Emergency contraception (EC) can be an effective option for preventing pregnancy if your other methods of birth control fail. There are different types of emergency contraception, including certain pill medications (both prescription and non-prescription) and the IUD. It’s important to remember that EC is most effective if used within five days of unprotected sexual intercourse.
What is emergency contraception?
Emergency contraception (EC) is a way to prevent pregnancy after unprotected or inadequately protected sex, or after sexual assault. It’s considered safe and effective, and it can be used within five days – although some methods are more effective the sooner you use them after unprotected sex. According to the CDC, almost one-quarter of women aged 22 to 49 who have ever had sexual intercourse have used emergency contraception at some point.
EC is not the same as RU-486 (mifepristone), an abortion pill. EC keeps a pregnancy from happening. It doesn’t cause an abortion or miscarriage or harm a developing embryo. In fact, EC won’t work if you’re already pregnant.
How does emergency contraception work?
Emergency contraception works primarily by delaying ovulation (the release of an egg from the ovary for fertilization) and/or interfering with fertilization (keeping the sperm from fertilizing an egg). It may also reduce the likelihood of implantation of a fertilized egg.
IUDs work for emergency contraception by preventing sperm cells from getting to an egg. A copper IUD releases copper particles that disrupt the sperm and ovum, acting as a spermicide. The hormonal IUD works because it thickens the mucus on the cervix, trapping and blocking sperm. It also sometimes prevents ovulation, so there’s no egg to fertilize, and it can also thin the lining of the uterus, possibly making it less likely for an egg to implant.
(While IUDs have been proven safe and effective for EC use, they’ve not been approved by the Food and Drug Administration for this purpose, and so the use of them is considered “off-label.”)
EC pills (ECPs) work primarily by delaying ovulation. Because sperm can live inside your body for up to six days, stopping ovulation for that length of time can prevent pregnancy. How well it works depends on where you are in your menstrual cycle. It you’ve already ovulated, it’s too late. That’s why it’s important to take the pills (depending on the type) as soon as possible. ECPs can also make it more difficult for sperm to travel to an egg, and it can also thin the lining of your uterus.
Emergency contraception won’t protect you from sexually transmitted infections (STIs), and they won’t prevent pregnancy if you have unprotected sex again after you take them. (In fact, because ECPs can delay ovulation, you may be more fertile soon after taking them.) You must use another method of contraception.
What are the different emergency contraception options?
The options for emergency contraception include pills and IUDs.
Emergency contraceptive pills (ECPs) are the most commonly used method. They should be taken asap after sexual intercourse. There are three options:
Ulipristal acetate (UPA)
Ulipristal is not a hormone, but it’s a drug that affects progesterone. It’s available only by prescription and is taken as a single dose of 30 mg. The brand name in the Unites States is Ella. In other countries, brand names include EllaOne and Fibristal. You can take UPA up to five days after unprotected sex.
Levonorgestrel (LNG)
Levonorgestrel (LNG) is synthetic progestin (it’s sometimes called the progestin-only EC pill. It’s taken either as a single dose (1.5 mg) or as a split dose (0.75 mg 12 hours apart), depending on the brand. Brand names include Plan B One Step, Take Action Option 2, My Way, Preventeza, After Pill, My Choice, Next Choice One Dose, Aftera, and E Contra. Ideally, LNG should be taken up to 72 hours after intercourse, though it can be used (less effectively) for up to five days.
Combined pills
Women sometimes take birth control pills (in higher-than-usual amounts) for emergency contraception (called the Yuzpe method). It’s better to use UPA or LNG pills if you can get them promptly because they’re more effective and cause less nausea. If that’s not an option, certain kinds of daily combination birth control pills and even some minipills have been shown to work as emergency contraception.
First, you’ll need to find out if your brand is one that can be used for emergency contraception and how many pills you’ll need to take for each dose. Make sure that you have enough pills to complete each dose and that you’re taking the right ones, especially if they’re the two- or three-phase kind. Also, remember that the last seven pills in a pack of 28 combination pills don’t contain any hormones. Don’t take more pills than recommended. Taking more will probably not reduce your chance of pregnancy any further, but it will make nausea and vomiting more likely.
It can be hard to figure out all this on your own. Call your healthcare provider for assistance.
IUD
An IUD is the most effective EC, and it’s a good choice if you want ongoing birth control. (You can leave it in and use it as effective birth control for 7 to 12 years, depending on the brand.) Simply have it removed any time you want to become pregnant.
Two types of IUDs are used for EC: the copper IUD and an IUD that releases the hormone progestin (levonorgestrel). The copper IUD is sold under the name Paragard, and the LNG is sold under the names Mirena and Liletta. Both types of IUDs have pregnancy rates of less than 1 percent.
You’ll need to have the IUD inserted by your healthcare provider within 5 days of unprotected intercourse. (If you know when you ovulate, it can be inserted beyond that time.)
How effective are emergency contraception pills?
While an IUD is the most effective form of emergency contraception (99 percent effective), EC pills are still very effective. UPA pills are the most effective, with a pregnancy rate of 1.2 to 1.8 percent. LNG pills have a pregnancy rate of 1.7 to 2.6 percent. (Combined pills aren’t as effective as UPA or LNG pills. They reduce your risk by about 75 percent if taken within 72 hours.)
The risk of pregnancy changes, however, according to these factors:
- When the pills are taken. UPA pills can be taken up to five days after unprotected intercourse with no decrease in effectiveness. LNG is less effective after three days – the sooner you take it the better.
- How much you weigh. The effectiveness of both EC pills seems to decrease with increased body mass index (BMI). Some research, for example, suggests that the risk of pregnancy is increased for women using LNG who have a BMI greater than 25. And for women with a BMI greater than 26, LNG may not work at all. The effectiveness of UPA also seems to decrease with increasing BMI, though not as significantly. Researchers haven’t yet confirmed that weight alone is responsible for the decreased effectiveness, and not all studies have reached the same conclusion. But if you have a BMI in the overweight or obese category, the IUD is a safer option.
- Other medications you’re taking. Some medications and herbal supplements can affect the way oral contraceptives work. Some of the substances that are known or strongly suspected to reduce the effectiveness of birth control pills include the herb St. John’s wort (Hypericum perforatum), the antibiotic rifampin, an antifungal drug called griseofulvin, barbiturates, some HIV drugs, and a number of anti-seizure medications. Talk to your caregiver if you’re taking any of these medications. They might suggest a higher dose of ECPs.
Note: Don’t use two different EC pills at the same time or within 5 days of each other. They may counteract each other and not be effective.
When should I go back to my original form of birth control?
If you took a UPA pill, wait five days to start using any hormonal birth control method (a ring, the pill, implant, patch, shot, or hormonal IUD). UPA can reduce the effectiveness of your contraception, so use a barrier method (condoms, diaphragm, cervical cap, and spermicide) until your next period.
If you used LNG or combined ECPs, you can start any birth control method right away. For seven days, however, abstain from intercourse or use a barrier method along with your regular birth control method.
Make sure you resume your regular birth control – or begin a regular birth control method – rather than rely on EC. EC isn’t as effective as regular birth control, it’s more expensive, and there are side effects.
What are the pros and cons of emergency contraception?
The advantages of an IUD as EC is that it’s highly effective and provides ongoing birth control. It requires a visit to your healthcare provider, however, and may be expensive initially, if you’re paying out of pocket. (It can provide ongoing birth control for many years, however.)
If you get an IUD, you may experience increased menstrual pain and bleeding in the first few months. A copper IUD may also cause heavier or longer periods and more or worse cramping during periods.
ECPs are readily available, affordable, and very effective.
They’re also safe. Millions of women have used ECPs, and there have been no reports of serious complications that can be definitively linked to their use. They occasionally cause some temporary, unpleasant side effects for a day or so, though, including:
- Nausea and vomiting (most common side effect, and more likely with combined EC pills)
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- Abdominal pain
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You may also have some irregular bleeding or spotting. This will go away on its own, usually in the week or month after taking the ECPs.
Call your healthcare provider if you:
- Experience severe abdominal or pelvic pain, which could be a sign of an ectopic pregnancy)
- Have continued irregular spotting or bleeding after a few days or cramping after a week or so, which could result in severe anemia
- Think you might be pregnant
- May have been exposed to a sexually transmitted infection and need to be tested
If you have signs of a blood clot, such as chest pain, trouble breathing, pain in your lower leg, weakness, tingling, trouble speaking, or vision problems, go to the ER or call 911.
What happens if I get sick after taking emergency contraception pills?
If you vomit within two hours after taking a dose of pills, call your caregiver for advice – you’ll probably need to take another dose. If it’s been longer than that, you’re probably fine. If you still have another dose to take, talk with your provider about taking an anti-nausea medication an hour before that next dose.
Who should use ECPs?
If you had vaginal intercourse without using any form of birth control or if your method of contraception failed or was used incorrectly, emergency contraception will significantly reduce your chance of getting pregnant. Consider using it, for example, if you don’t want to become pregnant and you find yourself in any of the following situations:
- Your partner’s condom broke or slipped off and he ejaculated inside your vagina.
- Your diaphragm or cervical cap slipped out of place and your partner ejaculated inside your vagina, or you removed the device too soon after intercourse.
- You had sex after forgetting to take your birth control pills or using your patch or ring incorrectly (you applied your patch on the wrong day, for example).
- You had sex when you were late in getting your next birth control shot.
- You’re using a fertility awareness method of birth control and realize that you miscalculated which days of your cycle you would be fertile and had sex during a fertile period.
- You were planning to use the withdrawal method and your partner didn’t pull out in time.
- You had sex without using any form of birth control.
In addition, ECPs are valuable for women who might become pregnant as a result of a sexual assault. If a woman who has been raped goes to a medical facility, she should be offered ECPs. But as this doesn’t always happen, women should be aware that they can ask for ECPs – and obtain them on their own, if necessary.
Because it’s a temporary use, you may even be able to use ECPs if you can’t regularly take birth control pills. Check with your provider.
It’s okay to take ECPs while breastfeeding, too. If you take UPA, you’ll need to pump and throw away your breast milk for 36 hours after taking it, but LNG won’t affect your breast milk.
The IUD isn’t recommended if you’re at risk for sexually transmitted infections. You may be required to take a sensitive urine or blood test to make sure you’re not pregnant before the IUD is inserted.
Will taking emergency contraception pills affect my cycle or my ability to get pregnant down the road?
No, using emergency contraception has no effect on your future fertility.
Most women get their period on schedule within a month of taking ECPs, though it’s not uncommon for the first cycle to come a week earlier or later than you would normally expect it. If you take ECPs often, though, your periods may become unpredictable.
Where can I find emergency contraception pills?
If you’d like to use a UPA pill, start with a call to your pharmacist, because in some states pharmacists can prescribe EC pills. If your pharmacist can’t provide a prescription, call your healthcare provider or a family planning clinic as soon as possible. Some providers and family planning clinics will phone in a prescription for ECPs without an office visit.
All brands of LNG ECPs are available without a prescription. But not all pharmacies carry ECPs, so call first. You can also buy LNG online, but that takes time.
If you’re interested in getting an IUD, you’ll need to see a healthcare provider for the insertion. Call and make an appointment to have the IUD placed within the next few days.
Some insurers cover ECPs and IUDs under their prescription drug coverage. In fact, thanks to the Affordable Care Act, insurance plans must now cover all prescribed contraceptive methods with no cost to you. Plans that existed before March 23, 2010 – and some religiously affiliated employers – are exempt, but many are complying with the changes anyway. The Affordable Care Act doesn’t cover over-the-counter ECPs, however. For full coverage, you’ll need to ask your healthcare provider for a prescription.
Consider keeping a pack of ECPs on hand – particularly if you live in an area where they aren’t consistently and readily available – so you’ll have them in case you need them and can take them right away. Your provider can give you a prescription for ECPs at any routine visit.
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