Emergency contraception (EC) is designed to prevent pregnancy. Some may choose it as their primary method of contraception, while others may use it in emergency situations only. Regardless of how you use it, it’s important to know all of your options and have the most accurate information, so you can make the best choice. There are so many myths about EC, so here are the facts.
EC is used after unprotected sex or after barrier protection (internal or external condom) fails. Some people may find that they haven’t been able to use their contraception method (like the pill or patch) or use fertility awareness as diligently as they planned.
There are a few methods of EC that are currently available—two in the form of a pill and the other in the form of an intrauterine device (IUD). Levonorgestrel (Plan B) and ulipristal (Ella) are both pill forms of EC that are currently available. Levonorgestrel may not work as well if you weight over 155 pounds, and is best if taken as soon as you determine that you need it (it may become less effective the longer you wait). Ulipristal is a better option for bodies of higher weight, but still may be less effective in those who weigh over 195 pounds. Ulipristal is equally as effective up to five days after unprotected sex. To be clear, having a higher weight doesn’t mean EC shouldn’t be taken at all—if you want to avoid pregnancy, it’s better to use EC than to not—it just means you should speak with your healthcare provider about your best options.
Levonorgestrel is available over-the-counter at a pharmacy and it’s also available on Amazon Prime; ulipristal is available with a prescription from a medical provider. Some college campuses now have EC pills accessible via vending machines, and California is working to mandate access to medication abortion on college campuses. It’s best to keep EC pills (and/or condoms) next to your bedside table, in your medicine cabinet, or in the suitcase you take on trips, so that you can take it as soon as it is needed (always remember to check the expiration date before taking the pill).
Different states have different laws regarding EC and that’s why I recommend keeping it on hand. Eight states allow pharmacists to dispense EC without a prescription, but other states, like Mississippi, allow both pharmacists and pharmacies to refuse to dispense any form of contraception if it conflicts with their religious beliefs. Remember, if a pharmacist refuses to fill your prescription, they still must refer you to another pharmacist or pharmacy to get it filled. The good news is lawmakers are working hard to prevent delays in contraception access at the pharmacy. Keep in mind that if you’re traveling abroad, many countries make EC pills available over-the-counter. For example, in the United Kingdom, same-day delivery of ulipristal has already begun.
While the pills are effective at preventing pregnancy, the most effective method of EC is actually the copper IUD (also known as the Paragard). Unlike some of the pill versions of EC, the copper IUD is just as effective regardless of body weight. The copper IUD can be inserted by a medical provider within five days of unprotected sex and it lowers your chance of getting pregnant by 99 percent. It can then be left in the uterus for up to 12 years to prevent pregnancy. If you wish to get pregnant, you can have the IUD removed at any time and return to your age-dependent level of fertility. While the copper IUD can act as EC as well as ongoing contraception, essentially every method of contraception can be initiated after someone has taken the EC pill.
Emergency contraception, or any form of contraception, does not cause infertility and has very few side effects. While EC pills may cause nausea or abdominal pain, not everyone experiences these side effects. If vomiting occurs within three hours of taking ulipristal or levonorgestrel, the dose should be repeated. The second dose can be taken vaginally. Despite some anti-abortion rhetoric, EC methods do not cause abortion. Levonorgestrel and ulipristal do not end a pregnancy that has already implanted. Instead, they work by delaying or preventing ovulation (the process where an egg leaves the ovary). Medication abortion pills act very differently than EC pills, but both are important to have accessible if preventing pregnancy is the desired outcome. Furthermore, there is almost no medical condition that prevents someone from using levonorgestrel, ulipristal or the copper IUD. You can still take EC pills or have a copper IUD inserted even after using alcohol or drugs.
I often get asked if it’s “bad” to take levonorgestrel or ulipristal too often. The answer is no. There is no limit to how often you can take oral EC, but I do recommend that patients only take it once within a 24-hour window. And levonorgestrel and ulipristal should not be taken within five days of each other (they work differently and could potentially cancel the effect of one another). Frequent use of EC pills may cause irregular and unpredictable bleeding or nausea, but there is no research to suggest that taking these pills has any long-term side effects.
Individuals with a uterus who are taking testosterone for gender transition may take any form of EC. While testosterone may affect fertility, many patients continue to ovulate even if they aren’t menstruating monthly. So, if someone with a uterus has penetrative intercourse with someone with sperm, pregnancy can be a risk, but EC—and other methods of contraception—are still available if needed.
Another important point that many people may not realize is that since the EC pills work to delay ovulation, and since sperm can survive in the partner’s body for up to five days, risk of pregnancy can be increased after taking the morning after pill. So, make sure to use protection and avoid unprotected sex after taking EC. If a patient wants to prevent pregnancy, I always make sure they know about this slightly higher risk of pregnancy after taking the EC pill and counsel on barrier contraceptive use.
EC is a safe and effective way to prevent pregnancy. And it’s worth mentioning, that no method of EC prevents against sexually transmitted infections.
Dr. Meera Shah, MD, MPH, MS is the Associate Medical Director of Planned Parenthood Hudson Peconic in New York and a fellow with the Physicians for Reproductive Health. Dr. Shah is currently working on a book of essays about reproductive health access.