Let me just make a few things clear right out of the gate. Accidents happen. It’s hard to remember to take a daily birth control pill, much less remember to take it at the same time each day. Condoms can break. You may have miscalculated your fertile time if you’re practicing natural family planning.
There are about a thousand different reasons you might need emergency contraception, and there are approximately zero reasons you should feel bad about purchasing it.
Even though some forms of emergency contraception have been available without a prescription for over a decade, misinformation about emergency contraception abounds. So, with the help of emergency contraception experts, we’re here to help set the record straight.
Here are the emergency contraception facts every woman (and frankly, every man) needs to know.
How Emergency Contraception Works
Emergency contraception can help prevent unintended pregnancy in a couple of different ways.
One of the most popular forms of emergency contraception is the morning after pill, which delivers a large dose of hormones designed to delay or prevent ovulation from happening. If you don’t ovulate, there’s no egg to be fertilized, meaning you can’t get pregnant.
Another method of preventing pregnancy through emergency contraception is through a copper IUD. Essentially, copper is toxic to sperm. So, when sperm try to swim toward their goal, the copper in your cervical mucus from the IUD kills the sperm.
How Emergency Contraception Works With Your Menstrual Cycle
Here’s a quick refresher on the menstrual cycle:
“Most women have a menstrual cycle that lasts around 28 days from the start of one period to the start of the next (a few are longer and some are shorter in length),” explains Melissa Grant, chief operating officer of carafem Health. “On average, most fertile women ovulate around day 14 of this cycle, meaning they release one egg cell during this time, and it survives about one day. If a fertile man’s sperm comes into contact with a woman’s reproductive tract (through the vagina, cervix, and uterus to the fallopian tubes) the sperm cells can live in her body for up to five days. This means even if a woman does not have sex on the day she ovulates, it is still possible for sperm and egg to join in conception if live sperm are still in her reproductive tract on the day she ovulates.”
This window of opportunity for pregnancy to occur is why Adeeti Gupta, MD, the founder of Walk In GYN Care, cautions women that while emergency contraception pills do work to prevent pregnancy, it’s hard for most women to accurately pinpoint their exact ovulation date to know whether or not they may become pregnant. “The menstrual cycle is helpful [in preventing pregnancy] only if your cycles are regular like clock work,” says Gupta. “However, this should not be used a gauge to decide when and whether or not you need to take emergency contraception.”
So, to recap: If you have unprotected sex around the time that you normally ovulate, you are at risk of becoming pregnant, even if it wasn’t on the exact day of ovulation.
When to Use Emergency Contraception
Luckily, there’s no guesswork involved in knowing when you should take emergency contraception.
“Emergency contraception can be used any time there is unprotected intercourse, unless you are already on birth control pills or have an IUD,” Gupta explains.
According to both Grant and Gupta, you can take emergency contraception at any time during your menstrual cycle and any time that you’re worried you might become pregnant after sex.
Even though most kinds of emergency contraception, like Plan B, are typically effective within 72 hours of intercourse (and others are effective for longer periods), both Grant and Gupta urge women to act quickly after unprotected sex to prevent an unintended pregnancy, and they say the claims that emergency contraception is as effective on day one as it is on day five isn’t completely true.
“It is variable. The efficacy also depends on the woman’s menstrual cycle, so it’s hard to predict,” Gupta says.
Still, research shows that all forms of emergency contraception should be taken as soon as possible after unprotected sex in order to be most effective.
And, if you were worried, this means that emergency contraception is not the same as having an abortion. I repeat: emergency contraception is NOT an abortion.
And if you’ve heard differently or are still unsure, take it from the expert:
“An abortion ends an established pregnancy,” explains Grant. “Emergency contraception pills work to prevent ovulation and have no effect on an ongoing pregnancy.”
Purchasing Emergency Contraception: A Guide
Now that you know the key facts about emergency contraception, here’s what you need to know about the most popular forms of emergency contraception available and how to purchase them.
The Morning After Pill
The “morning after pill” is a term that describes a couple different forms of emergency contraception pills. This type of emergency contraception contains hormones that help prevent ovulation.
Levonorgestrel is a type of progestin, one of the hormones that affects your menstrual cycle and pregnancy.
Most levonorgestrel emergency contraception options, like Plan B One Step (one of the most popular name-brand types of levonorgestrel emergency contraception), are single-dose options that are most effective when they are taken as soon after intercourse as possible.
When taken within 72 hours, levonorgestrel is 89 percent effective in preventing pregnancy. However, efficacy rates decline the longer you wait to take the pill; by day five, you’re five times more likely to become pregnant.
You should know that some research has shown that the morning after pill is slightly less effective in women with higher BMIs. In fact, one study showed that in women with high BMIs, pregnancy was three times more likely to occur despite using emergency contraception; if you have a BMI greater than 25, it’s recommended that you do not take levonorgestrel. If you have a high BMI, don’t despair: The two other methods of emergency birth control are shown to be more effective overall, even if you have a higher BMI.
Levonorgestrel Side Effects
Because levonorgestrel is a large dose of hormones, it’s normal to experience nausea or even vomiting as a side effect. If you do vomit after taking the morning after pill, Gupta advises following up with a second dose. Other common side effects are similar to how you feel during PMS: bloating, fatigue, breast tenderness, and cramping have all been reported.
Where to Buy Plan B One Step
Plan B (and generic forms of it) can be found in the family planning aisle of most drugstores, so anyone age 17 or older can purchase it without asking the pharmacist or having a prescription. That means your partner, your best friend, or a stranger on the street could purchase the morning after pill for you, no questions asked. You can also buy the morning after pill online through most retail pharmacies, but be aware that shipping times vary, and you may not receive the pill within 72 hours when it is likely to be most effective.
ella (Ulipristal Acetate)
Ulipristal acetate, known on the market as ella, is another type of morning after pill. Ulipristal acetate is a progesterone receptor modulator. Gupta explains that ella also works to delay ovulation, “but works through a different mechanism of action. It goes into the cells and blocks the progesterone receptor to prevent progesterone surges and hopefully ovulation.”
One of the best things about ella is that it can also be taken up to five days after intercourse, but unlike levonorgestrel-only pills, has even rates of efficacy as time goes on.
In addition, ella has been shown to be more effective in women with higher BMIs, but not failsafe. In one study of over 2000 women, a total of 1.9 percent became pregnant after using ulipristal acetate, but among obese women in the study, the rate of pregnancy while using this form of emergency contraception jumped to 8.3 percent.
Ella Side Effects
Side effects of ella are similar to the side effects of other morning after pills on the market. You may experience symptoms similar to those during PMS, but they should subside after a couple of days.
Where to Buy ella
Ella is currently only available with a prescription, but that usually doesn’t require a visit to your doctor. Usually, your physician can simply call the prescription in to your pharmacy, and in some states, you can even get the prescription straight from the pharmacist. With a prescription, ella can be ordered online and shipped to most states.
A copper IUD is the most effective form of emergency contraception at 99 percent efficacy up to 120 hours of insertion, regardless of BMI. Plus, unlike the morning after pill, a copper IUD can continue to act as birth control, preventing pregnancy for five to ten years or until you decide to have the device removed.
It only takes about five minutes to insert a copper IUD, and the experience is about as uncomfortable as having a pap smear or colposcopy. A speculum is inserted into the vagina, and then your doctor will use a special tool to place the IUD into your uterus.
Copper is toxic to sperm, so they prevent fertilization of an egg from taking place. Even if you ovulate, the IUD prevents implantation by impairing sperm motility.
How much does emergency contraception cost?
The Affordable Care Act requires insurers to cover FDA-approved contraception methods (thanks, Obama!). That includes emergency contraception, but there are restrictions, so your insurance may or may not cover the cost of emergency contraception. The best way to find out if your insurance covers emergency contraception is to call them directly.
If you go with the morning after pill, like Plan B, which can be purchased at any pharmacy, you’ll likely be paying out of pocket, though insurance may cover some of the cost. Generic brands of levonorgestrel-only emergency contraception have the same rates of efficacy, but are generally a little bit cheaper. You can also save money by visiting the Plan B website directly, as they usually offer online coupons that can be redeemed in stores. Since ella requires a prescription, insurance is more likely to cover all or a portion of the $50 cost.
The best bet for insurance-covered emergency contraception is the IUD, since it requires an in-office doctor’s visit. Without insurance, an IUD can be pretty expensive (think between $500 and $1,000), but insurance brings that cost down considerably.
If you need emergency contraception, but money is tight, you do have options. Visit your local health department or Planned Parenthood to find out about your options for receiving free or low-cost emergency contraception.
I found out I am pregnant after I took emergency contraception. Will it hurt the baby?
Sometimes women find they’re pregnant despite taking emergency contraception. This might be because ovulation had already occured when you took emergency contraception, or the emergency contraception may have been taken incorrectly.
Copper IUDs are 99 percent effective at preventing pregnancy, but while it is extremely rare, pregnancy can occur if the IUD malfunctions or was inserted incorrectly. Even more rare are adverse outcomes if you do become pregnant with an IUD. That said, studies have shown that the risk of ectopic pregnancy and miscarriage are much higher in women who become pregnant with an IUD in place.
That’s not the case with other forms of emergency contraception, though. If you find out you’re pregnant after taking emergency contraception, research has shown that the morning after pill likely has little effect on fetal development.
In fact, a 2009 study of over 600 women in China found that there were no statistical increases in the risk of miscarriage or other adverse pregnancy outcomes when women were exposed to levonorgestrel-only emergency contraception after becoming pregnant.
This may be because most OTC emergency contraception contain high levels of common hormones similar to pregnancy hormones like progesterone. So how can progesterone both promote and prevent pregnancy?
“Yes, progesterone is one of the hormones that surges during pregnancy,” Gupta says. “However, if we give that hormone from external sources [like emergency contraception] then it works through a mechanism called feedback suppression and suppresses ovulation.”
Basically, progestin is a synthetic hormone used in emergency contraception that mimics progesterone but is manufactured to act on the bodies progesterone receptors in a desired way, which is the feedback suppression Gupta mentioned. Grant further explains, “One effect of the type of progestin in emergency contraceptive pills is to inhibit ovulation (stop the release of an egg cell). The most commonly available emergency contraception pill in the United States contains the progestin levonorgestrel.”
Frequently Asked Questions About Emergency Contraception
You asked, we asked the experts, they answered.
Does emergency contraception prevent STDs?
“No, emergency contraception does not prevent STDs,” says Grant. If you have unprotected sex, it’s always a good idea to get tested, just in case.
Is it safe to use emergency contraception more than once?
“Yes, emergency contraception is very safe, and can be used as needed,” says Grant. Unless you throw up immediately after taking the morning after pill, there’s no need to follow up with a second dose. Any time you have unprotected sex and are concerned about pregnancy, you may take emergency contraception.
Can you use emergency contraception as regular birth control?
“No, not at all,” says Gupta. “I do not recommend this method on a routine basis because it can cause irregular periods and high chance of unwanted pregnancy.”
Are you sure that emergency contraception isn’t the same as the abortion pill?
“Yes! They have completely different compositions,” Gupta explains. “Ella is similar in chemical composition but it’s used differently and at a different dose for abortion.”
Will emergency contraception affect my menstrual cycle?
Maybe. “Emergency contraception can sometimes delay the cycle and cause unpredictable bleeding in the subsequent cycles,” says Gupta.
Does emergency contraception hurt?
“No,” says Gupta. “You may get some cramps, but it shouldn’t hurt too much.” See the side effects above so you know what to expect!
Is it safe to use emergency contraception if I recently started hormonal birth control?
“Yes, if your hormonal birth control is not yet effective and there is a risk of ovulation, emergency contraception pills can be a good way to further reduce the risk of an unintended pregnancy,” Grant explains.
If you take two morning after pills is it twice as effective?
Sorry, but nope. Plus, according to Grant, “The effectiveness of taking more than one EC pill has not been widely studied. Current recommendations are to follow the package directions.”
My period started right after I had unprotected sex. Do I still need emergency contraception?
“Some women bleed in the middle of a menstrual cycle and others may ovulate even during a period,” Grant explains. “If you have had unprotected sex and want greater protection from pregnancy, you can take emergency contraception pills at any time during your cycle.”
I feel HORRIBLE after taking emergency contraception. When should I call my doctor?
You shouldn’t feel bad after taking emergency contraception. If you do, Gupta says, “Call or go the nearest GYN office/ER right away. Your doctor needs to rule out pregnancy, ectopic pregnancy, or anything else that may be serious.”
Does emergency contraception affect fertility?
According to Grant, “Emergency contraception pills only prevent ovulation at the time you take them. They do not offer long-term protection against pregnancy, and they do not impact future fertility.”
Should I feel bad about using emergency contraception?
“The choice about when and whether to become pregnant or have children is one that is best decided by the people involved,” Grant says. “Having children when you feel ready is something to feel good about!”