The morning-after pill is emergency contraception — taken after unprotected sex, a burst condom or missed contraceptive pills, to reduce the chance of pregnancy. It is available from South African pharmacies without a prescription. It works by delaying ovulation, and the sooner it is taken the better it works.
What is Morning After?
“Morning after” is not a product name — it is what people call emergency contraception, and it is why no single registry entry matches the phrase. Several different things go by it, and they are not equally effective.
Levonorgestrel 1.5 mg is the common one. It is a single tablet, sold in South Africa under brand names including Escapelle, Norlevo and generic equivalents, and is available from a pharmacist without a prescription. It is licensed for use within 72 hours of unprotected sex, and works best in the first 24.
Ulipristal acetate 30 mg (EllaOne) works up to 120 hours — five days. It is better than levonorgestrel later in that window and in people over about 70 kg, though availability here is more limited.
The copper IUD (intrauterine device) is the most effective emergency contraception by a wide margin — over 99 per cent — and can be fitted up to five days after unprotected sex, or up to five days after the earliest likely ovulation. It also then continues as ongoing contraception for up to ten years. It requires a clinic visit and is fitted free at public health facilities. It is consistently the least-known and most effective option.
How the pills work matters, because it is widely misunderstood. Levonorgestrel and ulipristal work mainly by delaying or preventing ovulation — holding back the release of an egg so that sperm already present cannot fertilise anything. They do not end an established pregnancy. If you are already pregnant, they will not work and will not harm the pregnancy. The morning-after pill is not the same as an abortion pill, which is a different medicine used under different circumstances.
This also explains the timing. Once ovulation has happened, the pills have largely missed their window. That is why “as soon as possible” is not a slogan — the effectiveness genuinely falls day by day.
What is Morning After commonly used for?
- After sex without contraception.
- After a condom breaks, slips or comes off.
- After missing combined pills — generally two or more in a row.
- After being late with the progestogen-only pill or a contraceptive injection.
- After vomiting or severe diarrhoea shortly after a contraceptive pill, which may mean it was not absorbed.
- After being pressured into or forced into sex. In this situation, emergency contraception is one part of what is available, and it is worth knowing that designated public facilities in South Africa provide emergency contraception, HIV post-exposure prophylaxis (PEP), STI treatment and support after sexual assault, free of charge. PEP is time-critical — ideally within 72 hours — so going to a clinic or Thuthuzela Care Centre matters more than getting a pill alone.
It is for emergencies, not routine use. It is less effective than ongoing contraception, it is harder on your cycle, and it costs more over time. Using it repeatedly is a sign that the underlying method is not working for you — and there are many options, several of them free at public clinics.
It does not protect against HIV or other STIs. If that is a concern, a clinic visit for testing, and for PEP if within 72 hours, is the priority.
How Morning After fits into this medicine category
| Method | Window | Effectiveness | Access |
|---|---|---|---|
| Levonorgestrel 1.5 mg | Up to 72 hours | Good, best in first 24 hours | Pharmacy, no prescription |
| Ulipristal 30 mg | Up to 120 hours | Better late in the window | Pharmacy; limited availability |
| Copper IUD | Up to 5 days | Over 99% — the most effective | Clinic; free at public facilities |
| Ongoing contraception | — | Far more effective overall | Clinic, pharmacy, GP |
For other general medicines guides, see HP553 and K-Fenak OTC, and the general medicines hub.
What to check before using Morning After
Take it as soon as you can. This matters more than anything else on this page. Do not wait for morning, a weekend to end, or a more convenient time.
Tell the pharmacist if you:
- Weigh over about 70 kg or have a BMI over 26. Levonorgestrel is less effective at higher body weight, and ulipristal or a copper IUD may be the better choice.
- Take enzyme-inducing medicines — carbamazepine, phenytoin, phenobarbital, rifampicin, some HIV medicines, or St John’s Wort. These substantially reduce effectiveness, and a different dose or a copper IUD may be needed.
- Have taken ulipristal in the last 5 days, or are about to restart hormonal contraception — the two interfere with each other, and the order and timing matter.
- Have severe asthma on oral steroids, or severe liver disease.
- Are breastfeeding. Levonorgestrel is compatible; ulipristal requires expressing and discarding milk for a period.
- Could already be pregnant.
Also worth knowing:
- If you vomit within 3 hours of taking it, you need another dose. Go back to the pharmacy.
- It does not protect you for the rest of the cycle. If you have sex again after taking it, you need contraception again.
- Restarting or starting the pill afterwards needs specific timing, especially after ulipristal. Ask the pharmacist to explain it.
- Take a pregnancy test if your period is more than 5 to 7 days late, or is unusually light or different from normal.
Possible cautions and when to ask a pharmacist or doctor
Side effects are usually mild and short-lived: nausea, tiredness, headache, dizziness, breast tenderness, and lower abdominal cramping. Your next period may come early or late, and may be heavier or lighter than usual. This is expected and not a sign that something has gone wrong.
See a doctor promptly if:
- Your period is more than a week late, or is unusually light — take a pregnancy test.
- You have severe or one-sided lower abdominal pain, especially with a late period, faintness or shoulder-tip pain. Emergency contraception does not cause ectopic pregnancy, but if a pregnancy does occur, this needs excluding urgently. Go to an emergency department.
- You have heavy or prolonged bleeding.
- You vomited within 3 hours of the dose.
- You want STI or HIV testing, or think you may need PEP — this is time-critical.
- You want ongoing contraception — which is the more useful conversation, and the one worth having.
Get emergency help for severe abdominal pain, fainting, or swelling of the face, lips or tongue with difficulty breathing.
One last thing worth saying plainly. Pharmacists supply emergency contraception routinely and are not there to question you about it. Public clinics provide it, and the copper IUD, free. If you are ever refused, you are entitled to go elsewhere — and the clock matters, so go straight away rather than arguing.
Related medicine guides
Frequently asked questions
What is the morning after pill used for? Reducing the chance of pregnancy after unprotected sex, a contraceptive failure or missed pills. It is emergency contraception.
How long do I have to take it? Levonorgestrel is licensed up to 72 hours, ulipristal up to 120 hours, and a copper IUD can be fitted up to 5 days after. Effectiveness falls with every hour of delay, so take it as soon as possible.
How does it work? Mainly by delaying or preventing ovulation, so no egg is released for sperm to fertilise.
Is it an abortion pill? No. It prevents pregnancy from starting. If you are already pregnant it will not work and will not harm the pregnancy. Abortion medicines are different and used differently.
Do I need a prescription? No. Levonorgestrel is available from a pharmacist without one. Public clinics also provide emergency contraception free.
Does it work if I am overweight? Levonorgestrel is less effective above about 70 kg. Ulipristal or a copper IUD is a better choice — tell the pharmacist.
What if I vomit after taking it? If you vomit within 3 hours, you need another dose. Go back to the pharmacy.
Will my period be normal? It may come early or late and be heavier or lighter. If it is more than 5 to 7 days late, take a pregnancy test.
Can I use it as my regular contraception? No. It is less effective than ongoing methods and harder on your cycle. If you need it often, talk to a clinic about a regular method.