the morning after

Some young women don't even know it exists, others see it as a get-out-of-jail-free card after unprotected sex – but when it comes to the morning after pill, you're better off avoiding being in either of these two groups.

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Roughly 95 per cent effective, the morning after pill contains hormones which stop an embryo – if there's one hanging around – from attaching to the womb lining.

It's not as simple as it sounds, though – disruption of your menstrual cycle is one complication, and it offers none of the protection against sexually transmitted diseases that other forms of contraception can give you. Misunderstandings about the treatment are rife: even the name, for example, is misleading, as there is more than one pill and it can be actually be used within 72 hours of sex.

In fact, if you're a normal teenager, the whole morning-after pill issue is probably riddled with questions you're too afraid to ask. Check out our readers' queries and expert responses below, and you'll see that you're not the only one looking for the answers.

1. Alicia (16) wants to know if she should take emergency contraception after a condom split.
2. Stef (17) asks where she can get emergency contraception from.
3. Amir (25) wants some advice to reassure his girlfriend who took the morning after pill at the end of the 72-hour period.
4. Karina (15) is concerned because her period arrived early after taking emergency contraception.
5. Jasmine (18) heard that the morning after pill isn't effective if taken twice in one cycle and wants to know if this is true.
6. Danny (19) asks when condoms and morning after pills might not be effective.

Q. This morning me and my boyfriend had a condom split on us. He felt it and took it out before he had come but we don't really know how long it had been split before that. I am due to come on in the next week, do I still need to take the morning after pill even though he didn't ejaculate?

Alicia 16

our online advisors reply:

Although you describe what happened you would need a doctor's opinion to see if they felt you should still take the emergency contraceptive pill. A man does not need to ejaculate (come) inside the vagina to get a woman pregnant. The man releases a fluid before he comes which contains some sperm and could make you pregnant.

The emergency contraceptive pill must be taken within 72 hours of unprotected sex. You can also have a coil (IUCD) fitted to prevent pregnancy up to five days after unsafe sex. The earlier you get emergency contraception the better.

For more information about emergency contraception, you could visit www.netdoctor.co.uk/sex_relationships/
facts/morningafterpill.htm

You may find it helpful to talk through your questions about contraception face-to-face with someone. Brook centres provide free, confidential advice on sex, sexual health and contraception to all young people under the age of 25. Their website www.brook.org.uk has information on the services provided, frequently asked questions and details on how to get in touch with your local Brook centre.

Q. Where is the morning after pill available? Do I have to pay for it?

Stef, 17

our online advisors reply:

You can get emergency contraception free from:

• A family planning clinic
• A young person's clinic or Brook clinic
• Most sexual health clinics or genitourinary medicine (GUM) clinics
• Any GP who provides contraceptive services
• The accident and emergency (A&E) departments of some hospitals
• NHS walk-in centres
• Some chemists

You can also buy emergency contraception from:

• Most chemists if you are 16 years or over (this usually costs around £24)
• Some privately run clinics, such as British Pregnancy Advisory Service (BPAS) and Marie Stopes

There's more information about buying the emergency contraceptive pill over the counter in this feature in our sex section.

Q. While having sex with my girlfriend, the condom split. She took the morning after pill at the very end of the 72 hours period (the last pill was taken on the 72nd hour) and was due to come one yesterday (4 days after taking the pill) but hasn't. However, she's now really stressed as she feels like she hasn't got any of the usual period signs (bad back etc). I think she has – she says she feels bloated and is really worked up when normally she would be fairly calm, and as she is only a day late, I'm not yet too worried. My question is – is it worth getting a pregnancy test yet? Should she have come on within a couple of days of taking the pill? Does the morning after pill have any effects on when menstruation occurs (e.g. delaying it)? Also, what can a young man say to his irrational, stressed-out girlfriend of 8 years that will help calm her down?

Amir, 25

our online advisors reply:

Your girlfriend is obviously very worried. With emergency contraception, if your girlfriend was taking Levonelle or Levonelle-2, as long as the first pill was taken within the 72 hours it doesn't matter if the second one was taken outside that time as long as it was taken 12 hours after the first one. If the pills were Schering PC4 then all the pills need to be taken within the 72 hours. You say that the last pill was taken on the 72nd hour – I would suggest that this is fine. These pills contain hormones which prevent any egg from attaching to the lining of the womb and it is about 95% effective.

Because this pill contains a strong dose of hormones, it can often affect the menstrual cycle afterwards. Perhaps the best thing to do would be to go to the GP and discuss with them how it might affect hers.

Alternatively, she could contact the fpa on 0845 310 1334. This is a free and confidential pregnancy and contraception advice service and they would be able to advise her and tell her where her nearest clinic is. It might be worth her discussing other forms of contraception so that you don't have to go through this worry again in the future.

You ask about how to reassure your girlfriend. As you probably know, communication is really important in any relationship. However, men and women communicate in different ways and not understanding the differences can lead to misunderstandings. Women need to be listened to when they are worried or upset. They need their partners to know how they are feeling, this alone makes them feel closer to them. They don't really want advice about how to fix the problem (which men instinctively want to do), they want to be able to say how they feel and know that they are being treasured by their partner. To listen and be sympathetic to your girlfriend's feelings will probably really help her to calm down.

Q. I took the 'morning after' pill a couple of weeks ago and I came on two weeks early. Should I be worried?

Karina, 15

our online advisors reply:

The morning after pill (or emergency contraception) can affect your menstrual cycle and this is probably why you had a period two weeks early.

It might help you to contact Brook on 0800 0185 023 (Mon-Fri 9am-5pm). This is a confidential sex, contraception and pregnancy advice services, including for those under the legal age of consent (16 in the UK). They would be able to talk to you about your specific situation and advise you. They can also tell you where your nearest clinic is, should you want to see someone.

For some general information about emergency contraception you could visit: www.fpa.org.uk/guide/emergncy/index.htm

I must remind you that sex under the age of 16 is illegal in the UK – although you will still be able to get the help you need, in confidence.

Q. I had unprotected sex last Thursday night and took the morning after pill the next day. Then I was stupid enough to do it again the following Sunday night. I took the morning after pill again but I read that it doesn't work the second time if you have unprotected sex again before your next period is due. I'm terrified that my stupidity may have got me pregnant.

Jasmine, 18

our online advisors reply:

You are obviously very worried by what has happened and what you have read about the emergency contraceptive pill. I don't know where you heard that the emergency contraception doesn't work the second time if you have not yet had your period, but this is not correct. Although not the best thing to take regularly, it does still work and is about 95% effective when taken like this.

I would suggest that you contact Brook on 0800 1085 023 or the fpa on 0845 310 1334 for some individual advice. These are free and confidential sex, contraception and pregnancy advice helplines. They would also be able to tell you where your nearest clinic is for further help.

Emergency contraception is not the best form of contraception to keep using regularly so it would probably be worth talking to them about other forms of contraception so that you don't have this worry again in the future.

As you are probably aware, having unprotected sex also puts you at risk of sexually transmitted infections (STIs) such as HIV, herpes and chlamydia. You cannot tell if someone is healthy or not just by looking at them and it is really important to take personal responsibility for your own body so that you do not have future regrets.

Q. How safe are condoms and the morning after pill? And what causes them to fail? If my girlfriend and I had unprotected sex and then she took the morning after pill the next day would that mean there's no chance of her getting pregnant?

Danny, 19

our online advisors reply:

No contraceptive is 100% safe.

If used according to the instructions, the male condom is 98 per cent effective. This means that two women in 100 will get pregnant in a year using the male condom as their only means of contraception. If used in combination with a diaphragm, IUD, contraceptive pill, cervical cap, spermicidal foam, cream or jelly, protection from unplanned pregnancy is almost 100 per cent effective. If it is not used according to the instructions, then the chance of pregnancy is higher.

The main reasons for failure in using a condom are:

1. It splits during sex. To guard against this, always use a condom with a BSI Kitemark or CE mark on the back and check the expiry date on the packet.
2. It slips off during sex. This is most likely to happen if the condom has not been put on correctly in the first place.
3. An oil-based lubricant has been used which may damage the latex. To guard against this, always use a water-based lubricant such as KY jelly, available at any pharmacy.
4. The man's penis has touched the woman's vagina before the condom has been put on.

Emergency contraceptive pills (sometimes called the 'morning after pill') are very effective, preventing at least three out of four pregnancies that would have occurred if no emergency contraception had been taken. They should be taken as soon as possible after unprotected sex and are most effective if the first dose is taken within 24 hours. They must be taken within three days (72 hours).

The most common reasons for failure of the emergency contraceptive pills to protect against unplanned pregnancy are:

1. The first dose is taken more than 72 hours after unprotected sex.
2. The woman vomits within two hours of taking the pills.
3. The woman forgets to take the second set of pills or takes them late.
4. The woman has had unprotected sex at another time since her last period.
5. The woman has had unprotected sex after taking the pills.

(July 2004)