Hooked on the morning after pill
It used to be a last resort. Now a generation of young women use it as their regular contraceptive – with potentially devastating consequences
22:33 GMT, 9 May 2012
Tania Mirmothari was worried sick. The previous night, the 19-year-old from Wakefield, West Yorkshire, had had yet another drunken one-night stand.
Carefree at the time, the following morning she’d woken with a thumping hangover, horrified at the realisation she might be pregnant.
There was only one thing for it: Tania went to her local walk-in health centre and asked for the morning-after pill.
Risk-takers: Tania Mirmothari (left) and Helen Tsingos regularly take the morning after pill
As she sat in the waiting room, she cringed with humiliation. Shockingly, this was Tania’s fifth visit that year. Four other times in the past 12 months she’d found herself sitting, red-faced, in the same clinic, waiting for her prescription.
‘I look back with shame,’ says Tania, who is now 22, and in a long-term relationship while training to be a social worker. ‘I was just out getting drunk, messing about and being stupid, having one-night stands with boys who did not mean anything to me.
‘But going to the walk-in centre, I started to feel really embarrassed. I saw the same lady each time and she recognised me. I dreaded having to ask for the prescription, but then, what could I do’
Many might argue that, actually, there were quite a few things Tania could have done: not drinking herself into oblivion every weekend was one; not falling into bed with a stranger another; and using contraception a third.
Like a growing number of young girls in our binge-drinking culture, however, such precautions would be abandoned around the time of her fifth vodka and coke.
'I have friends who’ve taken it three times in one month. There’s so much pressure on us to be sexually active'
And at the back of her inebriated mind was the knowledge that, whoever she woke up with the next day, she’d be able to get hold of the morning-after pill just as easily as a paracetamol — or the next round of drinks.
Not so long ago, the morning-after pill was viewed very much as a last resort, described by health professionals as ‘emergency contraception’. It was designed for use in the rare event of regular contraceptives failing. But since it was made readily available over the counter 11 years ago, not to mention being increasingly accessible online, young women like Tania are taking it not in emergencies, but whenever it suits them, as their preferred method of contraception.
Today, Tania still struggles to rationalise her actions as a reckless teenager.
‘My periods are very irregular, and when I first started sleeping with boys I thought I couldn’t get pregnant. And then I panicked and thought I might,’ she says.
‘I suppose I could have gone on the Pill, but a friend told me you put on a lot of weight which put me off, as I struggle with my weight anyway.
‘I think one of the problems was that I didn’t have a lot of sex education at school, and my friends told me it was so easy to get the morning-after pill: you just walk in and ask for it or you can buy it from the chemist.’
Her friends were right. Indeed, the brutal truth is that a morning-after pill is just about as freely available as a sticking plaster.
According to a recent survey by the Co-Operative pharmacy, one in five 18 to 35-year-olds has used it within the past year. And, like Tania, one in five of them confessed to taking it following unprotected sex with a new partner after drinking heavily or taking drugs.
Even more shockingly, figures from the Office of National Statistics suggest around a quarter of a million women have taken it at least three times in a year.
Regrets: Bee Tsimoes was more worried about pregnancy than any side-effects of taking the morning-after pill
But at what personal cost Worryingly, doctors admit they don’t know the long‑term health risks of taking this heavy-duty dose of hormones regularly.
Dr Clare Gerada, chairman of the Royal College of General Practitioners, says that because its manufacturers have never marketed the morning-after pill as a regular contraceptive method, there have been no studies into the long-term effects of taking it repeatedly.
Levonelle, the brand usually used in the UK, works by releasing large amounts of the hormone progestogen into the bloodstream, preventing an egg from being released.
If the egg has already been released and fertilised, the hormones can stop it being implanted into the walls of the womb. Some argue this makes the pill a form of abortion rather than contraception, although most doctors say pregnancy does not begin until a fertilised egg is fully implanted.
‘What is certain is it contains very high doses of hormones and I would hate to know what it does to hormone levels if taken regularly,’ says Dr Gerada.
‘Every time a woman takes it she’d be risking all the listed side-effects such as heavy bleeding, headaches, nausea and vomiting. Her cycle will also be confused for a while, so she might be pregnant without realising it.’
And while users think they are getting peace of mind, what they don’t realise is that the morning-after pill is a far less reliable form of contraception than most other methods.
If taken within 24 hours of unprotected sex, Levonelle is said to have a 95 per cent success rate, falling to just 58 per cent after 72 hours.
‘In my professional life I’ve seen far too many women become pregnant because of the failure of the emergency pill to recommend to any woman that they should rely on it,’ says Dr Gerada.
In contrast, regular methods of contraception such as the Pill and IUDs are more than 99 per cent effective if used properly.
Condoms are 98 per cent effective and, in addition, give protection against sexually transmitted diseases (STDs), rates of which have soared since the morning-after pill became available over the counter.
'Like many women of my generation, I would
find being pregnant disastrous. I’m not particularly interested in
having children, and at this age I need to concentrate on my career'
According to figures from the Health Protection Agency, the number of syphilis infections in England increased by 173 per cent in the years 2000 to 2010. During the same ten years, chlamydia increased by 36 per cent, genital warts by 23 per cent and herpes by 76 per cent.
A study last year by the University of Nottingham found that areas in which the morning-after pill was available at pharmacies saw a 5 per cent increase in the rate of sexually transmitted diseases among teenagers — 12 per cent in the under-16s age group.
And yet, despite running the risk of contracting an STD or becoming pregnant, increasing numbers of women are relying on the morning-after pill. And it’s not just drunken teenagers who are regular users.
Helen Tsingos, 27, who is single and a theatre stylist from Doncaster, admits she has taken the morning-after pill six times in the past.
‘Mostly it’s just because I have been silly,’ she says. ‘I am constantly on the road and often staying in digs, and it is very hard to be organised. I don’t like to rely on condoms, and even though I have been on the Pill, I often forget to take it.
‘Like many women of my generation, I would find being pregnant disastrous. I’m not particularly interested in having children, and at this age I need to concentrate on my career. I’m really glad that the morning-after pill is so freely available, and I see no shame or problem in taking it if I need to. I don’t think it is an ideal form of contraception, but thank goodness it is there.’
Bee Simoes, a 22-year-old from South-East London, agrees. Two years ago Bee, who is single, took the morning-after pill three times.
Not an ideal solution: Running the risk of contracting an STD or becoming pregnant, increasing numbers of women are relying on the morning-after pill (posed by model)
‘I regret it now, but it was very much needed at the time,’ she says. ‘I was very bad at remembering to take the contraceptive Pill so I relied on the morning-after pill as my emergency form of contraception.
‘Each time I took it I felt sick and had a really heavy, unusual period afterwards. I dread to think how much harm I might have done taking it so often. It can’t be good for your body, and if you take it a lot I think it might even damage your fertility.’
But Bee, who works for a car hire company, admits she was far more worried about an unplanned pregnancy than any unknown side-effects of the morning-after pill.
‘This is the case for lots of women my age,’ she says. ‘For my generation, the morning-after pill has become our safety net,’ she says. ‘I have friends who have taken it three times in one month, and I think that would be really bad for you. But there’s so much pressure on my generation to be sexually active.’
While the morning-after pill may seem to encourage promiscuity, the Government actually made it more readily available in the hope of lowering the UK’s shameful teenage pregnancy rate — we have the highest number of pregnancies in unmarried teenagers in the world.
Not so long ago, getting this pill took some effort. Women had to visit their GP, who might ask questions about their lifestyles before writing a prescription.
‘If I saw a woman ask for the morning-after pill more than twice in a year, I would start to worry about what was going on and ask if some other contraceptive method might be more appropriate,’ Dr Gerada says.
Too many people also over-estimate how effective the morning-after pill is, says Rebecca Findlay, a spokesperson for sexual health charity the Family Planning Association.
‘It’s there as a back-up — it’s emergency contraception and is to be used in an emergency. It’s also not as reliable as regular methods such as, for example, the combined pill.
‘There’s no long-term side-effects and it’s actually a very safe method, but if you’re finding you’re having to take it three times in one cycle, you need to think about using a proper form of contraception. It will disrupt your periods, which can be distressing if you’re worrying you might be pregnant. And if you’re using the morning-after pill with lots of different partners, you will be at raised risk of sexually transmitted infections.’
But in 2001, the last Labour Government decided to allow pharmacists to sell the morning-after pill over the counter.
Soon afterwards, all primary and secondary school children were given access to nurses able to dole out emergency contraception on demand, without parental consent.
Since then teenage pregnancy rates have fallen slightly by four per cent. But they are still horrifyingly short of the 50 per cent drop the Government promised, and still rank as the highest in Europe.
The internet boom has made it even easier for young girls to get hold of morning-after pills, with just a click of a mouse.
UK pharmacies prescribed about 120,000 morning after pills last year — the equivalent of 2,300 a week
As of last month, the website DrEd.com is even promising to courier the pill ‘in discreet packaging’ by motorbike to a woman’s home or workplace within a couple of hours.
It’s a development causing much concern for health professionals like Dr Alyson Elliman, of the Faculty of Sexual and Reproductive Healthcare in London.
‘People may not give full information if they’re just answering questions online,’ she says. ‘It’s much better if they can access a trained health professional who can give them advice about, for example, checking for — and if necessary treating — sexually transmitted infections.’
DrEd’s co-founder Amit Khutti says the purpose of his service is to avoid embarrassment. ‘Socially, some people are still put off by having to answer questions face-to-face about why they need emergency contraception,’ he says.
But surely the function of embarrassment is to make us reflect on our actions
Tania admits that, at the very least, her regular encounters with the health clinic worker left her ashamed of her promiscuous behaviour, more than any lecture from a government minister or sex education lesson ever did.
‘The lady was very kind, and she asked me if I was in a long-term relationship. Then, when I kept coming back, she said that I was putting myself in a harmful situation and that this wasn’t very good for me.
‘I’m sure she was looking at me thinking: “Hasn’t she learned her lesson yet” ’
Bee, too, was given pause for thought by the pharmacist she visited. ‘He would take me to one side and ask me why I felt I needed it, what time I had sex and whether I had used any other form of contraception.
‘I felt as if I was being interviewed, which I slightly resented. Initially I made up a story that it was just a one-off. But having to go back and ask for it became really embarrassing.’
A small deterrent, perhaps, but not a very effective one. Would she — and so many women like her — have had all those casual one-night stands if the morning-after pill had not been so easy to come by
Tellingly, she thinks not: ‘Now I am a bit older I do look back with shame and think I was both nave and stupid.
‘The morning-after pill means you don’t have to worry. If it wasn’t so freely available I might have thought twice about having unprotected sex.’