Emergency contraception: How it works, how effective it is and how to get it

With abortion banned or severely restricted in many states, reproductive health experts believe it is important that both patients and providers know what options are available when it comes to emergency contraception. For many people, it is a final safety net against unintended pregnancy.

Many advocates suggest that women and anyone who may become pregnant have emergency contraception on hand before they need it. “It’s going to be very, very important for people living in states where it’s the last chance they have and they really need to prevent pregnancy,” says Cynthia Harper, a contraceptive researcher and professor of obstetrics, gynecology and Reproductive Sciences at the University of California, San Francisco.

But some emergency contraception options work better for some people, and some options are more readily available than others. Here’s what you need to know.

What is emergency contraception and how does it differ from the abortion pill?

The term refers to contraceptives used after intercourse to prevent an unintended pregnancy. You may need it if you have had unprotected sex, or if the condom has broken or you may have forgotten to take a few contraceptive pills.

It is not the same thing as a medication abortion or abortion pills, although it is a common misconception, says dr. Suzan Goodman, director of training for the University of California’s Bixby Center’s Beyond the Pill program, which aims to promote access and equity in contraceptive health care. .

Emergency contraception prevents a pregnancy from occurring in the first place, she explains, while a medication abortion is used to terminate a pregnancy that has already occurred.

Emergency contraception, “is not harmful to a developing pregnancy,” Goodman says. “Language that confuses emergency contraception with abortion is often used to restrict access,” she says. “But abortion pills work in many different ways by disrupting and expelling an implanted pregnancy.

What are the four types of emergency contraception?

Most people who have heard of emergency contraception probably think of the morning-after pill. But there are actually four different types of emergency contraception available – two are pills and two are intrauterine devices, or IUDs.

Plan B or other levonorgestrel pills: The most commonly available form of emergency contraception is over-the-counter pills containing levonorgestrel, perhaps best known under the Plan B brand name, although it is also sold under other brand names, including Aftera, My Way, Take Action and others. It is a single dose pill, with no age restrictions and no prescription required. It works best within 72 hours after unprotected intercourse.

Ella: The second type of emergency contraceptive pill is ulipristal acetate, which is sold under the brand name Ella in the USA. It is a single dose pill that requires a prescription. Research shows that Ella remains effective throughout the five-day window after intercourse, Goodman says, unlike levonorgestrel which shows a decrease in efficacy after day three. It is also more effective for patients weighing more than 165 pounds.

Copper and hormonal IUDs: The most effective form of emergency contraception in general is IUDs that must be inserted by a medical provider within five days of intercourse to prevent pregnancy. (They are also the most effective form of primary contraception.) Both copper and hormonal IUDs can be used.

The copper IUD is “almost 100% effective as an emergency contraceptive,” says UCSF’s Harper. She says more recent evidence shows that hormonal IUDs – sold under the names Mirena or Liletta – are also effective.

Getting an IUD for emergency contraception has a big added benefit, says Dr. Alison Edelman, a professor of obstetrics and gynecology at Oregon Health and Science University. Once you have it in place, you have continuous effective contraception. IUDs are effective for three to 12 years, depending on which one you get.

Where can you buy emergency contraception?

Even though levonorgestrel pills like Plan B are over the counter and are supposed to be stored on store shelves, studies have found that in practice they are often stored in closed display boxes or behind the counter, so you may need to ask the pharmacist for they. You can also order it online, though you will have to wait for them to be delivered, which means it may be a better option if you are looking for stock to have it on hand in case.

As for Ella, you need a prescription to get it. Studies have found that Ella is very rarely in stock in pharmacies – they usually have to order it. Therefore, many reproductive health experts recommend that physicians prescribe patients in advance. Companies like Nurx, SimpleHealth and PRJKT RUBY offer telemedicine appointments for women who need a prescription for Ella.

“We really want to encourage patients and also healthcare providers to have this conversation all the time to make sure people have emergency contraception on hand when they need it,” said Kelly Cleland, executive director of the American Society for Emergency Contraception.

Ulipristal acetate, sold under the brand name Ella in the USA, is a single dose pill that requires a prescription.  Research shows that Ella is effective during the five-day period after intercourse.

Ulipristal acetate, sold under the brand name Ella in the USA, is a single dose pill that requires a prescription. Research shows that Ella is effective during the five-day period after intercourse.

How does emergency contraception work?

Both the pill options, Plan B and Ella, work by delaying ovulation so that an ovum is not released until sperm are no longer viable. IUDs work primarily by preventing fertilization, so even when the egg is released, it never combines with the sperm.

When used as an emergency contraception, Edelman says that copper IUDs release copper ions that are toxic to sperm, creating a kind of “hostile environment” that prevents them from reaching or fertilizing the eggs. She says there is less evidence about the exact mechanisms that work with hormonal IUDs, but it probably disrupts how eggs and sperm are transported in the body so they do not meet.

Edelman notes that because there is still some uncertainty about how hormonal IUDs work as emergency contraception, that if you are at the greatest risk of getting pregnant because you are in the middle of your cycle, you may want to use one of the pill forms of contraception at the same time that you get your hormonal IUD.

How fast after sex should you use these methods?

If you use pills, the sooner the better. “Most people really do not know where they are within the cycle. They do not know if ovulation is tomorrow or the next day or tonight,” says Cleland of the American Society for Emergency Contraception. This means that you can miss the window to prevent ovulation if you delay taking the pills, and can get pregnant anyway.

For the IUD, it is also important to place it within the five-day window after unprotected sex.

Are some forms of emergency contraception more effective for overweight people?

Yes. Evidence suggests that levonorgestrel pills such as Plan B do not work as well in patients weighing more than 165 pounds. For them, Ella is a better choice – it works well in people up to 195 pounds. Of course, Ella needs a prescription, which can be a barrier to entry because the clock is ticking for this medication to work. For those weighing more than 195 pounds, IUDs are the most effective choice.

If you cannot get Ella or an IUD fast enough, another option may be to take a double dose of Plan B. Edelman, who has studied the link between weight and emergency contraception, says there is no clear evidence that double dosing works, but it is not dangerous. “If it was me and I urgently needed [emergency contraception]I will take a single or a double dose instead of doing nothing, “she says.

Edelman says there are also places like family planning clinics, Planned Parenthoods or university health centers where women may be able to get IUD placements as emergency contraception on the same day.

A copper IUD is almost 100% effective as a form of emergency contraception.

Adek Berry


AFP via Getty Images

A copper IUD is almost 100% effective as a form of emergency contraception.

How much does emergency contraception cost and does insurance cover it?

Federal law requires that most insurance plans cover prescription contraceptives, including IUDs, without sharing costs for the patient, although there are a few exceptions.

Plan B and its generic drugs are generally not covered by insurance because they are over-the-counter medicines. They usually sell for around $ 40- $ 50. You may also get them at a discount or for free at Planned Parenthood. You can often find levonorgestrel pills much cheaper online if you pre-order to have them on hand. Another idea: If your doctor prescribes a Plan B prescription for you, insurance will cover it.

Ella costs about $ 50 or more at the pharmacy, but it can be covered if you have health insurance or Medicaid. You need to get a prescription from a healthcare provider.

IUDs must be inserted by a trained technician and the procedure and device must be covered by insurance. If you have to pay for an IUD out of pocket, it’s about $ 1000 or more.

Is emergency contraception legal in places where abortion is prohibited?

Yes, although advocates of reproductive health are concerned that lawmakers in conservative states banning abortion will target next forms of emergency contraception. This is because the language on the label says that levonorgestrel can interfere with the implantation of an already fertilized egg. It was based on old science, says Cleland; a collection of evidence now shows that the drug works by stopping ovulation, and reproductive health experts are appealing to the Food and Drug Administration to change this label. “We need to ensure that these product labels are in line with the scientific evidence,” says Cleland.

Can emergency contraception fail?

Yes. Contraceptive pills work by delaying ovulation, but if you have already started ovulating before taking it, it may be too late to prevent a pregnancy. It can also fail if you continue to have unprotected sex in the same month – after the emergency pill’s effect wears off, you can still ovulate again if you are not on an effective form of primary birth control, warns Edelman. That’s why it might be a good idea to get an IUD immediately after unprotected sex, even if you did take pills, she says: “We know that getting birth control right on board helps get pregnant in that cycle. to prevent. ”

Is there an age limit to get emergency contraception?

No. There were once age restrictions on the pills, but they were all removed, Cleland says. For IUDs, there may be state laws that require parental consent for minors.

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