The levanorgestrel-based drug, known as the “morning-after pill” and classified as emergency contraception, is used to avoid the risk of an unplanned pregnancy after unprotected sexual intercourse, or in situations where there is a risk of fertilisation, such as when a condom breaks or a contraceptive pill is forgotten, or if a skin patch comes off. In short, it should only be taken as a last resort when other birth control methods have failed. It is also important to remember that it does not protect against sexually transmitted diseases; for that, you need a condom.
Morning-after pill VS abortion pill
It is important not to confuse the morning-after pill with the RU-486 abortifacient pill, as they belong to different categories. The latter is only available in healthcare facilities authorised by Law 194 (Article 8) and is intended for pharmacological abortion in cases of voluntary termination of pregnancy.
Currently, there are three main methods of emergency contraception in Italy:
- the emergency pill containing levonorgestrel, known as the “morning-after pill”.
- the emergency pill known as the “5-day-after pill”
- the copper intrauterine coil
How the morning-after pill works and when to take it
The morning-after pill contains the hormone levonorgestrel. If taken correctly within 24 hours of unprotected intercourse, it blocks or delays ovulation and acts on the spermatozoa, modifying the environment around the cervix to hinder their ascent towards the uterus and tubes.
However, timing is crucial:
- either ovulation is already underway, i.e. the oocyte has been expelled from the ovaries and has started to move up the fallopian tubes to be fertilised in the uterus, or
- implantation has already been successful
Levonorgestrel in these two cases fails to hinder the eventual development of the embryo.
For this reason, and only as an occasional emergency method, it is important to take the morning-after pill as soon as possible after unprotected sex, preferably within 12 hours for maximum efficacy. After 3 days, the pill is still effective, but only at 58% efficacy.
Women of legal age can request the morning-after pill without a prescription, but it should always be taken with caution as it is a drug.
On the other hand, the 5-day-after pill is an anti-progestin, meaning it counteracts the effects of progesterone in order to prevent conditions that are favourable to fertilisation and egg implantation. Based on the active ingredient uliprostal acetate, it is highly effective in preventing pregnancy, with a success rate close to 98%, according to a scientific study published in the Journal of Obstetrics and Gynaecology.
If taken within five days of unprotected sex, the pill can delay ovulation to prevent fertilisation and, thanks to its prolonged effect of up to 120 hours, prevent the implantation of a fertilised ovum in the uterus. The pill can only be obtained without a prescription by women over 18 years of age; minors must have a referral from a general practitioner, gynaecologist, or emergency room doctor. Taking it can reduce the effectiveness of hormonal contraceptives, so it is advisable to use condoms as a precaution while waiting for your next period.
Since 2020, the Italian agency AIFA has authorised the sale of the five-day-after pill in pharmacies without a prescription. This authorisation also applies to minors under the age of 18 without parental consent. On 19 April 2022, the Council of State confirmed the earlier decision of the Regional Administrative Court of Lazio to reject the appeal lodged by some pro-life associations against the AIFA measure.
Morning-after pill: side effects
The side effects of the morning-after pill are not particularly serious, and it is generally well tolerated, like the 5-day-after pill. However, long-term overuse could damage the liver. The most common side effects are:
- abdominal pain
- nausea (if vomiting occurs, however, the pill’s emergency contraceptive effect may be reduced)
- diarrhoea
- headache
- breast tenderness
- back pain
- spotting
- leucorrhoea (white vaginal discharge)
- late or long and heavy periods (hypermenorrhoea)
- tiredness or weakness
To request an online medical consultation or simply to book a gynaecological examination you can contact me here or book online. As an obstetrician gynaecologist I receive my patients every week in my offices in Milan and Florence.
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