Let’s talk about the morning after pill – the emergency contraceptive that’s not only used for the morning after.

Despite the abundance of available Information and education surrounding the use of emergency contraception, there’s little talk as to what actually goes on behind the closed doors of a pharmacy consultation room. Is it confidential? Is it discreet? Is it nerve-racking? We’re here to give you a comprehensive breakdown of the goings on in a pharmacy’s consultation room.

First, let’s quickly go over the fundamentals of the morning after pill.

What is The Morning After Pill?

The emergency contraceptive or morning after pill is taken to prevent an unwanted pregnancy following unprotected sexual intercourse. The morning after pill can often be purchased without needing a prescription following a consultation with a pharmacist.

The emergency contraceptive is often called the morning after pill, however the two available pills are proven to be effective for 72 or 120 hours following unprotected sex:

1. Levonelle (three days, 72 hours)
2. EllaOne (five days, 120 hours)

How Does it Work?

As mentioned, there are two main emergency contraceptive pills: Levonelle and ellaOne. Both work in different ways to achieve a similar response - preventing unwanted pregnancy.

Let’s take a look at how these work.

Levonelle (levonorgestrel) is a progesterone-only emergency contraceptive pill that works by suppressing the action of gonadotropins (a group of hormones that are secreted by the pituitary gland to regulate ovarian function), thereby interfering with the ovulation process. Specifically, it binds to progesterone receptors to prevent the surge of luteinising hormone (LH) that triggers ovulation. Levonorgestrel also thickens the mucus of the cervix, which makes it more difficult for the sperm to pass through. Studies report that Levonelle is most effective when taken before ovulation (ovulation usually occurs 14 days before your period is due).

Levonelle is most effective when taken as soon as possible after unprotected sex and is up to 95% effective at preventing pregnancy when taken within 24 hours of unprotected sex. Levonelle is also effective up to 72 hours (3 days) after unprotected sex.

EllaOne (ulipristal acetate) is a selective progesterone receptor modulator, and is the first-line oral medication to prevent unwanted pregnancy. It works by binding to the body’s progesterone receptors to delay or suppress ovulation and reduce endometrial thickness. The exact mechanism of ulipristal acetate is yet to be confirmed, although studies suggest that its action varies depending on the phase of the menstrual cycle during which it is taken; 

1. If taken before ovulation, it causes a delay in follicle development and prevents the release of the egg.
2. When taken during the LH surge, just before ovulation, it causes follicular rupture, which delays the release of the egg.
3. And finally, when taken during the latter part of the menstrual cycle, after ovulation, its effect may be attributed to its ability to reduce the thickness of the endometrium.

EllaOne is up to 98% effective at preventing pregnancy when taken within 120 hours (5 days) of unprotected sex.

Emergency Intrauterine Device

An emergency copper intrauterine device (“IUD” or “copper coil”) is actually the most effective way of preventing unwanted pregnancy after unprotected sex, with an efficacy of over 99% if taken within 120 hours (5 days) of unprotected sex. It can sometimes be inserted even longer after unprotected sex, as it is also effective up to 120 hours (5 days) following ovulation. A copper coil has the added advantage of providing effective contraception for 5–10 years when left in place. Copper acts as a spermicide, killing almost all sperm that enters the vaginal cavity. It also prevents fertilisation and implantation of any fertilised embryo.

The copper IUD is not available from pharmacies in the UK and requires insertion by a trained clinician, so whenever you attend for the morning after pill, the pharmacist will also tell you how to access the copper IUD.

There are some instances where the morning-after pill may not work or be as effective. As discussed, the morning-after pills work by delaying the release of the egg. If the egg is already released when sex occurs, then the effects of the morning-after pill are diminished. In such circumstances, the copper coil may be the only effective method for preventing pregnancy.

 

What Does a Visit to The Pharmacy For The Morning After Pill Look Like?

Emergency contraception has been made easily accessible and widely available through a number of different services, including GPs, pharmacies, and online pharmacies. However, there are some restrictions on who can obtain a free NHS emergency contraceptive. Most pharmacists are licensed to work under a patient-group-direction (PGD) which allows them to supply the emergency contraceptive for free, given that the patient meets the requirements for supply. 

So what exactly goes on behind the closed doors of a pharmacy?

1.   The Asking and Waiting

Arriving at a pharmacy may at first feel daunting. However, you should be aware that all staff in the pharmacy have signed confidentiality agreements and respect everyone’s privacy.

Statistics indicate that in 2021 alone, 9 in 1,000 women obtained emergency contraception, making it a much more common occurrence than you may think. You can raise your query to the pharmacist if they’re immediately available, or ask one of the pharmacy staff if you can speak with the pharmacist when they’re free.

You may be asked to wait before your consultation, depending on how busy the pharmacy is. During this time, you can check out the information regarding emergency contraception on the NHS website or ask for a leaflet from one of the pharmacy staff.

2.   The Private Consultation

Some women may consider the consultation with the pharmacist to be somewhat uncomfortable, however, we’re here to reassure you that, in fact, it isn’t. So yes, it may be personal and the questions asked may feel close to home, but they’re asked to ensure your safety.

When the pharmacist is ready, you’ll be taken into a confidential treatment room. The pharmacist will then introduce themselves to you and make you feel at ease before asking you a number of questions about why you need the morning after pill. And don’t worry, this is not an interrogation. It’s simply to ensure your safety and make sure you’re suitable for the morning after pill.

The questions the pharmacist will usually ask are:

Are you currently on any contraception?

EllaOne may interact with certain contraceptive pills by reducing their effectiveness for the five days following administration. If this is the case, the pharmacist will counsel you on when to restart your contraceptive pill and to use another form of contraception (e.g. condoms) for five days to prevent further unintended pregnancies. EllaOne is also less effective if you’ve taken certain contraceptives in the past seven days.

When did you have unprotected sex?

The pharmacist will need to know when you’ve had unprotected sex during your current menstrual cycle. Oral emergency contraception may not be suitable if you have had unprotected sex more than once in your current cycle.

When was your last period?

This helps the pharmacist to determine where you are in your menstrual cycle. If you had unprotected sex after ovulation, the morning after pill may be less effective or not appropriate.

Are you currently taking any medication?

Some medicines, such as anti-epilepsy medications, interact with the morning after pills. The pharmacist must know which medications you take to give you the appropriate advice or refer you for a copper IUD if your medications mean the morning after pill is not suitable.

Do you have any symptoms?

If you are experiencing symptoms such as painful urination, unusual vaginal discharge, or irregular bleeding, you may have contracted an STI and require further investigations. STI tests can be acquired discreetly from Yoxly here.

Was the sexual act consensual?

Pharmacists need to know whether or not consent was involved. If a sexual act was performed without your consent, the pharmacist will offer to help you seek legal advice/additional services to ensure your safety.

Can I ask how much you weigh?

Although this may seem personal and intrusive, pharmacists need to know your weight. Studies suggest that levonorgestrel is not as effective in those with a BMI of over 30kg/m² or weighing over 70kg. If you do have a BMI of over 30kg/m² or weigh >70kg, you may be required to take two levonorgestrel tablets, ellaOne, or be referred to a sexual health clinic.

3.   Administration of The Morning After Pill

Once the pharmacist is satisfied with your answers, they’ll offer you one of the morning after pills (if you’re eligible). You can either take these pills in the pharmacy consultation room or ask to take them at home.

The morning after pill should be taken as soon as possible with a glass of water.

4.   After Taking The Morning After Pill

You’ll be told that if you experience any vomiting or diarrhoea in the 3 hours after taking the pill, the dose must be repeated.

You’ll be counselled on when to expect your next period as this may be later than usual. You’ll also usually be advised to take a pregnancy test three weeks after the unprotected sex, to ensure you have not become pregnant, as the morning after pill is not 100% effective.

See? It’s Not THAT Bad

All information given to healthcare professionals in the UK remains confidential. Pharmacists are there to help you obtain the safest and most effective treatment, so don’t be worried or nervous about the consultation - it’s short and only there to make sure that you understand how your treatment works.

No matter your approach to discussing emergency contraception with a pharmacist, make sure to be honest with your answers. You can take your time to answer any questions they may ask, and use this opportunity to raise any questions or concerns you may have about emergency contraception.