Emergency Contraception

What Is Emergency Contraception?

Methods Of Emergency Contraception

ECPs containing ulipristal acetate (UPA)
ECPs containing levonorgestrel (LNG)
Intrauterine devices (IUDs)
Combined oral contraceptive pill

How Does It Work?

Most emergency contraception works by either delaying or preventing ovulation. Pregnancy doesn’t happen right after sex and sperm can live in your body for up to six days, so preventing ovulation by using emergency contraception prevents the sperm from ever fertilizing the egg. The one exception is the copper IUD which works by causing chemical changes in the egg and sperm before they unite.

Note: An already established pregnancy is not affected by the use of emergency contraception.

Who Can Use It?

Emergency contraception is an option for any person with a uterus who is of child-bearing age.

How Effective Is It?

Studies have shown pregnancy rates after the use of emergency contraceptive pills (ECPs) containing ulipristal acetate (UPA) to be 1.2%. The pregnancy rate was 1.2% - 2.1% after the use of ECPs containing levonorgestrel (LNG). While ECPs with LNG can be taken up to 5 days after having unprotected sex, they work best when taken within 3 days. In general, greater effectiveness was shown to occur the closer to the instance of intercourse that ECPs are taken, with ECPs with UPA being the most effective.

One note here is that ECPs with LNG are less effective if you weigh more than 165 lbs, in which case an ECP with UPA or an IUD would be recommended. There are a few medications and supplements that can also make ECPs less effective, so it’s a good idea to check with your pharmacist first.

The combined oral contraceptive pill can be used in situations where ECPs are not available and can reduce the risk of pregnancy by up to 75% when taken correctly, with the first dose within 5 days of unprotected sex and the second dose 12 hours after the first.

The IUD is the most effective form of emergency contraception, with an effectiveness rate of 99.9% when inserted within 5 days of having unprotected sex.

While some forms are more effective than others, any method of emergency contraception is better than none at all. And because ECPs are more effective the sooner they’re taken, it’s a good idea to keep one in your medicine cabinet just in case.

Is It Safe?

All methods of emergency contraception are considered very safe. Side effects are not common and serious side effects are practically nonexistent. The most common effect of ECPs is a slightly abnormal period (i.e. earlier/later, lighter/heavier than you’re used to). IUDs can cause mild to moderate pain and a few days of cramping when first placed. Copper IUDs can cause heavier periods in some people.

While it’s safe to take ECPs as many times as you need to, they aren’t the most effective method of preventing unintended pregnancies. Other preventative forms of contraception such as the IUD, pill, or condom, are typically lower in cost, more effective, and more convenient.

Temporary side effects occur more frequently with combined oral contraceptive pills than with the other methods of EC and include nausea, vomiting, abdominal pain, fatigue, breast pain, headaches, and dizziness.

When Can It Be Used?

Some of the most common situations where emergency contraception in typically used:

When no contraception was used during sex
In cases of sexual assault where the victim had no protection
In the event that contraception failed or was suspected to have failed (for example, condom slippage or breakage, failed withdrawal, missed oral contraceptive pills)

Where Do I Get It?

ECPs with LNG can be purchased over-the-counter in most pharmacies and drugstores. They’re available under the brand names Plan B, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, and EContra. AfterPill can be purchased online here.

There is only one brand for ECPs with UPA: ella. This pill is only available by prescription but can be picked up from a local family planning center such as Planned Parenthood. It is also available online with next-day delivery here.

The copper IUD is available under the brand name Paragard. Hormonal IUDs include Mirena and Liletta. All IUDs need to be placed by a medical provider, making them more difficult to get in an emergency situation.

How Much Does It Cost?

Plan B usually costs $40-$50 with generic ECPs with LNG typically costing less (around $11-$45). If you have Medicaid or health insurance, there’s a good chance you can get it for free with a prescription from your medical provider.

Ella can cost $50 or more at the pharmacy but is typically free through health insurance or Medicaid.

The combined oral contraceptive pill typically costs $22-$79 for a 30-day supply, but is often covered under private and government health insurance for little to no cost. The precise cost of using it as EC depends on the brand and how many pills are needed (typically 8-10).

IUDs can range in price quite a bit, up to $1300, but are usually covered under insurance plans for little to no cost. Their higher cost is an investment in pregnancy prevention though, as they can be effective for 7-12 years, depending on the type.

Sources:

World Health Organization: WHO. (2018, February 2). Emergency contraception. Who.int; World Health Organization: WHO. https://www.who.int/news-room/fact-sheets/detail/emergency-contraception

Planned Parenthood. (2016). Plannedparenthood.org. https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception

Using Oral Birth Control Pills as EC. International Consortium for Emergency Contraception (ICEC). https://www.cecinfo.org/icec-publications/using-oral-birth-control-pills-ec/