a way to avoid unwanted pregnancy when regular contraception has failed or not taken place at all. Here, you can find out what you need to know about the effects and side effects, how to take it, where you can buy the morning-after pill and who bears the costs.

Effect: What does the morning-after pill do in the body?

If a pregnancy occurs, an egg cell has previously been fertilized by a sperm. At the beginning of this process is ovulation. An egg cell travels from the ovary to the uterus via the fallopian tube during ovulation. In the fallopian tube, the egg cell can be fertilized by the sperm.

The probability of becoming pregnant is about five days before ovulation until one day after (fertile window). Outside of this time, no fertilization can take place. If you have unprotected sex outside of your fertile days, the morning-after pill is usually not necessary.

The morning-after pill uses preparations with two different active ingredients that prevent pregnancy in different ways.



Levonorgestrel is a progesterone receptor agonist. The active ingredient suppresses the increase in luteinizing hormone (LH peak). This hormone triggers ovulation when the concentration is high. Levonorgestrel suppresses ovulation entirely or postpones it. Means based on levonorgestrel are, for example, PiDaNa® and Levonoraristo®.

Ulipristal acetate

Ulipristal acetate is a selective progesterone receptor modulator. This also inhibits the LH peak and thus prevents or postpones ovulation. Preparations with ulipristal acetate include ellaOne® and Lenca®.


Ingestion – when and for how long is it possible?

Regardless of the active ingredient, the morning-after pill can only prevent pregnancy as long as ovulation has not yet taken place. That’s why it’s essential to take the morning-after pill as soon as possible after you’ve had sex – ideally, no more than 12 hours after.

In principle, it is also possible to take the medicine later – but the longer you wait, the higher the probability that ovulation has already taken place at the time you take it. So, the effectiveness decreases over time. If you take the morning-after pill during ovulation or immediately after ovulation, it is no longer effective.

Drugs with levonorgestrel can be taken up to three days after sexual intercourse, and preparations with ulipristal acetate can last up to five days.

How is it taken?

Unlike the contraceptive pill, the morning-after pill is not taken over a more extended period but only once after a contraceptive failure. It can be taken regardless of the time of day or meals. Those affected should swallow the tablet whole with water.

Alcohol does not affect the effectiveness of the morning-after pill, but caution should be exercised when consuming it, as vomiting can reduce its effectiveness. If vomiting occurs shortly after taking the drug, the preparation must be retaken.

In general, a non-hormonal contraceptive such as a condom should be used until the end of the cycle, even after taking the drug, as the morning-after pill can reduce the effectiveness of hormonal contraceptives.

Morning-after pill – now without a prescription

The morning-after pill has been available without a prescription since early 2015. Until then, the prescription for the morning-after pill had to be issued by a doctor (not necessarily a gynaecologist – a gynaecological examination was not necessary). Even today, the morning-after pill can be prescribed, which, depending on the age of the person concerned, can have an impact on whether the health insurance company will cover the costs.


Buy the morning-after pill.

The hurdles to getting the morning-after pill are now low. It can be bought in all pharmacies. Ordering from an online pharmacy is not permitted by law. On the one hand, this is due to the lack of advice and, on the other hand, to the fact that the medication should be taken as soon as possible after sexual intercourse – delivery times in mail-order companies usually do not make this possible.

Outside of regular opening hours, the morning-after pill can also be purchased from pharmacies at night or from emergency service.

Who pays for the morning-after pill?

Under certain circumstances, the costs of the morning-after pill can be covered in whole or in part by health insurance companies. This applies to legally insured persons under 18 (full payment of costs) and from 18 up to 21 years (payment of costs, a prescription fee applies). Statutory-insured women from the age of 22 must pay the costs themselves. Privately insured people can have the costs reimbursed afterwards, depending on their health insurance company.

However, a medical prescription is a prerequisite for (partial) assumption of the costs. The price of the morning-after pill is around 15 to 35 euros, depending on the product.

Side effects of the morning-after pill

The side effects of the morning-after pill do not differ significantly between the two active ingredients.

Very commonly (one in ten people treated may be affected):

A detailed list of all possible side effects can be found in the respective package leaflet.


When not to take the morning-after pill?

Severe liver disease can worsen after taking the preparation – if you suffer from such a disease, you should always consult a doctor before using the morning-after pill. The same applies to girls and women with severe asthma or if there are signs that could indicate an existing pregnancy.

Caution is also required when taking some medications: For example, antibiotics, preparations containing St. John’s wort, agents for the treatment of HIV or epilepsy and, in the case of the active ingredient ulipristal acetate, hormonal contraceptives such as birth control pill can influence the effect of the morning-after pill. Conversely, an influence of the morning-after pill on the effectiveness of hormonal contraceptives is also possible.

If you have had an ectopic or ectopic pregnancy in the past, or if you have had a fallopian tube infection, you should seek medical advice before using the drug.

Be careful with heavier weights.

The effectiveness of ulipristal acetate and levonorgestrel can decrease above a certain body weight. With ulipristal acetate, this is the case from around 95 kilograms, and with levonorgestrel from a weight of 70 kilograms.

In general, if you are very overweight ( BMI over 35), you should consider the “morning after” as an alternative.

Alternative: Spiral afterwards

Suppose some reasons speak against taking the morning-after pill (e.g. liver disease or being overweight). In that case, the IUD can be used as an alternative for up to five days after unprotected sexual intercourse.

This is the typical copper spiral. This has a contraceptive effect in that the copper it contains damages the sperm and also affects the lining of the uterus in such a way that no fertilized egg cell can implant itself. As soon as the spiral is removed, this effect is eliminated.

A copper spiral must be inserted into the uterus by a gynaecologist.


Pregnant on the morning-after pill?

The effectiveness of the morning-after pill varies depending on when it is taken – it, therefore, depends on how long ago the unprotected sexual intercourse was and on which cycle day the affected person is. The effectiveness is, therefore, between 59 and 98 percent. It is, therefore, theoretically possible to get pregnant despite the morning-after pill, even if the probability of this is not high.

The morning-after pill is not suitable for terminating an existing pregnancy, as it only prevents the actual fertilization. So it is not an “abortion pill”.

Morning-after pill for emergency contraception

With or without a prescription, the morning-after pill is an emergency contraception and should be viewed and used as such. Like any drug, it can have side effects.

Suppose you are often faced with the problem of having to resort to the morning-after pill. In that case, you should contact a gynaecological practice and get advice there on suitable long-term contraception.


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