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When journalist Rose Stokes got pregnant after taking the morning after pill, she was shocked to discover it doesn't work if taken around the time of ovulation. She was also surprised to find she was not alone. It opened up a whole series of questions around emergency contraception, how it works and why women don’t know more. She and a panel of medical experts appeared on Woman’s Hour to try and bust some of the biggest myths. This is what we found out…

“I've used the morning after pill a few times in my life but this time was after a failed condom. I took the pill as advised by the lady in the pharmacy. I found out maybe three weeks later that I was pregnant, and then had to go through the process of having an abortion,” Rose told Woman’s Hour.

“When I told people, people started coming out of the woodwork saying, ‘oh actually, I know someone that happened to’. I decided it couldn't be that I know all of the five in 100 women that it's happened to, so I started digging into it a little bit.

“I uncovered that it was dependent on ovulation, because the mechanism by which it works is by delaying ovulation. I did some calculations and realised I had already ovulated by that point and so it was never going to have worked. Nobody made me aware of the fact in the pharmacy.”

Here's what we learned about emergency contraception from our expert panel...

If you’re ovulating, some emergency contraception simply will not work

“We definitely need to have better information out there about the fact that emergency contraception can fail - if you're taking the pill form and you've already ovulated it's not going to work,” says Clare Murphy from the British Pregnancy Advisory Service (BPAS).

“I think it's really important to understand that the fertile window is the day of ovulation and five days before,” says Dr Paula Briggs, a sexual health consultant in Southport.

“Post ovulation, women are not going to conceive. Both emergency hormonal contraceptive options work by delaying ovulation so they push the process further down the cycle.”

Success rates for the morning after pill are hard to pin down

Dr Paula Briggs says the effectiveness of emergency contraception is “incredibly difficult to be certain about.”

“You need three things to conceive in the first place; you need eggs, you need patent tubes [unblocked], you need sperm. So if everything's perfect in any one cycle then the chances of conceiving are about 25%. So it very much depends on timing and lots of women who do take the morning after pill were not going to get pregnant anyway.”

“But… women don't take the morning after pill in nearly the numbers they should be,” claims Clare Murphy from BPAS. “Only a third of women take the morning after pill after an episode of unprotected sex. It is still one of our best lines of defence after something's gone wrong and it still has high levels of efficacy - no method of contraception is 100%.”

Emergency contraception doesn't just work 'the morning after'

“Levonelle is licensed to be used up to 72 hours after unprotected sex, whereas EllaOne can be used up to 120 hours after unprotected sex, so it's got a longer window of opportunity,” says Dr Paula Briggs.

“The other difference between these two hormonal choices is that with Levonelle, if the LH surge - which is what happens immediately before ovulation - if that's already started then Levonelle is no longer effective. Whereas EllaOne can be affective - but it still has a significant failure rate around the time of ovulation. Which is also when a woman is most likely to feel like having sex. That's just nature.”

So how can women tell when they’re ovulating and are most at risk of pregnancy?

“I think the most important thing for women is education about when they're likely to be fertile,” says Dr Paula.

“There are methods like [apps such as] Natural Cycles. It can be difficult to predict when ovulation occurs but you can develop a window when unprotected sex would be an issue.”

Clare Murphy adds another method is to monitor discharge when you go to the toilet - “a stringy plug” of creamy, relatively thick mucus when you wipe should signal ovulation.

The copper coil is an alternative form of emergency contraception

“A copper coil is much more effective than emergency hormonal options,” says Dr Paula Briggs. “It's 99.9% effective, it works up to five days after multiple episodes of unprotected sex and it can be taken up to five days after the predicted date of ovulation. And it also provides ongoing contraception. It's not comfortable for most women when it's being fitted, so it's important to be very supportive and explain that.”

But as one listener pointed out, even if you are informed about this option, getting one fitted might not actually be an option where you live.

"I lived in London for years where GPs wouldn’t fit the coil and the only option was a sexual health clinic, where getting an appointment was harder than anything, unless you were willing to queue up on the street for up to an hour. Where I live now it's a wait time of four weeks. If I had relied on that for emergency contraception I would be in big baby trouble by the time I got an appointment!"

The morning after pill won’t affect your fertility if you 'take it too many times’

Several listeners told us they’d been given the impression that emergency contraception wasn’t safe to use regularly. Some had been told they couldn’t take it more than two or three times a year - another said her mum had brought her up to believe it could make you infertile after two or three doses in a lifetime.

“There are so many misconceptions around the morning after pill and the safety of it,” says Clare Murphy from BPAS.

“The progesterone form has been around for decades, this is a very safe hormone. It can be taken as many times as needed, even within the same cycle.

“[It’s] simply not true [that you can’t take it regularly]."

So why don’t women know more?

Society’s “moral policing of women’s bodies” could be to blame, according to Dr Anne Hanley, a lecturer in the History of Science and Medicine at Birkbeck (University of London).

“When the contraceptive pill was introduced onto the NHS in the 1960s, it was only available to married women until 1967 - the assumption being that if you made this reproductive technology available, unmarried women would see this as a licence to go out and have sex with lots of different men. We really haven't [progressed as far as we might like to think]. It is fascinating and deeply troubling for me how much today's issues resonate with what I look at in the past… where if a woman expressed a sexual desire she was for all intents and purposes a prostitute. Even today a lot of women seem to feel very uncomfortable talking publicly about sexual desires, sexual practices, possibly because of a concern that they are going to be seen as morally vacant.”

Clare Murphy from BPAS adds that society needs to get rid of "the stigma around emergency contraception”.

"I think we've spun these misconceptions in order perhaps to stop women using it too often. It's almost as if wrapped up within this tiny pill are all these judgements about women's sexuality. The frameworks are all about supervising women, the narrative of women who use it is somehow 'reckless and feckless', rather than women who are making a responsible choice after something has gone wrong.

"We need to start talking about the morning after pill in a different way… taking it out of this framework where there are so many barriers - financial, the consultation [with the pharmacist]. Let women know this is a product they can use and they should never feel ashamed to use it.”

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