Why would I need a double dose of Levonorgestrel?

Reviewed by our clinical team

Levonorgestrel is a synthetic version of the hormone progesterone. It’s used as a type of emergency contraception (often under the brand name Levonelle) and can be taken after unprotected sex to prevent pregnancy. 

It’s thought that levonorgestrel works by stopping or delaying the release of an egg. To do this effectively, however, it needs to be taken within 72 hours (three days) of unprotected sex – and ideally within 12 hours.

Most women who take levonorgestrel will need to take exactly one pill, but some might be instructed by their doctor or pharmacist to “double up” by taking two. Read on to find out why. 

What to do after unprotected sex

If you’ve had unprotected sex in the last couple of days and you don’t want to get pregnant. The best thing to do is get medical advice as soon as possible. You can get advice about emergency contraception from the following places:

• Your GP surgery
• Contraception clinics
• Sexual health/GUM clinics
• NHS walk-in centres & minor injuries units
• Pharmacies

You may have worries or feel unsure about what you need to do. But you don’t have to decide on emergency contraception or STI tests yourself. A healthcare professional will make sure you get what’s safe and right for you.

If you already know that the morning after pill is right for you. You can use Online Doctor to order ellaOne or levonorgestrel. Fill out a short, confidential questionnaire for our in-house clinicians to look at. They'll let you know if you need a double dose of the morning after pill, or a different type of emergency contraception. 

You can find out more information on which questions you might get asked in our article on where to get the morning after pill.  

Morning after pill levonorgestrel dose

The standard Levonelle dose is 1.5 milligrams (mg). However, some people might need double that dosage i.e. 3 milligrams (mg). Altering the dose can make taking levonorgestrel more effective for you. 

There are a few reasons why your doctor or nurse might prescribe this double dose of the morning after pill, including the following. 

1. Weight

You might need a double dose of levonorgestrel if you weigh over 70 kilograms or have a BMI over 26. This is because having a higher bodyweight/BMI is thought to reduce the effectiveness of oral emergency contraceptives. 

2. Medications

There are several types of medication that can prevent levonorgestrel from working properly.  

If you’re taking medicine for any of the following conditions, you should tell your pharmacist or doctor: 

You should also tell them if you’re taking any of the medications which can be found in our article on the differences between ellaOne and levonorgestrel, or anything that contains the herbal remedy St John’s wort.

Depending on the medications you’ve been taking, you might need to double up on your dose of levonorgestrel. 

3. Sickness

Another reason for taking two levonorgestrel pills is sickness. If you vomit within two hours of taking levonorgestrel, you’ll need to go back to your pharmacist or doctor to take another tablet or get advice about alternative emergency contraception. 

Other types of emergency contraception

Levonelle/levonorgestrel is probably the best-known type of emergency contraception. It’s usually the type that’s easiest to obtain. However, it won’t be right for all women. There are alternative types of emergency contraception you can get for free on the NHS: 

ellaOne

Is another type of emergency contraceptive pill that contains ulipristal acetate. You might think you know about ellaOne, but there are a lot of myths surrounding this medication. Did you know that ellaOne can be taken at any point during your menstrual cycle? Read on for more advantages and the disadvantages of this option. 

Advantages of ellaOne

The advantages of ellaOne are:

• It can be taken up to five days after unprotected sex
• It’s generally thought to be more effective in preventing pregnancy than levonorgestrel
• It’s readily available at pharmacies and through services like Online Doctor
• It’s very easy to take
• It doesn’t require an appointment with a healthcare professional

Disadvantages of ellaOne

However, this type of morning after pill also has its downsides:

• You can’t take ellaOne if you’re taking certain types of medication e.g. those for epilepsy, HIV and tuberculosis 
• You shouldn’t breastfeed for a week after taking ellaOne
• You’ll need to take a second tablet if you throw up within three hours of taking ellaOne
• Like any medication there are side effects, find out about the side effects here

Copper coil emergency contraception

The copper coil or IUD – a small, T-shaped device made from plastic and copper that is inserted into the uterus. Read on for the advantages and disadvantages of this option. 

Advantages of the copper coil

There are advantages to using the copper coil/IUD as emergency contraception:

• It’s the most effective type of emergency contraception
• It can be left in and be used as ongoing contraception for several years
• It doesn’t contain hormones 

Disadvantages of the copper coil

The disadvantages of using an emergency coil include:

• The IUD requires an appointment with your GP or with a sexual health or contraception clinic
• The coil has to be fitted by a healthcare professional
• Having it fitted can be uncomfortable and even painful
• Your periods may be heavier or longer
• Small risk of pelvic infection after it has been fitted

How many times can you take the morning after pill?

You can take the morning after pill more than once during your menstrual cycle. If you’re taking the morning after pill regularly as a form of contraception you may want to consider a different type of contraception. This is because the morning after pill:

• isn’t as effective as other forms of contraception
• doesn’t protect against STIs like condoms do
• can be expensive compared to contraceptive pills
• can make your periods irregular making them hard to track
• side effects may be more inconvenient compared to other methods of birth control 

Conclusion

When it comes to emergency contraception there are advantages and disadvantages to think about. You may not have realised a double dose may be offered to you based on your weight, other medications or potential sickness. If you feel more confident about taking the morning after pill including levonorgestrel, start your consultation today or you can find out where you can get it here. 

References

https://www.nhs.uk/conditions/contraception/emergency-contraception
https://www.medicines.org.uk/emc/product/7308/smpc#gref
https://bnf.nice.org.uk/treatment-summary/emergency-contraception.html
https://assets.publishing.service.gov.uk/media/
https://www.nhs.uk/conditions/contraception/iud-coil/