Information on how to get emergency contraception in Malta

Emergency contraception is used after sexual intercourse to prevent a pregnancy. It is typically used after a regular contraceptive has failed (for example a condom tearing) or after unprotected sex. 

There are two main types of emergency contraception: the morning after pills which are tablets containing hormones and taken as one dose, and the copper coil (IUD). The copper coil, although available in Malta as regular contraception, is not used an emergency contraceptive in Malta due to the strict abortion laws. However, the morning after pills have been available in Malta since 2016 following a judicial protest by the Women's Rights Foundation.

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The morning after pills available in Malta are the following:

- Levonorgestrel-based pills Levonelle and Escapelle that can be used up to 72 hours (3 days) after sex

- EllaOne that can be used up to 120 hours (5 days) after sex

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You may have heard of the morning after pill Plan B One-Step. This is not usually available in Malta, but Levonelle and Escapelle contain the same active ingredients as Plan B One-Step.

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How morning after pills work

The morning after pills work by preventing ovulation and fertilisation. You can use morning after pills at any time in your menstrual cycle, even if you think you have already ovulated. Morning after pills reduce the risk of pregnancy even when used in the second half of your menstrual cycle.

Morning after pills cannot abort a pregnancy that has already begun. If you have had a positive pregnancy test and do not wish to remain pregnant you will need to have an abortion.

The efficacy of morning after pills

On average, morning after pills prevent three out of four pregnancies that would otherwise occur. The sooner they are used, the more likely they are to work.

Levonelle and Escapelle are up to 95% effective if used in the first 24 hours after unprotected sex. The efficacy rate declines to 85% when used between 24 and 48 hours after unprotected sex, and declines further to around 55% between 48 and 72 hours after sex.

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Some other medicines reduce the efficacy of the morning after pills. These include:

• the herbal medicine St John's Wort (usually used to treat mild depression and anxiety)

• some medicines used to treat epilepsy, HIV, or tuberculosis (TB)

• medicines that reduce stomach acid like Lansoprazole and Omeprazole

• some less commonly used antibiotics (Rifampicin and Rifabutin)

If you take any of these medications, discuss with your doctor or pharmacist before using the morning after pill.

ellaOne is widely regarded to be more effective than Levonelle and Escapelle, particularly in cases where unprotected sex happens at the time of ovulation, and in cases where the morning after pill is taken relatively late.

Important points to note to ensure you do not get pregnant

• If you vomit within two hours of taking a morning after pill (or three hours in the case of EllaOne), you will need to take another dose.

• If you are obese, you may need to take a double dose of Levonelle or Escapelle. EllaOne does not need a dose adjustment in obese women.

• The morning after pill only protects you once. If you have unprotected sex again, you will need to take another morning after pill. If you find yourself using morning after pills regularly, consider using regular methods of contraception. Not only are regular methods more effective at preventing pregnancy, they are also cheaper.

Possible side effects of morning after pills

Like any other medication, morning after pills can have side effects. These are usually mild and wear off after a few hours. They include:

• nausea and vomiting

• dizziness or tiredness

• headaches

• breast tenderness

• spotting

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It is normal for your next period to be lighter or heavier, and earlier or later than usual.

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Morning after pills are safe, and they have been used by millions of women around the world for over thirty years without any serious incidents.

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Who can use the morning after pills

Most women can use the morning after pills, even those who cannot use the combined contraceptive pills or contraceptive patch for health reasons. Breastfeeding women can also use the emergency contraceptive pill.

Certain medicines (both prescribed and supplements) can affect efficacy of the morning after pills and if you take other medicines you should seek the advice of your pharmacist or doctor before using the morning after pill.

How to know that the morning after pill has worked

If your next period seems and feels like a normal period, it is unlikely that you are pregnant. However, you should do a pregnancy test if:​

• you have symptoms of pregnancy

• your period has not arrived within 3 weeks of taking the morning after pill

• you are on the regular hormone pill and you do not bleed when at the expected time

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Can I take several doses of regular contraceptive pills instead of a morning after pill?

Prior to the legalisation of the morning after pills in Malta, it was common for women to be advised to use the Yuzpe method of emergency contraception, which involved taking several doses of regular contraceptive pills to inhibit ovulation. However, the morning after pills are now available and they are more effective than the Yuzpe method and have less side effects. The use of the Yuzpe method is therefore no longer recommended.

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