Julie Medical Advisor
How weight impacts the morning-after pill
Does the Morning After Pill have a Weight Limit?
Technically no, but it’s complicated. A few studies have shown that the effectiveness of the morning-after pill does decrease in people who weigh more than 165 pounds or have a body mass index (BMI) over 25. Why? Unfortunately, we don’t really know.
There is only preliminary research testing the efficacy of the morning-after pill on people with a BMI over 25 and 30. The research that led to the morning-after pill’s creation in the 1990s didn’t take into account different body weights, which is one of the reasons that we know so little about its effectiveness today.
The few studies that have been done aren’t definitive, and some even contradict each other. More research needs to be done, especially considering the average weight of women in the US is 170 pounds. We need emergency contraceptive research to catch up and be inclusive of everyone. In the meantime, let’s go over what we do know.
In 2009, a study found that women taking emergency contraception with a higher BMI had a 3x greater risk of pregnancy than women with lower BMIs. Doctors hypothesize that in overweight people, drugs might take longer to absorb into the bloodstream or end up stored in fat in the body instead of circulating.
Does BMI Impact Effectiveness?
Because the research is limited, even experts don’t know the weight at which the morning-after pill’s efficacy begins to decrease. But here’s where the science is at right now:
The emergency contraceptive pill is safe to use for women with BMI of 25 or higher. In terms of how effective it is at preventing pregnancy, the research is not conclusive. There is clearly reduced efficacy, but if 100 women were to take Julie, about 95 of them would not get pregnant if the medication is used as directed.
It is also safe for women with a BMI over 30 to take emergency contraception. Here again, efficacy is reduced, but of those 100 women discussed before, still over 90 of them would not get pregnant if they use the medication properly and have not already ovulated.
Side note: BMI is a total measure of your body fat based on height and weight. Not sure what your BMI is? Use this helpful calculator from the NIH.
Even though we have seen effectiveness decrease with higher BMIs, these studies have shown that the morning-after pill (aka levonorgestrel) is still safe and effective at reducing the risk of pregnancy. For example, one study showed that the risk of pregnancy for women with a BMI over 30 who took levonorgestrel was 2%, compared to 1.2% for the entire group, which included people with lower and higher BMIs. So while effectiveness decreases as BMI increases, the morning-after pill can still be effective no matter your BMI.
In fact, the FDA has approved oral levonorgestrel, aka Julie, for everyone, regardless of weight. So if you’re questioning taking Julie because of your BMI, know that taking it can’t harm you, and there’s a chance that it will work. However, there are alternative emergency contraception options that are proven to be more effective in people with BMIs over 30.
Alternatives to the Morning-After Pill
While Julie and other OTC morning-after pills are safe to use, there are more effective alternatives for people with a BMI over 25, like Ella and the copper IUD.
Ella: For women who weigh 165-195 pounds, doctors recommend Ella, an emergency-contraceptive pill containing ulipristal acetate. However, the efficacy of Ella also decreases with increasing BMI. Ella can be taken up to five days after unprotected sex and requires a prescription from a doctor or nurse.
Copper IUD: Wrapped with a copper coil, the copper IUD contains no hormones and can be inserted by a healthcare professional up to five days after unprotected sex. Weight does not impact its efficacy, making this a great option for people with higher BMIs. The copper IUD has a failure rate of .1%, meaning that only 1 in 1,000 women who get it inserted within 5 days of unprotected sex will become pregnant. The only downside is that you need to get an appointment with a healthcare professional immediately to get one inserted in time.
Does Double-Dosing Work for People with a High BMI?
Some studies have shown that the concentration of levonorgestrel in people with a BMI over 30 was half that of the concentration in people with a BMI under 25, so doctors considered doubling the dose. One study showed that the double dose (3mg) brought the level of levonorgestrel up in people with a BMI over 30 to 1.5mg, the same level of women with a BMI under 25. But, a follow-up study showed that the double dose had no clinical improvement in pregnancy prevention.
Taking the Morning-After Pill Can’t Hurt
There’s no doubt that research about the morning-after pill efficacy in people who weigh more than 165 pounds is confusing. However, a review of four World Health Organization studies concluded that pregnancy rates for individuals with various BMIs who took the morning-after pill stayed below 3%, which is reassuring. So though we cannot be super definitive about the efficacy of the morning-after pill for women with higher BMIs, we do know that overall, the medication still reduces the chance of getting pregnant by a lot.
If your BMI is over 30 and you’re wondering whether the morning-after pill, like Julie, will work for you, we unfortunately don’t have the answer. If possible, and if it’s something you want to do, getting the copper IUD inserted is the most effective way to protect yourself against pregnancy after unprotected sex. If that isn’t an option, taking Julie or Ella is the next best thing. Even if it doesn’t work for you, there is no harm in taking it. It cannot harm you or a fertilized egg, if you do end up being pregnant, won’t affect your fertility, and doesn’t cause any serious side effects.
Although the information above may be useful, it shouldn’t replace the advice of your healthcare professional. For questions about birth control and other women’s health issues, please talk to your healthcare professional.
Emergency contraceptives like Julie work when you take them after sex. That’s because emergency contraception prevents pregnancy by delaying when you ovulate. By taking emergency contraception before sex, you may not be delaying ovulation long enough.
No. Julie is not what is commonly called “the abortion pill” or “medication abortion”. The active ingredient in the abortion pill is mifepristone. Pregnancy needs a hormone called progesterone to grow normally. Mifepristone blocks your body’s own progesterone, stopping the pregnancy from growing. Julie does not and will not impact an existing pregnancy, and works by delaying ovulation before there is a pregnancy.
The FDA recently made an update in December 2022 to remove any language suggesting that Julie may prevent implantation of a fertilized egg. We are currently working on removing this outdated disclaimer but you may still see it present on some of our packaging in the meantime. Please disregard these statements because they are out of date. Julie will not impact an existing pregnancy.
Julie is an emergency contraception you can take after:
- You didn’t use any form of birth control or had unprotected sex
- There was an issue with your regular birth control method (eg, the condom broke or slipped)
- You missed a dose (or more) of your regular birth control pill
Taking Julie will not impact your ability to get pregnant.
After taking Julie you can continue on with your regular birth control method if you have one (for example, continue taking birth control pills).
You will know Julie has been effective when you get your next period, which should come at the expected time, or within a week of the expected time. If your period is delayed beyond 1 week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional.
Julie is a backup or emergency method and should not be used as a regular birth control method. Consult with your doctor about a birth control method that makes sense for you.
Please know that taking a dose of Julie will only protect you from one instance of unprotected sex, it will not prevent pregnancy from unprotected sex over the coming days or weeks. If you have unprotected sex in the future and want to prevent pregnancy, be sure to take a new dose of Julie and talk to your doctor about the best birth control options for you.
Your menstrual bleeding patterns may change temporarily after using levonorgestrel. If you find that your period is more than a week late, take a pregnancy test to confirm whether the contraceptive has worked.
Julie can be used by all women, regardless of weight but women with BMIs above 29.9 have a pregnancy risk of 5.8% - meaning that out of every 100 women who take Julie, 6 may become pregnant. We advise that you speak with your doctor for further information on how this may affect you personally.
Take Julie tablets orally (swallow it). It is preferable to take it with water, and you can take it with or without food. Do not insert Julie vaginally.
Julie is not an abortion pill and will not harm an existing pregnancy nor will it be effective if a woman is already pregnant.
Julie is a progestin‑only emergency contraception product that helps prevent pregnancy before it starts when taken within 72 hours after unprotected sex.
Julie is a backup method of preventing pregnancy and should not be used as regular birth control. Use as directed.
Julie is effective up to 72 hours (3 days) after unprotected sex. The sooner it’s taken after unprotected sex, the better it works.
Julie can significantly decrease your chances of getting pregnant. When used as directed, about 7 out of every 8 women who could have gotten pregnant will not become pregnant after taking Julie. The most important factor affecting how well Julie works is how quickly it is taken. When taken as directed within 72 hours after unprotected sex or birth control failure, Julie can significantly decrease the chance that a woman will get pregnant. In fact, the earlier Julie is taken after unprotected intercourse, the better it works.
Emergency contraception is not 100% effective, which is why it is critical that women have a regular birth control method. If you have any further questions, we encourage you to talk to your healthcare provider.
Since emergency contraception can affect the length of your menstrual cycle, your period might come about a week later or earlier than usual after taking Julie. If your period is more than one week late, consider the possibility of pregnancy.
No. No one needs a prescription to purchase Julie or EC. However, some insurances require a prescription for reimbursement. Some pharmacies and places where EC is sold may tell you that you need a prescription. You do not.
You do not need to see a doctor before or after taking Julie. You do not need a prescription from a doctor. We do encourage you to speak to a doctor you feel comfortable with about sex, reproductive health, and contraception.
No. We know this is a common misconception so let’s break it down. Using Julie (no matter how many times you take it) does not affect your fertility — and it will not prevent you from becoming pregnant in the future. You should feel free to use Julie whenever you think it’s necessary. Julie (and all EC) is not recommended as an ongoing form of birth control because it’s not as effective at preventing pregnancy as birth control methods like the IUD, patch, pill, ring, or shot. Also, frequent use of EC may cause periods to become irregular and unpredictable. That’s it!
Yes. You are not alone. Often times, people who buy EC are feeling stressed out, concerned, embarrassed, confused or ashamed. The important thing to remember is that you are not alone, you have nothing to be ashamed about, and the Julie community is here to support you. By taking Julie after unprotected sex, you are taking control of your future and taking a safe, effective, approved method of preventing pregnancy.