How to Use Emergency Contraception


Courtesy of Jean Amoura, MD

N. Jean Amoura, MD, is an associate professor in the department of obstetrics and gynecology at the University of Nebraska Medical Center in Omaha.

Q: What is emergency contraception?

A: Emergency contraception, sometimes also known as the morning-after pill, is a high-dose version of hormones similar to those found in regular birth control pills. It can prevent pregnancy if taken soon after having unprotected sex. There are two products on the market that you can buy at a pharmacy—one over-the-counter, no prescription required, and one that requires a prescription from your doctor. You can take these if you've had unprotected sex due to a broken condom or other failed birth control method, or if you have had unprotected sex for any reason and dont want to get pregnant.

Q: Is emergency contraception the same thing as having an abortion?

A: No. The two types of emergency contraception available today—Plan B and Ella—both work by preventing pregnancy, not by interfering with an already existing pregnancy. Plan B contains a single progestin hormone, levonorgestrel, which is also found in much lower doses in birth control pills. Ella contains an antiprogestin. Both seem to work the same way, largely by stopping any ovulation that might be due to happen in the next few days. These "day after" pills may also stop fertilization either by affecting sperm or egg motility (how it moves) or by preventing the sperm from entering the uterus. It's also possible that Ella and Plan B can prevent a fertilized egg from implanting in the uterus wall. In medical terms, a fertilized egg that has not been implanted does not qualify as a pregnancy.

Q: How old do I have to be to get emergency contraception?

A: Girls and women of any age can now get Plan B, which is also available in generic form (levonorgestrel), just by asking their pharmacist. Before a court order handed down in April, Plan B was only available over-the-counter to women aged 17 and older. Anyone younger than 17 had to have a prescription. Ella is available to all ages but only with a prescription.

Q: When should I take emergency contraception?

A: Women should take Plan B as soon as possible after unprotected intercourse as its effectiveness drops off quickly. It is generally recommended that women take it within the first three days, although it is most effective in the first 12 hours after unprotected sex. You can stretch it out to five days but its effectiveness is substantially less towards the end of that five-day period than it is at the beginning. Ella, on the other hand, is nearly as effective at the end of five days as it is at the very beginning.

Q: How effective is emergency contraception?

A: Plan B is 98-99% effective in preventing pregnancy within the first menstrual cycle after unprotected sex. If you take it early enough, it is 80-85% effective in preventing pregnancies that would have occurred anyway. Effectiveness can drop to 60% if you wait to take it. Ella is also about 80-85% effective in preventing pregnancies that would have occurred anyway. That stays true throughout the five-day recommended time window.

Q: Are morning-after pills safe?

A: There are no serious medical risks that are known. We have many years of experience with Plan B and we know it's very, very safe. We also have decades more experience with the regular old birth control pill which acts similarly and we know that is safe. We have less experience with Ella but that appears also to be safe. Even if there are some potential health risks, they would be totally outweighed by an unplanned pregnancy.

Q: Do they have side effects?

A: The side effects associated with Ella and Plan B are relatively minor. The most common side effects are nausea and vomiting and that's still only 50% of women. In fact, the nausea and vomiting some women experience are actually less than those sometimes seen with the regular birth control pill. Some women who take Ella or Plan B will also have headaches and some will have breast tenderness but all of these things tend to be short-lived because it's a one-time dose of medication.

Q: Who shouldn't use emergency contraception?

A: The only people who shouldn't use emergency contraception are those who are already pregnant and even then it's only because they won't work. It's not so much a safety issue as an effectiveness issue. The morning-after pill may even be safer for some women than regular birth control pills. Women who have a high risk of blood clots, who have liver problems or who are over 35 and still smoke are not good candidates for birth control pills but can use emergency contraceptive pills.

Next Page: Is it dangerous if I take it now and then again at some point in the future?

[ pagebreak ] Q: Is it dangerous if I take it now and then again at some point in the future?

A: This has been fairly well studied and there are no known safety risks with having to use these medications repeatedly. However, it's not recommended because emergency contraception is not as effective as using regular and consistent ongoing birth control.

Q: If I take emergency contraception and still get pregnant, is there any risk to the fetus?

A: There are no risks that are known. Plan B has been used by millions of women worldwide and we haven't seen any increase in birth defects, miscarriages or any complications for the fetus.

Q: Will emergency contraception affect my chances of getting pregnant and having babies in the future?

A: We have seen no impact on future chances of having children and, again, morning-after pills have been used by millions of women. It's the same thing I would tell someone using birth control pills on a regular basis: There is no long-term impact on her fertility.

Q: Will emergency contraception protect me against sexually transmitted diseases (STDs)?

A: No. Emergency contraception does not confer any protection against STDs. In fact, by definition, someone who is at risk for an unplanned pregnancy may be at risk for an infection as well, so she should be using condoms to prevent infection.

Q: When will my next period start after I take emergency contraception?

A: After taking Plan B or Ella, your period may start slightly earlier or later than usual, generally only a day or two but sometimes several days. If it's more than a week late, you need to do a pregnancy test. In rare cases, there will be an effect beyond this first menstrual cycle. The most likely scenario is that you get back to your regular periods right away.

Q: Is it true that I can't get pregnant till my next period?

A: No. A single dose of Plan B or Ella will only cover that one incidence of unprotected intercourse. If you miss a birth control pill again or the condom breaks again, you'll need to take emergency contraception again. This is true even if you haven't had another period since the first incidence of unprotected sex.

Q: When should I start taking my birth control pills again?

A: You should start them again as soon as possible regardless of how many pills you've missed. But if you've only skipped one pill, you don't need emergency contraception. If you miss two or more, you do need emergency contraception. And, remember, even when you restart the pills, they won't start being effective for seven days.

Q: How much does emergency contraception cost?

A: Plan B is now available in generic form but it's still pretty pricey: about $45 for a single dose from a standard pharmacy versus $55 for the brand name. One dose of Ella costs about $52. Some insurance plans will cover the pills and some won't. Generally, if an insurance plan covers regular contraception, it's more likely to cover this but one of the downsides of having Plan B available over-the-counter is that insurance is less likely to cover it.

Q: Should I have emergency contraception as a standby at home?

A: Yes. I recommend that sexually active women have Plan B, which you can now obtain without a prescription, on hand. It is way more effective when taken early on.

Q: Why is it a bad idea to use emergency contraception as birth control?

A: Both because of price and effectiveness. You need to take emergency contraception with every act of unprotected sex. This can get very expensive very quickly. Even for women who do use the day-after pill repeatedly, it's still not as effective as having an ongoing form of contraception.

Q: Does taking emergency contraception promote promiscuity?

A: Studies of women, especially teenage women, do not show changes in the number of sexual partners or age at which sexual activity is initiated. Studies have also not shown any increase in STDs. All three of these can be indications that a woman is engaging more frequently in sex with different partners.

Q: Why is emergency contraception so controversial?

A: I believe the biggest area of controversy and confusion is that, for women, the line between the morning-after pill and an abortion pill has been blurred. For medical providers, that line is very distinct. These are two completely different medications.