What is Morning-after pill: Purpose, Procedure, Results & Costs in India

Life is unpredictable, and sometimes, despite our best intentions, things don't go as planned. When it comes to contraception, there are moments when a planned method fails, or no contraception is used at all. In such critical times, knowing about emergency contraception, commonly known as the "morning-after pill," can be empowering and crucial. This comprehensive guide, brought to you by Ayu, aims to demystify the morning-after pill, explaining its purpose, how it works, what to expect, and its accessibility and cost in India. Our goal is to provide accurate, reliable information so you can make informed decisions about your reproductive health.

What is Morning-after pill?

The morning-after pill is a form of emergency contraception (EC) designed to prevent pregnancy after unprotected sexual intercourse or contraceptive failure. It is a critical last-resort option, but it is essential to understand what it is and, equally important, what it is not.

Key Points about the Morning-After Pill:

• Emergency Contraception (EC): This is the correct medical term. It's meant for emergencies, not as a regular method of birth control.
• Not an Abortion Pill: This is a crucial distinction. The morning-after pill works primarily by preventing ovulation or fertilization. It does not terminate an existing pregnancy. If a fertilized egg has already implanted in the uterus, the morning-after pill will not be effective. Abortion pills (like mifepristone and misoprostol) work differently and are used to end an established pregnancy.
• Mechanism of Action: The primary way EC pills work is by delaying or inhibiting ovulation (the release of an egg from the ovary). If there's no egg to fertilize, pregnancy cannot occur. Some types may also thicken cervical mucus to block sperm or alter the uterine lining to prevent implantation, though preventing ovulation is considered the main effect.

Types of Morning-After Pills Available in India:

There are two main types of emergency contraceptive pills available, differing in their active ingredients and effectiveness windows:

1. Levonorgestrel (LNG) Pills:

   • Active Ingredient: A synthetic progestin hormone.
   • How it Works: Primarily by delaying or stopping the release of an egg from the ovary (ovulation). It may also thicken cervical mucus, making it harder for sperm to reach an egg, and thin the uterine lining, potentially making implantation less likely.
   • Effectiveness Window: Most effective when taken as soon as possible, ideally within 72 hours (3 days) of unprotected sex. Its effectiveness decreases significantly after this timeframe, though some studies suggest a limited effect up to 120 hours (5 days).
   • Dosage: Typically available as a single, high-dose pill (1.5 mg levonorgestrel). Historically, a two-dose regimen (0.75 mg taken 12 hours apart) was common, but the single-dose pill is now preferred for convenience and similar efficacy.
   • Availability in India: Widely available over-the-counter (OTC) at pharmacies without a prescription.
   • Common Brands in India: I-pill, Unwanted-72, Norlevo, EzeeContracep, among others.

2. Ulipristal Acetate (UPA) Pills:

   • Active Ingredient: A selective progesterone receptor modulator.
   • How it Works: Acts by delaying or inhibiting ovulation, even when the LH (luteinizing hormone) surge has already begun (which signals impending ovulation). This means it can be effective later in the menstrual cycle than LNG.
   • Effectiveness Window: Effective for up to 120 hours (5 days) after unprotected sex. Studies show it maintains its effectiveness more consistently throughout this 5-day window compared to LNG.
   • Dosage: A single pill containing 30 mg of ulipristal acetate.
   • Availability in India: While approved and available in some parts of the world (e.g., EllaOne), its widespread OTC availability and common branding in India might be less prominent than LNG. It may require a prescription in some regions or be less readily stocked. It's crucial to check with a pharmacist or doctor for availability.

Understanding the Timeframe:

The "morning-after" in the name can be misleading. While sooner is always better, these pills are effective for several days after unprotected sex. However, their efficacy diminishes over time, emphasizing the need for prompt action.

It's vital for individuals to understand these differences to choose the most appropriate EC method based on the time elapsed since unprotected sex and their accessibility to specific types. Always consult a healthcare professional or pharmacist if you are unsure.

Why is Morning-after pill Performed?

The morning-after pill is not a routine procedure but an emergency intervention. It is "performed" (taken) to prevent an unintended pregnancy in specific situations where the risk of conception is high. Its primary purpose is to offer a crucial second chance after a contraceptive mishap or a lack of contraception.

Primary Reason: Prevention of Unintended Pregnancy

The core reason for taking the morning-after pill is to prevent an unintended pregnancy following sexual intercourse where:

• No Contraception Was Used: This is a common scenario, often due to spontaneous decisions, lack of access to regular contraception, or misinformation.
• Contraceptive Method Failure: Even reliable contraception can sometimes fail. Examples include:
  • Condom Breakage or Slippage: A very common reason, as condoms can tear, slip off, or be used incorrectly.
  • Missed Oral Contraceptive Pills: Forgetting to take regular birth control pills (especially multiple doses) can reduce their effectiveness.
  • Diaphragm/Cap Dislodgement: If these barrier methods move out of place during intercourse.
  • Incorrect Use of Other Methods: For instance, improper use of spermicides or natural family planning methods.
  • Expulsion of IUD/Implant: Although rare, if an intrauterine device (IUD) or contraceptive implant is expelled.
• Sexual Assault or Rape: In the deeply traumatic event of sexual assault, the morning-after pill provides a critical option to prevent pregnancy, often administered in conjunction with medical care and support.
• Uncertainty About Contraceptive Effectiveness: If there's any doubt about whether a contraceptive method was effective (e.g., a condom's integrity is questionable, or pills were taken unusually late).

Important Considerations:

• Emergency Only: It cannot be stressed enough that the morning-after pill is for emergencies only. It is not designed to be a regular form of birth control. Using it repeatedly as a primary contraceptive method is less effective than regular methods and doesn't offer protection against sexually transmitted infections (STIs).
• Time-Sensitive: The effectiveness of the morning-after pill is highly dependent on how quickly it is taken after unprotected sex. The sooner, the better. This urgency is why it's crucial to understand its availability and how to access it.
• Empowerment and Choice: For many, the morning-after pill offers a sense of control and empowerment in unforeseen circumstances, allowing individuals to prevent a pregnancy they are not ready for.

By understanding the "why," individuals can make timely and informed decisions when faced with an emergency contraceptive need, ensuring they use this vital tool responsibly and effectively.

Preparation for Morning-after pill

Unlike medical procedures that require extensive physical preparation, "preparation" for taking a morning-after pill largely revolves around understanding the urgency, knowing your options, and addressing any immediate concerns. It's about being informed and acting quickly.

1. The Most Crucial "Preparation": Timing is Everything

• Act Immediately: The single most important "preparation" is to recognize the need and act as soon as possible after unprotected sex or contraceptive failure. The effectiveness of the morning-after pill decreases with every hour that passes.
• Know Your Window:
  • Levonorgestrel (LNG) pills: Most effective within 72 hours (3 days), with decreasing efficacy up to 120 hours (5 days).
  • Ulipristal Acetate (UPA) pills: Effective up to 120 hours (5 days), maintaining consistent efficacy throughout this period.
• Don't Delay: Do not wait for symptoms or a missed period. The pill is a preventative measure, not a treatment for an established pregnancy.

2. Understanding Your Options (Types of Pills)

• Know the Difference: Be aware of the two main types (LNG and UPA) and their respective effectiveness windows. This knowledge will help you choose or ask for the appropriate pill at the pharmacy or clinic.
• Accessibility: In India, LNG pills are widely available over-the-counter (OTC) without a prescription. UPA might require a prescription or might be less readily available in all pharmacies.

3. Consultation (When to Seek Medical Advice):

While LNG pills are OTC, a brief consultation can be beneficial in certain situations:

• Uncertainty: If you're unsure which pill to take, how much time has passed, or have any underlying health conditions.
• Underlying Medical Conditions:
  • Severe Asthma: UPA is generally not recommended for women with severe asthma poorly controlled by oral glucocorticoids.
  • Liver Impairment: Both types are metabolized by the liver, so severe liver conditions might warrant caution.
  • Previous Ectopic Pregnancy: While not a contraindication, discussing your history with a doctor can be wise, as EC doesn't prevent ectopic pregnancy.
  • Medication Interactions: Certain medications can reduce the effectiveness of EC pills. These include some anti-epileptic drugs (e.g., carbamazepine, phenytoin), St. John's Wort, certain HIV medications (e.g., ritonavir), and some antibiotics (e.g., rifampicin). If you are on any regular medication, it's prudent to check with a pharmacist or doctor.
• If You've Already Taken EC Recently: Taking multiple doses of EC within the same menstrual cycle is generally not recommended and might not be effective or could cause more side effects. A doctor can advise on alternative strategies.
• Body Weight: While not an absolute contraindication, studies suggest that LNG EC might be less effective in individuals with higher body mass index (BMI > 25 kg/m²) or weight over 75 kg. UPA may be a more effective option in such cases.
• Sexual Assault: In cases of sexual assault, seeking medical attention is crucial, not just for EC but also for STI prevention, injury assessment, and emotional support.

4. Dispelling Myths (What's NOT Required):

• No Medical Exam Needed: For OTC LNG pills, you typically do not need a physical examination, blood test, or pregnancy test beforehand. The goal is rapid access.
• No Parental Consent (for adults): Adult individuals in India can purchase and use EC without parental consent.
• No Prescription (for LNG): For LNG pills like I-pill or Unwanted-72, a prescription is not necessary.

5. Practical Considerations:

• Identify a Pharmacy: Know where your nearest pharmacy is and its operating hours.
• Cash/Payment Method: Ensure you have the means to purchase the pill.
• Read the Leaflet: Once acquired, always read the enclosed patient information leaflet carefully for specific instructions, potential side effects, and warning signs.

By being prepared with knowledge and acting promptly, you maximize the chances of the morning-after pill being effective in preventing an unintended pregnancy.

The Morning-after pill Procedure

Taking the morning-after pill is a straightforward process, but understanding each step, from acquisition to administration, is key to ensuring its effectiveness. It's less of a "procedure" in the medical sense and more about careful, timely medication intake.

1. Acquisition: Getting the Pill

• Levonorgestrel (LNG) Pills (e.g., I-pill, Unwanted-72):
  • Over-the-Counter (OTC): In India, these are widely available at almost any pharmacy without a prescription. This makes them highly accessible.
  • Ask for "Emergency Contraceptive Pill": You can simply ask the pharmacist for an emergency contraceptive pill or by a common brand name like "I-pill" or "Unwanted-72."
  • Privacy: Pharmacists are generally discreet, but you can request privacy if you feel uncomfortable.
• Ulipristal Acetate (UPA) Pills (e.g., EllaOne - availability varies):
  • Prescription May Be Required: Depending on the region and specific pharmacy, UPA pills might require a doctor's prescription. It's advisable to check with a doctor or pharmacist.
  • Less Common: They might not be as readily stocked as LNG pills in all pharmacies.

2. Dosage and Type

• Single-Dose Regimen: Most modern EC pills (both LNG and UPA) come as a single tablet to be taken orally. This is simpler and has been shown to be as effective as older two-dose regimens for LNG.
• Verify Active Ingredient: Always check the packaging to confirm you have the correct type of pill (LNG or UPA) and the correct dosage.

3. Administration: How to Take It

• Oral Intake: Swallow the pill whole with water.
• Food is Optional: You can take the morning-after pill with or without food. Taking it with food might help reduce nausea, a common side effect for some.
• Do Not Chew or Crush: The pill is designed for oral ingestion as a whole tablet.

4. Timing is Paramount

• As Soon As Possible: This cannot be overemphasized. The effectiveness of the morning-after pill is directly linked to how quickly it is taken after unprotected sex.
  • LNG: Best within 72 hours (3 days), with diminishing returns up to 120 hours.
  • UPA: Effective up to 120 hours (5 days) and maintains its efficacy better throughout this window.
• One Dose Per Incident: Do not take multiple doses for the same unprotected sexual act, as this does not increase effectiveness and can increase side effects.

5. What to Expect Immediately After Taking the Pill

• Mild Side Effects: Some individuals may experience mild side effects shortly after taking the pill. These are usually temporary and include:
  • Nausea (most common)
  • Vomiting
  • Headache
  • Fatigue
  • Abdominal pain or cramps
  • Breast tenderness
  • Dizziness
• Vomiting After Taking the Pill:
  • Crucial Action: If you vomit within 2-3 hours of taking an LNG pill or within 3 hours of taking a UPA pill, there's a chance your body didn't absorb enough of the medication. In this scenario, you should contact a doctor or pharmacist immediately. They might advise you to take another dose of the pill.
  • Anti-emetics: If you are prone to nausea, you might consider taking an anti-nausea medication (anti-emetic) an hour before taking the EC pill, but consult a doctor or pharmacist first.

6. What to Avoid (and What Not to Worry About):

• Avoid Alcohol: While not directly contraindicated, heavy alcohol consumption can exacerbate nausea or make it harder to remember if you've taken the pill correctly. It's generally wise to avoid it when taking medication.
• Drug Interactions: Be aware of potential interactions with other medications (as mentioned in the "Preparation" section). If you are on any regular medication, consult a doctor or pharmacist.
• Do Not Use as Regular Contraception: Do not rely on the morning-after pill as a primary birth control method. It is less effective than regular contraception and offers no protection against STIs.
• No Immediate Lifestyle Changes: You don't need to change your diet or daily routine dramatically after taking the pill, other than being mindful of potential side effects.

By following these steps, you can ensure you take the morning-after pill correctly and maximize its potential to prevent an unintended pregnancy. Remember to seek medical advice if you have any concerns or experience severe symptoms.

Understanding Results

After taking the morning-after pill, the most critical "result" you're looking for is the prevention of pregnancy. However, understanding how to confirm this, what side effects to expect, and when to seek further medical advice is crucial.

1. Effectiveness of the Pill:

• Highly Effective, But Not 100%: The morning-after pill significantly reduces the risk of pregnancy but is not foolproof. Its effectiveness varies depending on:
  • Time taken: The sooner it's taken after unprotected sex, the more effective it is.
  • Type of pill: UPA generally maintains its efficacy better over the 5-day window than LNG.
  • Point in menstrual cycle: It is most effective before ovulation. If ovulation has already occurred, its effectiveness diminishes greatly.
  • Body weight/BMI: As mentioned, LNG may be less effective in individuals with higher body weight.
• General Efficacy Rates (approximate):
  • LNG: Reduces the risk of pregnancy by about 75-89% if taken within 72 hours.
  • UPA: Reduces the risk of pregnancy by about 85% if taken within 120 hours.

2. How to Know if it Worked: Your Next Period

• The Primary Indicator: The most reliable sign that the morning-after pill has been effective is the arrival of your next menstrual period.
• Expected Period Changes:
  • On Time: Your period might arrive around the expected date.
  • Earlier: It could come a few days earlier than usual.
  • Later: It might be delayed by a few days, or even up to a week. This is a common side effect and can be unsettling.
  • Different Flow: The flow might be lighter or heavier, and the duration might be shorter or longer than your typical period.
• Spotting or Bleeding: You might experience some irregular spotting or light bleeding before your actual period. This is also a common side effect and usually not a cause for concern.

3. What if Your Period is Significantly Delayed or Different?

• Take a Pregnancy Test: If your period is delayed by more than a week, or if it is unusually light and different from your normal period, it is highly recommended to take a home pregnancy test.
• When to Test: Wait at least 1-2 weeks after the expected date of your period, or at least 3 weeks after the unprotected sex, to get an accurate result. Taking it too early might result in a false negative.
• Medical Confirmation: If the home test is positive, or if you're still unsure, consult a doctor for a blood test or ultrasound to confirm pregnancy.

4. Common Side Effects of the Morning-After Pill:

Most side effects are mild and temporary, resolving within 24-48 hours.

• Very Common (affecting more than 1 in 10 people):
  • Nausea
  • Abdominal pain
  • Headache
  • Dizziness
  • Fatigue
  • Breast tenderness
  • Irregular bleeding or spotting (before your next period)
• Common (affecting up to 1 in 10 people):
  • Vomiting (if this happens within 2-3 hours for LNG or 3 hours for UPA, contact a doctor for advice on re-dosing)
  • Diarrhoea
  • Muscle pain
  • Back pain
  • Mood changes

5. When to Seek Medical Attention:

While most side effects are harmless, certain symptoms warrant immediate medical consultation:

• Severe Abdominal Pain: Especially if it's persistent and localized on one side, as this could be a sign of an ectopic pregnancy (where the fertilized egg implants outside the uterus). While rare, EC pills do not prevent ectopic pregnancies.
• Heavy or Prolonged Bleeding: If you experience very heavy vaginal bleeding or bleeding that lasts much longer than your usual period.
• Symptoms of Pregnancy: If you develop symptoms of pregnancy (e.g., persistent nausea, breast tenderness, extreme fatigue) even after your period arrives or if it's delayed.
• Allergic Reaction: Signs of a severe allergic reaction (e.g., rash, itching, severe dizziness, swelling of face/throat, trouble breathing) are rare but require immediate emergency care.
• No Period After 3-4 Weeks: If your period hasn't arrived within 3-4 weeks after taking the pill, regardless of a negative home pregnancy test, see a doctor.

6. Long-Term Effects and Future Fertility:

• No Known Long-Term Effects: Extensive research has shown that taking the morning-after pill, even multiple times, does not have any known long-term adverse effects on your fertility, ability to get pregnant in the future, or the health of future pregnancies.
• Does Not Protect Against STIs: The morning-after pill only prevents pregnancy; it offers no protection against sexually transmitted infections (STIs) like HIV, chlamydia, gonorrhoea, or syphilis. If you are concerned about STIs, get tested and use barrier methods like condoms for future protection.

Understanding these results and knowing when to seek professional help ensures that you manage the aftermath of taking the morning-after pill responsibly and effectively for your reproductive health.

Costs in India

Accessibility and affordability are crucial factors when it comes to emergency contraception, especially in a diverse country like India. Fortunately, the morning-after pill is generally affordable and widely available, making it a viable option for many.

1. Price Range of Levonorgestrel (LNG) Pills:

• Most Common & Affordable: LNG pills are the most prevalent type of morning-after pill in India and are relatively inexpensive.
• Typical Price Range: A single tablet of LNG (1.5 mg) typically costs between ₹70 to ₹120.
  • Common Brands:
    • I-pill (Piramal Healthcare): Often found in the range of ₹90-₹110.
    • Unwanted-72 (Mankind Pharma): Similarly priced, usually around ₹75-₹95.
    • Other generic or less common brands may be slightly cheaper or similarly priced.
• Availability: These are available over-the-counter (OTC) at almost all pharmacies across India without a prescription.

2. Price Range of Ulipristal Acetate (UPA) Pills:

• Less Common/Higher Cost: UPA pills, while effective for a longer duration (up to 120 hours), are less commonly stocked and may be more expensive if available.
• Typical Price Range: If available, a UPA pill (30 mg) might cost anywhere from ₹250 to ₹500 or more, depending on the brand and availability.
• Availability: Availability varies significantly. It might require a prescription, and not all pharmacies may stock it. It's best to inquire with a larger pharmacy or a gynecologist.

3. Consultation Costs:

• Pharmacist Consultation: For LNG pills, you typically don't need a doctor's consultation, so there are no associated consultation fees. A pharmacist can provide basic information for free.
• Doctor's Consultation: If you choose to consult a doctor before taking the pill (e.g., for UPA, if you have pre-existing conditions, or concerns about drug interactions), the consultation fee can range from:
  • Government Hospitals/Clinics: Nominal fee (e.g., ₹50 - ₹200) or sometimes free.
  • Private Clinics/Doctors: ₹300 - ₹1000 or more, depending on the doctor's experience, location (tier 1 vs. tier 2/3 cities), and the clinic.
• Teleconsultation: Many online platforms now offer teleconsultations with gynecologists, which can range from ₹200 to ₹800. This can be a convenient option for quick advice.

4. Public Health System Accessibility:

• Government Hospitals and Primary Health Centers (PHCs): In some government hospitals and PHCs, emergency contraceptive pills might be available at a highly subsidized rate or even free of cost, especially in cases of sexual assault or for vulnerable populations. However, availability can be inconsistent, and stocks may vary.
• NGOs and Family Planning Centers: Organizations focused on reproductive health might offer EC pills at reduced costs or provide them as part of their services.

5. Other Potential Costs:

• Pregnancy Test: If your period is delayed, you might need to purchase a home pregnancy test, which usually costs between ₹50 and ₹150.
• Follow-up Doctor Visits: If you experience unusual side effects, severe pain, or a positive pregnancy test, follow-up doctor visits will incur additional consultation and diagnostic costs.

Overall Affordability:

The widespread availability and low cost of LNG pills make emergency contraception quite accessible for a significant portion of the Indian population. This affordability is crucial for ensuring that individuals can make timely decisions to prevent unintended pregnancies. However, it's important to remember that this is for emergency use and not a substitute for regular, more effective, and often more cost-efficient long-term contraception.

How Ayu Helps

Ayu simplifies your health journey by providing a secure platform to manage all your medical records digitally, set medication reminders for regular contraception, and locate nearby pharmacies or healthcare providers for emergency needs.

FAQ (Frequently Asked Questions)

Here are some common questions about the morning-after pill:

1. Is the morning-after pill an abortion pill? No, absolutely not. This is a common misconception. The morning-after pill (emergency contraception) works by preventing pregnancy from occurring, primarily by delaying or stopping ovulation. It does not terminate an existing pregnancy. An abortion pill (like mifepristone and misoprostol) works differently to end a pregnancy that has already been established and implanted in the uterus. If you are already pregnant, the morning-after pill will not be effective.

2. How soon after unprotected sex should I take the morning-after pill? You should take it as soon as possible after unprotected sex. The effectiveness decreases with every hour that passes.

• Levonorgestrel (LNG) pills (e.g., I-pill, Unwanted-72): Most effective within 72 hours (3 days), with some efficacy up to 120 hours (5 days).
• Ulipristal Acetate (UPA) pills: Effective for up to 120 hours (5 days) and maintains its efficacy better throughout this window.

3. Can I use the morning-after pill as regular birth control? No, the morning-after pill is designed only for emergency situations and should not be used as a regular method of birth control. It is less effective than routine contraceptive methods (like birth control pills, IUDs, or condoms) and does not offer protection against sexually transmitted infections (STIs). Repeated use within the same cycle can also lead to more side effects and is not recommended. For ongoing prevention of pregnancy, discuss long-term contraceptive options with a healthcare provider.

4. What are the common side effects of the morning-after pill? Most side effects are mild and temporary. Common side effects include nausea (the most frequent), vomiting, headache, dizziness, fatigue, abdominal pain or cramps, and breast tenderness. You might also experience some irregular bleeding or spotting before your next period. These symptoms usually resolve within 24-48 hours.

5. How will I know if the morning-after pill worked? The most reliable sign that the morning-after pill was effective is the arrival of your next menstrual period. Your period might come a few days earlier, later, or around the expected date. It might also be lighter or heavier than usual. If your period is delayed by more than a week, or if it's unusually light and different from your normal period, you should take a home pregnancy test. If the test is positive or you're still concerned, consult a doctor.

6. Does the morning-after pill affect future fertility? No, extensive research has shown that taking the morning-after pill, even multiple times, does not have any known long-term adverse effects on your fertility or your ability to get pregnant in the future. It does not impact your chances of having a healthy pregnancy later on.

7. Where can I buy the morning-after pill in India, and how much does it cost? Levonorgestrel (LNG) morning-after pills (like I-pill, Unwanted-72) are widely available over-the-counter (OTC) at almost all pharmacies across India without a prescription. They typically cost between ₹70 and ₹120. Ulipristal Acetate (UPA) pills are less common, may require a prescription, and can be more expensive (₹250-₹500+), with availability varying by region.

8. What if I vomit after taking the morning-after pill? If you vomit within 2-3 hours of taking an LNG pill or within 3 hours of taking a UPA pill, there's a chance your body hasn't absorbed enough of the medication. In this situation, you should contact a doctor or pharmacist immediately. They might advise you to take another dose of the pill. You can also consider taking an anti-nausea medication about an hour before taking the EC pill if you are prone to vomiting, but consult a professional first.