Emergency contraception: why the morning-after pill isn’t always effective and what alternatives exist

Dear Doctor,

I had intercourse 3 days ago and the condom broke. I took the morning-after pill within 5 hours, but now I’m scared, because a friend told me that some women still get pregnant despite that. What should I do?

Leslie*, 22 years old *name anonymized

Dear Leslie,

Thank you for your question – many young women find themselves in the same situation after a contraceptive accident. You are not alone, and it is important to have clear, reliable information to know what steps to take.

1. The morning-after pill: effective, but not always

The morning-after pill (levonorgestrel or ulipristal acetate) reduces the risk of pregnancy after unprotected sex. However, its effectiveness depends on several factors:

• Timing: the sooner it is taken, the more effective it is.

• Cycle phase: if ovulation has already occurred, its effectiveness decreases significantly.

• Body mass index (BMI): some studies suggest it may be less effective in women with higher BMI.

It may also temporarily disturb menstrual cycles, which can be unsettling but is not dangerous.

2. The copper IUD: the most reliable emergency method

The copper IUD is considered the most effective method of emergency contraception:

• More than 99.9% effective, even if ovulation has already taken place.

• Independent of body weight.

• Provides long-term protection: once inserted, it can stay in place for 5–10 years as regular contraception.

  
  

3. The hormonal IUD: an emerging option

Traditionally, the hormonal IUD (LNG-IUS) was not used as emergency contraception. However, a recent small study (Turok et al., New England Journal of Medicine, 2021) showed that insertion within 5 days after unprotected sex can also effectively prevent pregnancy.

👉 The advantage is that it combines emergency contraception with a long-term reliable method. However, the data is still limited compared to the copper IUD, which remains the gold standard.

Conclusion

• The morning-after pill helps, but is not guaranteed in all situations.

• The copper IUD remains the most reliable and best-documented emergency solution.

• The hormonal IUD may be an interesting alternative, although the evidence is still limited.

To all women asking themselves the same question: you are not alone. My role is to support you through these stressful moments and to help you find the solution best suited to your situation.

Warm regards,

Dr. Sandra Yene Amougui