Answer side-effect and tolerability questions around morning after pill, including expected changes, warning signs and safe escalation guidance.
Sources
This page covers emergency contraception — a group of products, not a single one. Each statement below is taken from the SAHPRA-approved patient information leaflet named beside it:
Retrieved 2026-09-03. Your own medicine’s leaflet is the one that applies to you, and where it differs from this page the leaflet is correct.
What is morning after pill?
Emergency contraception covers several products registered in South Africa, not one. They work in a similar way, and their approved leaflets do not list identical side effects.
The medicines covered here, and the leaflet used for each:
- levonorgestrel — ERMAFT, PHARMACARE LIMITED (Tablets)
- ulipristal — Ella, Actor Pharma (Pty) Ltd1 (Tablet)
Check your own pack
Two medicines in the same group can differ in their approved uses, their cautions and their side effects. The leaflet inside your pack is the one that applies to you.
Who should take extra care
Cautions from each medicine’s approved leaflet.
Levonorgestrel (ERMAFT)
Do not use it at all if:
- If you are hypersensitive (allergic) to levonorgestrel or to any other ingredients of ERMAFT
- If you have severe liver problems
- If you are pregnant or suspect that you are pregnant
- If you suffer from bleeding between your regular menstrual cycles (periods) that has not been diagnosed by your doctor, or if you have a history of or current high risk of arterial disease
- If you had already taken ERMAFT within the same monthly cycle
- If you have depression, which is not well controlled with treatment
Use with care, and tell your doctor, if:
- ERMAFT is only intended for occasional use and should not be taken on a regular basis, or as a substitute for long-term birth control. Talk to your doctor or pharmacist about long-term birth control methods
- If you still become pregnant after using ERMAFT, your doctor will closely evaluate you for an ectopic pregnancy especially if you have a history of an ectopic pregnancy, fallopian tube surgery or a pelvic inflammatory disease
- A previous ectopic pregnancy and a previous infection of the fallopian tubes increase the risk of a new ectopic pregnancy
- If you have a disease of your small bowel (such as Crohn’s disease) that inhibits the absorption of ERMAFT
- The use of ERMAFT does not protect you against sexually transmitted diseases (STDs). If you are worried about a sexual transmitted disease, talk to your doctor or pharmacist. Tell your doctor before using ERMAFT:
- If you are on treatment for depression
Ulipristal (Ella)
Do not use it at all if:
- If you are hypersensitive (allergic) to ulipristal acetate or any of the other ingredients of ELLA (listed in section 6)
- If you suspect that you are pregnant
Use with care, and tell your doctor, if:
- Talk to your pharmacist, doctor or other healthcare provider before taking this medicine: if your period is late or you have symptoms of pregnancy (heavy breasts, morning sickness), as you may already be pregnant; if you suffer from severe asthma; if you suffer from severe liver disease
- In all women, emergency contraception should be taken as soon as possible after unprotected intercourse
- There is some evidence that this medicine may be less effective with increasing body weight or body mass index (BMI), but these data were limited and inconclusive
- Therefore, ELLA is still recommended for all women regardless of their weight or BMI
- You are advised to speak to a healthcare provider if you are concerned about any problems related to taking emergency contraception
- If you become pregnant despite taking the tablet, it is important that you see your doctor
Common side effects of morning after pill
Each medicine in this group has its own approved leaflet, and the effects below are the ones that leaflet lists. They are shown separately rather than combined, because the leaflets do not agree on what to list or how to word it.
Levonorgestrel (ERMAFT)
- Headaches or dizziness
- nausea (feeling sick), vomiting (being sick), lower abdominal pain, diarrhoea
- changes in your menstrual cycle (period), irregular bleeding, vaginal bleeding not related to your menstrual cycle
- breast tenderness
- fever, feeling tired
- Breast enlargement in men
- changes in your libido (sex drive)
- changes in your liver enzyme results when blood tests are done
- pain in your stomach area
- hives (red, raised, itchy skin rash)
- painful menstruation with abdominal cramps, pelvic pain
- swelling of your face. Side effects with an unknown frequency
The leaflet lists 8 more. Read the full leaflet.
Ulipristal (Ella)
- nausea, abdominal (stomach) pain or discomfort, vomiting
- painful periods, pelvic pain, breast tenderness
- headache, dizziness, mood swings
- muscle pain, back pain, tiredness Less frequent side effects (may affect up to 1 in 100 people)
- diarrhoea, heartburn, wind, dry mouth
- unusual or irregular vaginal bleeding, heavy/prolonged periods premenstrual syndrome, vaginal irritation or discharge, lesser or greater sex drive
- hot flushes
- appetite changes, emotional disorders, anxiety, agitation, trouble sleeping, sleepiness, migraine visual disturbances
- influenza
- acne, skin lesions, itching
- fever, chills, malaise Other side effects (may affect up to 1 in 1,000 people)
- genital pain or itching, pain during sex, rupture of an ovarian cyst, unusually light period
The leaflet lists 5 more. Read the full leaflet.
Bleeding, cycle and hormonal changes
Changes to bleeding and to the menstrual cycle are among the most commonly reported experiences with hormonal contraception, and they are one of the main reasons people stop a method. Knowing what pattern to expect with morning after pill makes it easier to tell an expected change from one worth checking.
Bleeding patterns can include lighter or shorter periods, irregular spotting between periods, or periods stopping altogether. Which of these is expected depends on the method, and on how long it has been used.
Evidence required before publish — source the following for morning after pill from the SAHPRA-approved patient information leaflet or professional information, and cite what you actually used.
- The bleeding pattern the approved information for morning after pill describes as expected
- How long the source says an irregular pattern typically continues before settling
- What the source says about periods stopping, and whether that is described as harmless
- Bleeding that the source says should prompt medical review
Bleeding that needs checking
Very heavy bleeding that soaks through protection hourly, bleeding with severe pain or dizziness, or bleeding after sex that is new for you should be looked at by a healthcare professional rather than waited out.
Serious side effects and warning signs
None of the leaflets reviewed set out a separate serious-effects list.
General warning signs that apply to any medicine
Call for emergency help now if any of these happen
- Difficulty breathing, wheezing, or tightness in the throat or chest
- Swelling of the face, lips, tongue or throat
- A widespread rash with blistering or peeling skin, or sores in the mouth, eyes or genitals
- Fainting, collapse, or a sudden severe drop in alertness
- Chest pain, or sudden weakness or numbness on one side of the body
- A fit (seizure), or confusion that comes on suddenly
In South Africa call 10177 for an ambulance, or 112 from a mobile phone. Go to your nearest emergency department if it is faster. Do not wait to see whether the symptom settles.
How long can side effects last?
How long a side effect lasts depends on the effect, the product, how long it has been used, and the person. Some effects ease within days as the body adjusts. Others continue for as long as the product is used. A few can persist after stopping, and some need review rather than waiting.
- Settling effects — mild effects that ease over the first days or weeks of use
- Ongoing effects — effects that continue while the product is being used and improve after stopping
- Persistent effects — effects that continue after stopping and need medical review
- Delayed effects — effects that appear after weeks or months rather than immediately
Which of these applies to a particular effect is a clinical question. If a side effect is not settling, is getting worse, or is affecting your daily life, that is worth a conversation with a pharmacist or doctor regardless of how long it has been going on.
Evidence required before publish — source the following for morning after pill from the SAHPRA-approved patient information leaflet or professional information, and cite what you actually used.
- Anything the approved information for morning after pill says about how long specific effects last
- Whether the source describes any effect as usually temporary, or as needing review if it persists
- Whether any effect is described as continuing after the product is stopped
What happens after stopping or changing the method?
What happens after stopping or changing morning after pill depends on the method. Some methods stop working as soon as they are removed or discontinued; others take longer to clear. This matters both for side effects and for whether you are still protected against pregnancy.
Contraceptive cover
If you are changing method, there is often a window where you need additional protection. Getting that timing right is the single most important part of switching — ask a pharmacist, nurse or doctor to confirm it for your specific change rather than working it out from a general description.
Side effects and cycle after stopping
Side effects linked to a hormonal method usually ease once the hormone clears, though the time this takes varies by method. Cycles may take several months to settle into their own pattern, and that pattern may not be the same as before the method was started.
Evidence required before publish — source the following for morning after pill from the SAHPRA-approved patient information leaflet or professional information, and cite what you actually used.
- What the approved information for morning after pill says about stopping or removal
- How long the source says it takes for the effect to wear off
- What the source says about return of fertility
- Any symptom the source says to expect after stopping, and any that needs review
When to contact a healthcare professional urgently
Some symptoms need medical attention straight away rather than an appointment in a few days. Do not wait to see whether they settle.
Call for emergency help now if any of these happen
- Difficulty breathing, wheezing, or tightness in the throat or chest
- Swelling of the face, lips, tongue or throat
- A widespread rash with blistering or peeling skin, or sores in the mouth, eyes or genitals
- Fainting, collapse, or a sudden severe drop in alertness
- Chest pain, or sudden weakness or numbness on one side of the body
- A fit (seizure), or confusion that comes on suddenly
In South Africa call 10177 for an ambulance, or 112 from a mobile phone. Go to your nearest emergency department if it is faster. Do not wait to see whether the symptom settles.
Get same-day medical advice if you have
- A high fever, or a rash together with feeling generally unwell
- Yellowing of the eyes or skin, or unusually dark urine
- Unusual bruising or bleeding that you cannot explain
- Severe or persistent vomiting or diarrhoea, especially if you cannot keep fluids down
- A sudden change in mood, or thoughts of harming yourself
- Any symptom that is rapidly getting worse
If you are having thoughts of harming yourself
Help is available in South Africa. The SADAG helpline is 0800 567 567, or you can go to your nearest emergency department. You do not have to wait until it feels like an emergency.
How to report a suspected side effect in South Africa
South Africa has an official system for reporting suspected side effects, run by the South African Health Products Regulatory Authority (SAHPRA). Reports from the public and from healthcare professionals are how safety signals get detected after a product is already in use.
Who can report
Anyone can report — you do not have to be a healthcare professional, and you do not need to prove that the product caused the problem. A suspicion is enough. Patients, caregivers and family members can all submit a report.
What to have ready
- The name of the product, its strength and form, and the batch number if you have it
- Why it was being used, and when it was started and stopped
- What the suspected reaction was, when it began, and how long it lasted
- Any other medicines, supplements or remedies being used at the same time
- Basic details about the person affected — age and sex are usually enough
How to report
SAHPRA accepts adverse reaction reports through its e-Services reporting system and through the Med Safety mobile app. Healthcare professionals can also report through the same routes. Current forms and access points are published on the SAHPRA site.
- SAHPRA Health Products Vigilance — the main vigilance and reporting hub
- SAHPRA e-Services — current adverse reaction reporting access
Reporting is not a substitute for medical care
If someone is unwell now, get medical help first and report afterwards. Urgent symptoms always take precedence over paperwork.
For a fuller walkthrough see how to report an adverse drug reaction.
Related pages
← Back to more contraception side effects.
Report a side effect
If you think you have had a side effect, you can report a suspected side effect in South Africa. Report a suspected side effect through the appropriate SAHPRA pathway where relevant.
Information only
This page gives general medicine-safety information for people in South Africa. It is not a diagnosis and not personalised medical advice. It cannot tell you whether a symptom you are having is caused by a particular product. Speak to a pharmacist or doctor about your own situation, and do not stop or change a prescribed treatment on the basis of a web page.
Editorial status: draft — not for publication
Brief SE-00028 · build rank 28 · Phase 1 · Tier 1. Every evidence slot on this page must be completed from the SAHPRA-approved source and the page signed off by a qualified clinical or pharmacy reviewer before it is published. Target length 1,500–2,200 words.