- Emergency Contraceptive Choices: Plan B One-Step, Next Choice, and Ella
- 6 Things You Should Know About The Morning-After Pill, As Told By A Gyno
- 1. The morning-after pill is made of progesterone.
- 2. Take it as soon as possible.
- 3. Emergency contraception is designed for emergencies.
- 4. It is not an abortion pill.
- 5. Side effects usually only last a few days.
- 6. Follow up with your OB-GYN.
- Q: What are options for emergency contraception?
- Q: How long can you wait to take the morning-after pill?
- Q: How does the copper IUD work as an emergency contraceptive?
- Q: Can the morning-after pill make you spot?
- Q: Can the morning-after pill make your period late?
- Q: Does the morning-after pill make you sick?
- Q: Can you take the morning-after pill twice in one month?
- Answers to Frequently Asked Questions About…
- How Many Times Can You Actually Take Plan B? Asking For a Friend
Emergency Contraceptive Choices: Plan B One-Step, Next Choice, and Ella
Women who don’t want to get pregnant after having unprotected sex can use emergency contraception in the form of a medication popularly called the morning-after pill. In fact, emergency contraception can significantly decrease your chance of conception not just the morning after — if taken correctly, at least one choice can be effective for up to five days following unprotected sex.
And after years of controversy, emergency contraception pills are now available both over-the-counter and by prescription — and there are various brands to choose from, including Plan B One-Step, Next Choice and Ella.
Emergency Contraception: When to Use It
Women should consider using emergency contraception under any of the following circumstances:
- You had unprotected intercourse.
- Your partner’s condom broke or slipped off during sex.
- You missed two or more birth control pills during the first three weeks of your menstrual cycle and had unprotected sex.
- You are two or more days late starting a new birth control pill pack, vaginal ring, or patch, and had unprotected sex.
- Your diaphragm slipped out of place during sex.
- It’s been more than 13 weeks since your last Depo-Provera shot and you had unprotected sex.
Emergency Contraception: How It Works
The various morning-after pills are designed to prevent fertilization by stopping ovulation and inhibiting the movement of sperm. They also can stop a fertilized egg from attaching to the womb by altering the lining of the uterus.
Plan B One-Step and Next Choice are progestin-only morning-after pills — they contain levonorgestrel, the same synthetic form of the hormone progesterone used in birth control pills for more than 35 years. Taken orally and with food as soon as possible, these morning-after pills give the body an intense hormonal burst that disrupts pregnancy. Plan B One-Step is a single pill option; Next Choice requires taking two pills 12 hours apart.
Ella’s active ingredient is UPA, or ulipristal acetate, a drug that interferes with the function of progesterone and can delay or prevent ovulation. Ulipristal is available by prescription only, but it may be worth the call to your doctor to get it — some researchers have found that it is more effective than progestin-only pills in preventing pregnancy. Doctors recommend using ulipristal only once during a menstrual cycle, since the effects of repeated use are not yet known. Women also are encouraged to use condoms or other non-hormonal forms of birth control after taking the drug, since it might decrease the effectiveness of birth control pills.
Keep in mind that emergency contraception does not cause a miscarriage. If a fertilized egg successfully attaches to your womb before you take one of these drugs, the pregnancy will not be affected.
Emergency Contraception: Effectiveness
Success rates vary by drug and how soon after sex you take it. The progestin-only drugs can reduce the risk of pregnancy by 95 percent if taken within the first 24 hours after unprotected sex. The chances of avoiding pregnancy decrease to 61 percent when you take the medication between 48 hours and 72 hours after unprotected sex. Some research has found that Plan B One-Step still provides some protection against pregnancy as much as 120 hours after unprotected sex, but only Ella’s effectiveness is steady for that entire five-day timeframe.
Emergency Contraception: Side Effects
Nausea is the most common side effect of emergency contraception, yet in the case of Ella less than 10 percent of women are bothered by it. If you’re concerned about nausea, eat small and frequent meals for a day or so after taking the morning-after pill.
Other possible side effects include:
- Abdominal pain or cramps
- Breast tenderness
These should fade within a couple of days after taking the morning-after pill.
Emergency contraception drugs can cause changes in your menstrual cycle. Some women have spotting for a few days afterwards. Plan B One-Step can delay ovulation, so your risk of pregnancy could be elevated in the days following treatment. Be sure to use effective contraception for the rest of the menstrual cycle.
Also, your next period may start a few days early or late after you’ve taken any emergency contraception pill, and there may be some change in the volume of your menstrual flow. If you visit your doctor for any reason during the cycle in which you took a morning-after pill, let him know that you’ve used emergency contraception. Also, if your next period is a week or more late, call your ob-gyn because you may be pregnant.
Emergency Contraception: Availability and History
Any woman 17 or older can buy Plan B One-Step or Next Choice as an over-the-counter medicine. Girls younger than 17 will need a prescription.
The U.S. Food and Drug Administration (FDA) first approved the original version of Plan B One-Step, called Plan B, as a prescription drug for all women in May 1999, and it involved taking two pills. The manufacturer’s decision to have Plan B approved as an over-the-counter medication met with controversy.
The FDA rejected the over-the-counter application in May 2004, even though its advisory committee had voted 23 to 4 in favor of making Plan B more easily available. The decision unleashed a firestorm of criticism, with women’s groups accusing the Bush Administration of playing politics with a medical judgment. Later, a Government Accountability Office inquiry found that the decision had gotten entangled in pro-life politics, with some religious groups arguing that Plan B was a form of abortion.
The company that makes Plan B repeatedly amended its over-the-counter application at the FDA’s behest, placing a minimum age of 16 on availability and then raising the minimum age from 16 to 17, and then from 17 to 18.
On August 24, 2006, the FDA approved making Plan B available to adults as an over-the-counter medication to be used as emergency contraception and not for everyday use. Then, in July 2009, it approved Plan B One-Step, the single pill version.
Emergency Contraception: Another Option
Although not as widely used as the morning-after pill, an IUD or intrauterine device is another emergency contraception choice. If inserted by your doctor within 7 days of unprotected sex, it may actually be more effective than morning-after pills in preventing unwanted pregnancy — and it serves as long-term birth control in the process.
If you are interested in knowing more about any of these forms of emergency contraception, talk to your doctor or ob-gyn before you actually need to use one.
6 Things You Should Know About The Morning-After Pill, As Told By A Gyno
You stand there. You feel timid. You’re either staring at the drug store floor or texting fervently in an effort to avoid eye contact with the pharmacist. You lift up the box and place it on the counter.
All of a sudden, you feel like you’re in an ’80s sitcom. Your mother is dressed as an angel, sitting on your right shoulder and judging you.
“What are you doing?” she asks.
A mini you stands on your left shoulder. She’s dressed in a tight dress, and is wearing 6-inch Louboutins. She has devil horns, a pitchfork and a ridiculous amount of cleavage.
She’s shouting, “Don’t worry, girl. It was worth it.”
Buying emergency contraception can be one of the most embarrassing experiences for a woman, especially for a single woman. No matter how old you are, there is something embarrassing about publicly admitting you have sex. Having a complete stranger acknowledge that fact (while exchanging currency) can ignite a spiral of shame.
It is similar to the feeling a woman experiences when she buys condoms. But this is 10 times worse, since this purchase occurs after the fact.
As an OB-GYN, I can attest that emergency contraceptive use is extremely underreported and rarely discussed with a physician. Even still, it is highly used. Last week, I went into my local CVS in Los Angeles, near UCLA. There were no Plan B boxes on the shelf; the store was sold out.
So, I must ask: If it’s clearly so frequently used, why do we never discuss it? My patients rarely ask about emergency contraception, even though I’m sure there are many questions and concerns about its use.
Here are a few facts about emergency contraception, also known as the morning-after pill:
1. The morning-after pill is made of progesterone.
This is one of the hormones found in birth control pills. But, it’s in a much higher dose in the morning-after pill. The progestin-only pills are available as a single pill (Plan B One-Step) or two pills that have to be taken 12 to 24 hours apart (Plan B and Next Choice).
2. Take it as soon as possible.
You should take the morning-after pill as soon as possible after unprotected sex. It can be protective for up to five days after intercourse. However, it is recommended that it be taken within 72 hours. If you can, don’t even wait that long.
The morning-after pill is about 75 percent effective for preventing pregnancy, but its effectiveness decreases with time. So, as much as you want to first go to brunch with your BFF and drown your guilt and anxiety in a bucket of cheese fries, go straight to the pharmacy.
3. Emergency contraception is designed for emergencies.
That’s why it has such a name. As it will fail one out of eight times, it’s not an effective form of primary birth control.
4. It is not an abortion pill.
There is this awful misconception that Plan B is an abortifactant. Some people believe the pill interrupts already-existing pregnancies. This is completely false.
It works mainly by preventing ovulation, in the same way birth control pills work. It will not work if you happen to already be pregnant, and it will not affect a pregnancy that has already started.
So, please don’t add the “Am I having an abortion?” question to your already anxiety-ridden mind. You are not.
5. Side effects usually only last a few days.
The most common side effects include abdominal pain, nausea, breast tenderness, dizziness and fatigue. I can also personally attest to the additional side effects of increased hunger and emotional liability. (Although, I’m not positive that this effect isn’t just the anxiety associated with taking emergency contraception. Or maybe, I’m just always ready for an excuse to eat a bunch of chocolate.)
Another side effect is spotting. You should expect your period to be off that month. In fact, many times, you won’t get your period that month at all.
Of course, you should take a pregnancy test just in case the morning-after pill doesn’t work. Just know that if the test is negative, you will probably miss your period.
6. Follow up with your OB-GYN.
If you’re using emergency contraception because you’ve had unprotected sex, make a follow-up appointment with your OB-GYN within the week for STD testing.
Overall, it is important to know that it is normal to have sex, even if you don’t have a ring on your finger. If you’re going to have sex, it is crucial you be smart and cautious enough to protect yourself from an STD or unwanted pregnancy.
Don’t be embarrassed. Brush your shoulders off and purchase that pill with confidence.
You probably think of emergency contraception as the “morning-after pill,” but that’s actually a bit of a misnomer. There are different kinds of emergency contraception that a woman can use as many as five days after unprotected sex, and some of them aren’t actually pills.
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Ob/Gyns don’t recommend using emergency contraception as a primary form of birth control, but in an unexpected or emergency situation, there are options.
Ob/Gyn Diedre McIntosh, MD, addresses some common and important questions.
Q: What are options for emergency contraception?
A: There are currently four available methods:
- Levonorgestrel (Plan B One-Step ® and generics). These pills contain a synthetic hormone called progestin and are available over-the-counter. They prevent pregnancy by delaying the release of the egg from the ovary to prevent fertilization. They will not work if you are already pregnant.
- Ulipristal acetate (ella®). This medication also suppresses or delays ovulation but is only available by prescription. It will not work if you are already pregnant.
- Copper-releasing IUD. Once it’s placed in the uterus by a healthcare professional, it offers additional pregnancy protection for as long as you keep it in, up to 10 years.
- Yuzpe regimen. This method calls for a woman to take multiple birth control pills that total 100 mcg of estrogen and 1 mg of progesterone twice in a 12-hour period. It is the least effective method of emergency contraceptive, and will not work if you are already pregnant.
Q: How long can you wait to take the morning-after pill?
A: It’s ideal to take Plan B One-Step® within 72 hours (that’s three days) of having unprotected sex. You can take it up to five days after, but there’s a higher failure rate the longer you wait. Ella® can be taken up to five days later without a drop-off in effectiveness.
The copper IUD can also be placed up to seven days later. The Yuzpe method is best used within three days of unprotected sex.
Q: How does the copper IUD work as an emergency contraceptive?
A: It’s the most effective form of emergency contraceptive. It causes an inflammatory reaction in the uterus, so it creates an unfavorable environment for sperm and for implantation to occur.
The one big difference with the IUD is that it could disrupt a good pregnancy. If a woman is considering a copper IUD and has had abnormal periods, she should make sure to do a pregnancy test first.
Q: Can the morning-after pill make you spot?
A: Yes. Emergency contraceptive pills tends to delay ovulation, so you might have a delay in your regular menstrual cycle and have irregular bleeding for that first month afterward.
Q: Can the morning-after pill make your period late?
A: Yes, you might find that your period is pushed back one or two days.
Q: Does the morning-after pill make you sick?
A: It can make people nauseous, but most people tolerate it pretty well. If you vomit within an hour of taking it, contact a healthcare professional.
Q: Can you take the morning-after pill twice in one month?
A: You can take it more than once a month, but we do not recommend using it as a main form of birth control – not only because of the cost but because you will have irregular cycles.
Additionally, with the pills there’s a higher failure rate the greater your BMI. So for women with a BMI over 30, those medications will be less likely to be effective.
Your Ob/Gyn can help you find the most appropriate contraceptive option for you.
Answers to Frequently Asked Questions About…
How long do I have after sex to take emergency contraceptive pills?
If you have sex without using other contraception, your regular birth control fails, or you are made to have sex against your will, take action right away to learn what your options are. Even though emergency contraception is often called the “morning after pill” or “day after pill,” it may be effective for up to 5 days (120 hours) after unprotected sex.
In the United States, there are two different kinds of emergency contraceptive pills available: ulipristal acetate (ella) and progestin-only (like Plan B One-Step, Next Choice One Dose, My Way).
ella is a prescription-only product. It is more effective than progestin-only EC, particularly on the 5th day after sex. ella is more likely to work when taken closer to ovulation than progestin-only pills; this is important because women have the highest chance of getting pregnant, and are most likely to be having sex, immediately before the egg is released. In clinical studies, the effectiveness of ella did not decline over a 5-day period; however, what’s important for each individual woman is where is you are in your menstrual cycle (how close you are to ovulation). If you are close to ovulation, EC may not be able to prevent pregnancy if you wait 5 days. Therefore, the best thing to do is take EC as soon as you can get it.
Progestin-only EC (like Plan B One-Step and My Way) is now available directly on the shelf (check the family planning aisle) for women and men of any age – you don’t need to show ID. Studies show that progestin-only EC may be effective only through 4 or 5 days after sex.
for more detailed instructions for using daily birth control pills as emergency contraception.
Another excellent option for emergency contraception is the copper IUD (sold in the United States as ParaGard). The copper IUD can be inserted up to 5 days after unprotected sex, and is 99.9% effective at preventing pregnancy after sex. It can be left in place for up to 10 years of highly effective ongoing contraception. You’ll need to have an IUD inserted by a trained healthcare provider, so call your provider right away if you’d like to get an IUD for EC.
A thorough and up-to-date academic review of the medical and social science literature on emergency contraception, including research showing that emergency contraceptive pills can be used up to 120 hours after sex, is available in English and Spanish.
To find health care providers, including pharmacists, who offer emergency contraception in your area, .
How Many Times Can You Actually Take Plan B? Asking For a Friend
When your regular form of birth control fails—whether it’s a broken condom or missed oral contraceptive—taking the morning-after pill as soon as possible can help prevent an unplanned pregnancy. While it’s perfectly safe to take the morning-after pill, should you be concerned if you’ve taken it more than once, or even countless times? And could it affect your ability to get pregnant in the future? We asked experts to weigh in.
The most common morning-after pills are over-the-counter tablets containing higher doses of levonorgestrel, a synthetic progestin hormone that is also in oral contraceptives. These pills work by preventing the ovary from releasing an egg, which in turn means you don’t ovulate, lowering the risk of male sperm fertilizing an egg. You might know them by their brand names, such as Next Choice One Dose, Take Action, My Way, or the most well-known, Plan B One Step.
Important disclaimer: Although morning-after pills aren’t 100% effective at preventing a pregnancy, they can reduce the risk by 75-89%, according to Planned Parenthood. If you have unprotected sex, you should take Plan B as soon as possible; they work best within the first three days after sex.
While the morning-after pill won’t have harmful long-term effects on your body, taking it multiple times can turn your hormones upside-down, says Sherry A. Ross, MD, a Los Angeles-based ob-gyn and author of She-ology ($26; amazon.com). “It’s temporarily harmful in that you will have irregular bleeding and may feel emotionally unraveled,” she tells Health.”But once you stop taking it, your body will have the opportunity to reset.”
Orlando-based ob-gyn Christine Greves, MD, a fellow of the American Association of Obstetrics and Gynecology, agrees with Dr. Ross. You might experience unpleasant side effects after taking Plan B, she explains, including nausea and lower abdominal cramps in addition to irregular bleeding. But she stresses that these are short-term effects.
Although taken less often, Ella, another type of morning-after pill available with a prescription, also won’t have long-term effects on your health, says Dr. Greves. But she does note that you shouldn’t take other forms of birth control pills that contain progesterone for at at least five days after using Ella, because it could interfere with the pill’s effectiveness.
However, if you’ve taken the morning-after pill for the umpteenth time, you might want to speak to your gynecologist about alternate contraceptive options, says Bat-Sheva Lerner Maslow, MD, a reproductive endocrinologist at Extend Fertility, pointing out that it’s better to have a reliable form of contraception than constantly turning to emergency ones. If you struggle to remember to take birth control pills, for example, long-term contraception such as an intrauterine device (IUD) can make forgetfulness a non-issue. A copper IUD, for example, “is more than 99.9% effective at preventing pregnancy, and can be kept in for up to 10 years.”
So, say you had unprotected sex and took the morning-after pill. Would that same pill prevent pregnancy if you then had unprotected sex again a few days after taking it? (Hey, accidents happen.) To play it safe, it’s best to take Plan B after every unprotected sexual encounter, experts say.
“In theory, it should cover you until your next period because of the changes it causes in the uterine lining,” says Dr. Maslow, “but I wouldn’t necessarily recommend relying on it as a proactive form of birth control.”
And can taking Plan B make it difficult to get pregnant when you do want to down the road? Fortunately, all experts we polled were in agreement on this: The morning-after pill won’t have any long-term affects on your future fertility. Phew!