Emergency Hormonal Contraception: Levonelle Vs EllaOne Guide

About emergency hormonal contraception

Emergency hormonal contraception, often called the “morning-after pill,” provides a vital option to prevent pregnancy after unprotected sex, contraceptive failure, or missed pills. The two primary types available without prescription in the UK are Levonelle (containing levonorgestrel) and ellaOne (containing ulipristal acetate). These pills work primarily by delaying or preventing ovulation, ensuring no egg is released for sperm to fertilize. They are not effective if ovulation has already occurred or for terminating an established pregnancy.

Levonelle must be taken within 72 hours (3 days) of unprotected sex, while ellaOne extends this window to 120 hours (5 days), offering greater flexibility. Both are over 95% effective when taken soon after intercourse, but effectiveness declines with time for Levonelle. Clinical data shows ellaOne is approximately 2.5 times more effective than levonorgestrel within 24 hours.

These contraceptives do not protect against sexually transmitted infections (STIs), so testing is recommended if risk exists. They can be obtained free from NHS sexual health clinics, pharmacies, or online services.

Key facts about Levonelle and ellaOne

Levonelle’s effectiveness: 95% (0-24 hrs), 85% (24-48 hrs), 58% (48-72 hrs). ellaOne maintains higher efficacy across its window.

How does emergency hormonal contraception work?

These pills mimic or block hormones essential for ovulation. Levonorgestrel, a progestogen, delays ovulation and may thicken cervical mucus to hinder sperm movement or alter the uterine lining to prevent implantation (though primarily pre-ovulatory).

Ulipristal acetate in ellaOne selectively blocks progesterone receptors, more potently postponing ovulation even if the LH surge has begun, explaining its superior efficacy in later windows.

Neither pill affects an implanted embryo and is not abortifacient. Success depends on timing before ovulation; post-ovulation, they offer little protection.

When to use it

• After unprotected vaginal sex or contraceptive accidents (e.g., broken condom, missed combined pill doses).
• Levonelle: Within 72 hours for best results.
• ellaOne: Up to 5 days, ideal if >24-72 hours have passed.
• Not for routine use; regular contraception is preferable.
• Consider IUD if >5 days or other factors.

Take as soon as possible. If using hormonal contraceptives, follow-up with barrier methods until next period.

Dosage and how to take it

Both are single tablet doses swallowed with water, anytime, with or without food. No advance preparation needed.

• Levonelle: 1 tablet (1.5 mg). Repeat if vomiting within 2-3 hours.
• ellaOne: 1 tablet (30 mg). Repeat if vomiting within 3 hours. Avoid until breastfeeding ends.

Available OTC at pharmacies for women 16+ (under 16 via doctor/pharmacist).

How effective is emergency hormonal contraception?

Effectiveness varies by timing and individual factors like cycle phase, weight (>70kg may reduce efficacy, especially Levonelle).

ellaOne outperforms Levonelle beyond 24 hours; copper IUD is >99% effective up to 5 days. Baseline pregnancy risk ~8%; pills reduce this significantly.

Cautions

• Not for known/suspected pregnancy.
• Weight >70kg: Reduced efficacy; consider IUD.
• ellaOne: Avoid if breastfeeding (pump/discard milk 1 week); delays progesterone contraception.
• Levonelle safe breastfeeding.
• Drug interactions (e.g., enzyme inducers like rifampicin reduce effect).
• QT prolongation history: Caution with ellaOne.

Side-effects of Levonelle and ellaOne

Common, temporary (1-2 days): nausea (23%), headache (17%), fatigue, abdominal pain, dizziness. Rare: vomiting, breast tenderness, menstrual changes.

• Levonelle: Earlier/tender/heavier period.
• ellaOne: Possible spotting; period delay up to 7 days.

Seek help if severe pain (ectopic risk), no period in 3 weeks, or STI symptoms.

Interactions

• Avoid combined pill 5 days before/after ellaOne.
• Levonelle less interactive but use backup 48 hours after.
• Medicines: Antiepileptics, St John’s wort, rifabutin reduce efficacy.

Alternatives to the emergency hormonal contraception pill

Copper intrauterine device (IUD): >99% effective up to 5 days; provides ongoing contraception. Fitted by clinician.

No hormonal IUD as emergency option.

Period after emergency hormonal contraception – what to expect

Expect period within 3-4 weeks; may be early/late, heavier/lighter. Pregnancy test if >7 days late or unusual bleeding.

Pregnancy testing after emergency hormonal contraception

Test 3 weeks post-sex or if period >7 days late. Negative allows resuming contraception; positive requires counseling.

Frequently Asked Questions (FAQs)

Q: Which is better, Levonelle or ellaOne?

ellaOne is more effective, especially after 24 hours (2.5x within 24 hrs), with a longer window.

Q: Can I take the morning-after pill more than once in a cycle?

Yes for both, but not ideal; use regular methods.

Q: Does it protect against STIs?

No; use condoms routinely.

Q: What if I’m overweight?

>70kg: Efficacy lower; prefer IUD or ellaOne.

Q: Can I drive after taking it?

Yes, but dizziness possible; avoid if affected.

Q: How soon can I have sex after?

Immediately, but use condoms until next period.

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Medha Deb is an editor with a master's degree in Applied Linguistics from the University of Hyderabad. She believes that her qualification has helped her develop a deep understanding of language and its application in various contexts.

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