In Malta, the most commonly sold morning after pills are Levonelle, Escapelle, and EllaOne. All are available over the counter (no need for a doctors' prescription) and are available in may pharmacies in Malta and Gozo. The costs of morning after pills are similar, with EllaOne usually being slightly costlier.
Levonelle and Escapelle have the same active ingredient: Levonorgestrel 1.5g. EllaOne, on the other hand, uses a different active ingredient: Ulipristal 30mg. And, as you would expect, there are some differences between Levonorgestrel and Ulipristal that you should be aware of:
- Both Levonorgestrel and Ulipristal are effective in preventing pregnancy when taken up to three days after sex (with Ulipristal probably being slightly more effective). However, Ulipristal continues to be effective at preventing pregnancy when taken up to five days after sex. Therefore, women who are going to take a morning after pill between 3 and 5 days (72 and 120 hours) after sex should opt for Ulipristal.
- Ulipristal is more effective than Levonorgestrel when the woman has had sex during the five days before ovulation, or on the day of ovulation, and is recommended as first line in these cases by the British National Formulary.
- Levonorgestrel 1.5g (ie: a single pill of either Escapelle or Levonelle) may be less effective in women who are overweight (BMI of over 26). The efficacy of Ulipristal 30mg (one pill of EllaOne) does not seem to be affected by weight. Therefore, the British National Formulary recommends either a double dose of Levonogestrel (ie: two pills of Escapelle or Levonelle), or a single EllaOne in women who are overweight.
- The side effects of nausea, vomiting, abdominal pain, and bleeding/spotting are common with both Levonorgestrel and Ulipristal, but Ulipristal is more likely than Levonorgestrel to delay the next period.
- If you take the oral contraceptive pill and you have used a morning after pill, you should use a condom for the next 7 days (9 days with Qlara). If you have taken Levonorgestrel (Escapelle or Levonelle), you can restart the oral contraceptive pill the next day. If you have taken Ulipristal (EllaOne), you should wait 5 days before restarting your oral contraceptive pill.