How Often Can I Take The Morning-After Pill?

Answer

Hi Cheryl, and thanks for reaching out to us.

The “Morning-After pill”, a commonly used method of contraception, contains a hormone known as levonorgestrel, which works by delaying the release of the egg from the ovary to block fertilization, thereby preventing pregnancy. (1) This type of emergency contraceptive pill (ECP) is most popular, followed by ulipristal acetate pills, for which less evidence exists. (6)

This method of emergency contraception is designed for women who've had unprotected intercourse or whose main method of birth control has otherwise failed. (2) The term “emergency”, however, can be quite subjective, and this can lead to the unwarranted use of the medication. This brings us to an important question: “How much is too much?”.

I was curious about how the public perceives the safety of the pill, so I conducted a survey with a small group of locals who did not have a professional background in pharmacy. The question presented was open-ended to prevent bias and is as follows: “How often do you think is safe to take the morning-after pill?” The results are shown below:

As seen in the graph above, there is a wide spectrum of responses, which proves that perspectives on this matter vary widely among the Trinidad and Tobago public. The most accurate answer is found within the product specification listed by its manufacturer.

Postinor (levonorgestrel) is the most commonly accessible version of the ECPs locally. Based on the manufacturer’s recommendations, the pill should not be taken more than once within one menstrual cycle. (3) Usage exceeding this limit increases the risk of several side effects, including irregular periods and spotting between cycles.

Notwithstanding, the World Health Organization’s 2015 Medical Eligibility Criteria (MEC9) states: “There are no restrictions on repeated use for LNG (levonorgestrel) or UPA (ulipristal acetate) for ECPs.” Additionally, The American Congress of Obstetricians and Gynecologists (ACOG) states: “Emergency contraception may be used more than once, even within the same menstrual cycle.” (6) As with any medication, this pill can pose a few short-term and potentially long term adverse effects.

Levonorgestrel ECPs, such as Postinor, are associated with nausea in 23% of cases, abdominal pain in 18%, fatigue or headache in 17% and vomiting in 6% of women. (5) The risks of frequent long-term use have not been adequately assessed, however, and findings are currently inconclusive. There are theories that long-term disruption of hormonal levels has potential to cause serious side effects, birth defects and other health problems. (7)

Lastly, ECP’s are intended for single, infrequent use as opposed to the primary method of birth control. Although limits to the safe utility of these pills appears to vary widely, the general consensus based on existing evidence is that ECP’s are safe for repeated use. In summary, the morning-after pill can be used more than once within one menstrual cycle. It should be noted, however, that ECPs are not the preferred method of contraception. If you or someone you know is using ECPs repeatedly, I would recommend consulting a physician to assist in selecting a more appropriate long-term birth control method.

I hope this information helps. If you have other questions, feel free to write us again in the future.

References

1. “What You Should Know about the Morning-after Pill.” Health Essentials from Cleveland Clinic, 3 June 2019, https://health.clevelandclinic.org/what-you-should-know-about-the-morning-after-pill-hint-its-not-the-only-option-for-emergency-contraception/.
2. “Morning-after Pill - Mayo Clinic.” Mayoclinic.org, 2018, https://mayoclinic.org/tests-procedures/morning-after-pill/about/pac-20394730.
3. “How to Take POSTINOR?” Postinor, 11 Oct. 2017, https://postinorpill.com/what-is-postinor/how-to-take-postinor/. Accessed 11 Sept. 2022.
4. “How Often Can You Take the Morning-after Pill?” www.plannedparenthood.org, 22 Jan. 2021, https://plannedparenthood.org/learn/ask-experts/how-often-can-you-take-the-morning-after-pill. Accessed 11 Sept. 2022.
5. Paediatr Child Health. “Emergency Contraception.” Paediatrics & Child Health, vol. 8, no. 3, Mar. 2003, pp. 181–183, https://ncbi.nlm.nih.gov/pmc/articles/PMC2792670/, 10.1093/pch/8.3.181.
6. “Repeated Use of Emergency Contraceptive Pills: The Facts.” International Consortium for Emergency Contraception (ICEC), 2015, https://cecinfo.org/icec-publications/repeated-use-emergencycontraceptive-pills-facts/.
7. Felix, Dr. “How Many Times Can You Take the Morning after Pill.” UK Online Doctor and Pharmacy | DrFelix, https://drfelix.co.uk/health-center/how-many-times-can-you-take-the-morning-after-pill/. Accessed 11 Sept. 2022