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Notes on Women's Health
Notes on Women's Health

A primer on emergency contraception pills

Thoughtful woman sitting on floor using laptop in living roomYou’ve heard about emergency contraception pills but do you really understand exactly what they do?

First, the simplest way we describe these pills to our patients is to call them emergency contraception that prevents pregnancy after unprotected sex. They are not traditional birth control. And they do not cause abortion because they work before a pregnancy occurs.

According to the American College of Obstetricians and Gynecologists, fertilization, the union of an egg and a sperm, occurs in the fallopian tube. During the next few days the fused egg and sperm move through the fallopian tube to the lining of the uterus, where it implants as a cluster of cells that will become the fetus and placenta. Emergency contraception pills do not work at this point.

Are all emergency contraception pills the same?

The only pills approved by the Food and Drug Administration either contain levonorgestrel (Plan B One-Step or Next Choice) or ulipristal (Ella). Plan B One-Step is an over-the-counter drug that needs no prescription or proof of age for purchase. Next Choice is available over-the-counter but women must prove they are 17 to buy the drug. Ella is only available by prescription.

When do I take an emergency contraception pill?

The sooner you take an emergency contraception pill after unprotected sex, the greater its effectiveness.

  • Plan B One-Step should be taken as soon as possible but always within 72 after unprotected sex. You take only one pill.
  • The first Next Choice pill should be taken as soon as possible but always within 72 hours after unprotected sex. The second pill is taken 12 hours after the first pill.
  • Ella is another one-dose pill, taken as soon as possible but always within 120 hours after unprotected sex.

If you take an emergency contraception pill within 24 hours, it is about 95 percent effective. If you wait 72 hours, the risk of pregnancy is reduced to 89 percent.

Bottom line: No matter how soon you take an emergency contraceptive pill after unprotected sex, it is not as effective as regular contraception. Additionally, you are not protected from sexually transmitted diseases. We tell our patients to view these pills as the Plan B One-Step name implies: As a backup plan, not something to regularly use.

What does the emergency contraception pill do?

It depends on where you are in your menstrual cycle, but an emergency contraception pill will prevent or delay ovulation; interfere with the fertilization of an egg; or keep a fertilized egg from implanting in the uterus. According to the Mayo Clinic, recent evidence suggests the levonorgestrel pills do no inhibit implantation. It is unclear if Ella does.

How does an emergency contraception pill differ from RU-486?

The RU-486 pill is an abortion pill that ends an established pregnancy – where the fertilized egg has attached to the uterine wall and has begun to develop. An emergency contraception pill does not cause an abortion or miscarriage. Once the fertilized egg implants in the uterus, an emergency contraception pill will not stop the development of the fetus.

Should I check with you before taking an emergency contraception pill?

You should absolutely check (link to http://www.garofaloobgyn.com/contact.html) with us first, because you may be allergic or hypersensitive to some of the ingredients in the pill. We also know your history and can advise you about whether this pill is for you and what pill you should take.

Why would I take an emergency contraception pill?

  • You had unprotected sex;
  • You were raped;
  • You were not using birth control;
  • Your birth control failed, for example, your diaphragm slipped, the condom fell off or broke or you missed taking a few birth control pills in a row.

Does an emergency contraception pill work for everyone?

Plan B One-Step and Next Choice are less effective for women with a Body Mass Index (BMI) greater than 25, and may not work for women with a BMI over 30. Ella is less effective for women with a BMI of 35 or greater.

In addition, the effectiveness of emergency contraception pills decrease if you are taking barbiturates or St. John’s wort.

Plan B One-Step and Next Choice can be taken while breastfeeding, while Ella should not be taken. In addition, never take Ella if you think you are pregnant since its effects on a developing baby are unknown. If you are pregnant, Plan B One-Step or Next Choice will not harm the developing baby.

Are there any side effects to these pills?

There can be, including:

  • Nausea or vomiting
  • Headache
  • Fatigue
  • Dizziness
  • Tenderness in the breast
  • Bleeding between periods or heavier menstrual bleeding
  • Diarrhea
  • Lower abdominal pain or cramps.

If you have any questions about emergency contraception, or would like to discuss whether these pills are right for you, please don’t hesitate to give us a call at 203.855.3535.