During my third-year Ob-Gyn rotation in medical school, I would see patients around my age and straddle the line between provider and peer. One young woman was in her first serious relationship and wanted to start birth control after a pregnancy scare. We discussed her options and settled on an IUD, an excellent and incredibly effective form of birth control. (Learn more about IUDs here.)
When I brought up having emergency contraception until her IUD placement, she looked at me blankly. After I explained how emergency contraception works, she wished she had known about it earlier and prevented weeks of stress and worry.
A lot of people, especially young women, don’t know about emergency contraception or how to use it effectively. Others worry it is unsafe or can make it harder to become pregnant in the future. In fact, there are a number of options for emergency contraception. Some also work as long-term contraception.
What are my options for emergency contraception?
If you recently had unprotected sex — or your birth control failed in some way, such as a condom breaking — and want to make sure you don’t get pregnant as a result, there are several options. These include:
- Progestin-only pill. This medication is made with a type of progestin known as levonorgestrel. It’s sold under the brand names such as Plan B One Step and Her Style. This is the only emergency contraception currently available over the counter. It is sold at many pharmacies, but you may have to ask the pharmacist for it. Since not all pharmacies carry it, call ahead to ensure it is available. It is most effective when taken within 72 hours (3 days) after unprotected sex but can be effective for up to 120 hours (5 days).
- Ulipristal. This pill is sold under the brand names Ella and Logilia. This is the most effective emergency contraception pill but requires a prescription. There are online services, such as Nurx or PRJKT RUBY, that provide same-day consultations and next-day delivery. It works if taken within 120 hours (5 days) after unprotected sex.
- Copper or hormonal IUD. IUDs are the most effective form of emergency contraception. They are also an effective long-term form of birth control. As emergency contraception, they are 99.5% effective if placed within 5 days after unprotected sex. They remain in place for years (generally up to 5 to10 years) and can be removed if pregnancy becomes desired.
How well does emergency contraception work?
Though IUDs are the most effective form of emergency contraception, the pills are also quite effective. About 97% to 99% of women will not become pregnant after taking the pills within the recommended time frame.
Oral contraception pills like Plan B or Ulipristal are more effective when they are taken sooner after unprotected intercourse. IUDs are equally effective at any point up to 5 days after unprotected intercourse.
An important note: Higher weights can make oral emergency contraception pills less effective. Over the counter progestin-only pills are less effective if you weigh over 165 pounds and ulipristal is less effective if you weigh over 195 pounds. In these cases, you may want to consider an IUD.
What are the risks and side effects of emergency contraception?
After taking oral emergency contraception pills, some people experience headaches, nausea, fatigue, and vaginal spotting or bleeding. These symptoms should go away within a week, though irregular bleeding can last for up to a month. These pills have no long-term side effects.
IUDs are very safe but not risk free. IUDs can very rarely perforate, or poke a hole through, the uterus. IUDs also can be uncomfortable when inserted, especially if you haven’t had children before.
How does emergency contraception work?
Using emergency contraception prevents you from getting pregnant, which is why it must be used within a few days of unprotected intercourse. It is not considered pregnancy termination or abortion. It works mainly by preventing or delaying ovulation.
Emergency contraception does not affect your ability to get pregnant in the future. If you choose to use an IUD, fertility returns within a few days of IUD removal.
Other things to keep in mind
You can buy emergency contraception pills ahead of time so they are available when you need them. You can buy the progestin-only pill at your local pharmacy or ask your doctor for a prescription for ulipristal during a health care visit.
While it is safe to take emergency contraception as many times as you need it, it is not a good substitute for effective, long-term birth control. You can talk to your primary care doctor or Ob-Gyn to find ongoing birth control that is right for you.
The following articles are great resources if you want to learn more:
- Emergency contraception — American College of Gynecologists and Obstetricians
- Emergency contraception — CDC
Relevant reading
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