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:
BMI 25+
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.
BMI 30+
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.
There are a few medications that may interact with the morning-after pill. The most common medications include:
-Some anti-HIV medications
-Some anti-seizure medications
-Rifampin (an antibiotic mainly used to treat tuberculosis)
-Griseofulvin
-St. John’s wort
If you have concerns about a medicine you are taking potentially interacting with the morning-after pill, please consult with a pharmacist or medical provider.
No, studies have confirmed that taking two pills will not change the effectiveness of the morning-after pill, even for those with higher BMIs.
Essentially nothing. Julie is not an abortion pill and it will not harm or end an existing pregnancy. Julie helps prevent pregnancy by stopping or delaying ovulation, but if you’re pregnant, then there’s no ovulation to stop. The medication, levonorgestrel, won’t harm you or your fetus if you do end up taking Julie while pregnant. This makes Julie a great option for people who want to be safe after unprotected sex—if you aren’t pregnant yet, it may stop a pregnancy from occurring, and if you are already pregnant, it won’t impact the fetus.
No. The morning-after pill only stops ovulation short-term. When you take it after unprotected sex, it reduces your chance of getting pregnant now. When you start a new cycle next month, you’ll go through a brand new ovulation phase, which is a new opportunity to get pregnant. So if you’re planning on having babies in the future, rest assured your chances of getting pregnant won’t be affected by Julie.
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.
Technically, no. Julie can be used by anyone with a uterus regardless of weight. However, studies have shown that the effectiveness of the morning-after pill does decrease in people who have a body mass index (BMI) over 25. For those with a BMI under 25, pregnancy risk after taking the morning-after pill is less than 2%. For those with a BMI over 29.9, the risk of pregnancy increases to 5.8% - meaning that out of every 100 individuals with a BMI over 29.9 who take Julie, six may become pregnant.
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. Read more here.
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.
The medication in the morning-after pill, levonorgestrel, temporarily blocks or delays ovulation, which is when your ovary releases an egg. It essentially puts the emergency brakes on your ovaries so an egg can’t be released. If there’s no egg, then there’s nothing for sperm to fertilize, which means a pregnancy can’t develop.
Read more about how the morning-after pill works here.
The morning-after pill, like Julie, is 89% effective when taken within 72 hours (or 3 days) after unprotected sex. The golden rule is the sooner you take it, the better it will work.
One thing to note: Weight does impact the effectiveness of the morning-after pill. If your BMI is over 25, Julie may not be the best option for you, but there are other options if you have access to a medical provider. Ella® is another type of emergency contraception pill that works more effectively for women with a BMI under 30. Like Julie, it’s a one-time pill but it does require a prescription from your provider. Copper and hormonal IUDs are the most effective form of emergency contraceptive and are not affected by weight at all. However, they do need to be inserted by a healthcare professional up to 5 days after having unprotected sex.
Learn more about how weight impacts Julie here.
You do not need to see a doctor before or after taking Julie because the pill is available without a prescription. However, there are a few reasons you might want to speak with a doctor after unprotected sex. The first reason is that unprotected sex carries the risk of catching sexually-transmitted infections. The second reason is that the morning-after pill is not as effective as regular birth control. A doctor will be able to counsel you on better options if you plan to remain sexually active.
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, the morning-after pill (including Julie) and the abortion pill are two very different medications. The morning-after pill prevents a pregnancy from starting by stopping an egg from being released. If there’s no egg, there’s no chance of pregnancy. Plus, it’s FDA-approved and legal in all 50 states.
On the other hand, the abortion pill ends an existing pregnancy, which is something that the morning-after pill cannot do. If you’re already pregnant, the morning-after pill and the medicine within it, levonorgestrel, cannot end the pregnancy or impact it in any way.
See more common morning-after pill myths here.
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.
The morning-after pill—like Julie— is one of the most common and convenient forms of emergency contraception. It’s an over-the-counter pill found at retail chains like Target, CVS, and Walmart nationwide. The morning-after pill is made of the hormone levonorgestrel, the same hormone found in many birth control pills and is FDA-approved and legal in all 50 states. When used correctly, it can significantly reduce your chance of getting pregnant. It doesn’t require a prescription, ID, or credit card, and can be purchased easily by anyone (you, your partner, your friend, or the nice guy from GoPuff). Learn more about the morning-after pill here.
The morning-after pill is a backup method of preventing pregnancy and should not be used as regular birth control.
You should take Julie if you had unprotected penis-to-vagina sex and:
- You didn’t use any form of birth control
- Your birth control method failed—e.g. the condom broke or slipped off
- You missed 2 or more doses of your regular birth control pill
- You’re not sure if he pulled out in time
Remember to take Julie ASAP to have the best chance of it working. It’s 89% effective when taken within 72 hours of unprotected sex, but can be effective up to 120 hours after. Learn more about Julie here.
No. No one needs a prescription to purchase Julie or other brands of the morning-after pill. However, some insurance companies require a prescription for reimbursement. Some pharmacies and other places where emergency contraceptives are sold may tell you that you need a prescription. You do not.
Take the Julie tablet orally (swallowed). It is preferable to take it with water, and you can take it with or without food. Do not insert Julie vaginally.
Julie can be taken up to 72 hours (3 days) after unprotected sex. The sooner it’s taken after unprotected sex, the better it works. Learn more about the morning-after pill effectiveness here.
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!
You can get Julie at your local CVS, Target, Walmart or on our website.
No, that’s not recommended. Emergency contraceptives, like Julie, work when you take them after sex. That’s because emergency contraception prevents pregnancy by delaying when you ovulate, which is when an egg is released from the ovary. Sperm can live inside you for up to 5 days, so if you take Julie and then have unprotected sex, the medication might not be able to delay ovulation for the entire length of the sperm’s life, creating a potential for pregnancy.
Learn more about how Julie works here.
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.
Julie and other over-the-counter morning-after pills contain a high amount of levonorgestrel, a synthetic hormone that’s also in some birth control pills. The extra amount of this hormone can affect your menstrual cycle and cause some side effects. Most side effects come and go within hours of taking the pill, but some can last up to a couple of days. Learn more about Julie's side effects here.
No. Levonorgestrel, the hormone in Julie, only pauses ovulation for a very short period of time. Over-the-counter morning-after pills like Julie won’t impact your ability to get pregnant later. Check out more myths about the morning-after pill here.
- Bleeding/spotting between periods
- Temporary changes to a period cycle (the next period comes early or late)
- Heavier or lighter next period
- Nausea
- Abdominal pain
- Fatigue
- Headache
- Dizziness
- Breast tenderness
For more information about Julie side effects and how long they last, read this.
Side effects like nausea, abdominal pain, and fatigue can start within a few hours of taking the morning-after pill. If you vomit within two hours of taking the pill, it’s important to talk to a healthcare professional to find out if you should take another dose.
Most side effects are easily manageable, but sometimes they can be annoying. If that headache just won’t go away or your breasts are super tender, it’s safe to take ibuprofen, acetaminophen, or any over-the-counter pain reliever—they won’t interact or interfere with levonorgestrel.
Listen to your body. After all, you’ve just taken a pill that affects your hormones. Feeling a little weird is normal. Rest, keep yourself hydrated, and give yourself some extra compassion.
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.
Your cycle might be temporarily affected after taking Julie. That’s because there’s a higher dose of levonorgestrel compared to what’s found in daily birth control pills. It’s likely to impact your body’s natural hormone levels for a short period of time. This might result in an earlier or later period.
If your period is delayed beyond one week, it is possible you may be pregnant. You should get a pregnancy test and follow up with your healthcare professional if positive. Your period might also be lighter or heavier than usual, or you might experience spotting in between cycles. If your schedule is impacted beyond a month or two, it’s worth checking in with your medical provider. Read more about how Julie might affect your period here.
No! The most common side effects are changes in your period, nausea, lower stomach pain, fatigue, headaches, dizziness, and breast tenderness. These symptoms typically go away within a few hours and shouldn’t last more than a couple of days. If you have any side effects that bother you, call your healthcare professional. Read more about Julie's side effects here.
Yes. You are not alone. Oftentimes, 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. If you want to share your experience and talk with others in our community, head to our Tik Tok, Instagram, and Quora space, After Sex, where all sex questions and commentary are welcome.
It depends. Some people get their period a few days earlier or later than they were expecting, while some have reported a delay in menstruation beyond a week. Stress can also delay your period, which can be heightened when taking emergency contraception. If your period is more than one week late, it doesn’t necessarily mean that you’re pregnant, but it is recommended to take a pregnancy test.
Waiting for your period to arrive can be stressful, especially after taking emergency contraception, but just know that it might be totally normal. A delayed or early period is actually one of the most common side effects of taking the morning-after pill. Levonorgestrel, the hormone in Julie, delays ovulation, which can move the timing of your cycle back a few days. Your period might also be lighter or heavier than usual, or you might experience spotting in between cycles. If your period is delayed beyond one week, it doesn’t necessarily mean that you’re pregnant, but it is recommended to take a pregnancy test. You can read more about how Julie might affect your period here.
The best thing to do after taking Julie is to rest and hydrate. If you’re feeling any side effects, you can take over-the-counter painkillers to make yourself feel more comfortable. A heating pad or hot water bottle can also help if you’re having stomach pain or cramping. If you can, a day on the couch with Netflix or a good book often does the trick. Read more about managing Julie side effects here.
Typically just for one menstrual cycle. Most people notice that their period starts either a few days early or a few days late, though some people have reported a two-week delay in menstruation. If you are not pregnant, your cycle should return to normal the next time you get your period. If changes last beyond a month or two, it’s best to check in with a doctor.
Read more about changes to your period after taking Julie here.
