Emergency Contraception FAQ: Your Top Questions, Answered

If you’ve been here before, you’re not alone. You’ve just finished having super-hotsex and while you’re lying in bed basking in the afterglow and feeling pretty awesome, your partner suddenly utters those three little words: Where’s the condom?

And just like that, a night of carefree and connected fun turns into a search and recovery mission. Buzz. Instantly. Killed. Okay, you’ve got this.

You sit up, flex your fingers, and go in. A few seconds later, after groping unsuccessfully in the dark for the rubber that went rogue, your panic-stricken mind begins to consider the possibility that your vagina might’ve actually swallowed the condom whole. I mean, seriously, where exactly can it hide in there? But then you strike ‘gold’. When it comes out, you feel the same way the condom looks: empty and deflated. To make matters worse, you’re pretty sure you’re ovulating and you’re DEFINITELY sure you don’t want to be a mom in forty weeks. So, now what? Take a deep breath and try to relax. Because when plan A fails, there’s always a plan B: emergency contraception.

What is it? Where do I get it? Do I need a prescription? How does it work? Any side effects?

If you’ve got questions, we’ve got you covered. Keep on reading to learn everything you want to know (and some things you don’t even know you want to know) about a special kind of contraception that can really come in handy when your regular form of contraception ‘slips up’ during sex.

What is emergency contraception?

Emergency contraception (EC), also known as “the morning-after pill”, is a type of birth control that can be used to prevent pregnancy if you’ve had unprotected vaginal sex anytime in the last five days, if you used your regular method of birth control incorrectly or if your birth control method has failed (condom breaks, birth control skin patch comes off, forgot to take birth control pills two or more days in a row). The “morning-after pill” is a bit of a misnomer since you don’t actually have to take it the morning after for it to work. But there is a short window of time during which EC is effective and, as a general rule, it works best when you use it as soon as possible after having unprotected sex or experiencing a birth control failure.

A few other points are worth mentioning here. EC is intended for backup contraception only and is not meant to be a primary method of birth control. Also, EC is not the same thing as mifepristone (Mifeprex) aka the abortion pill. ECdoesn’t end a pregnancy that has started. Instead, EC works by delaying or preventing ovulation (release of the egg from the ovary) or by preventing an egg from being fertilized by a sperm. Oh, and if you’re already pregnant, EC won’t stop or do any harm to your pregnancy.

So far, so good?

There are two types of EC: pills and intrauterine devices (IUDs). Simple, right? Well, not exactly, because there are three kinds of EC pills – ulipristal (ella), levonorgestrel (Plan B One-Step), and combined birth control pills – and two types of IUDs.

Types of emergency contraception pills

Ulipristal (ella)

This non-hormone medication works on progesterone to delay or prevent ovulation. It can be taken up to five days after unprotected sex without a decrease in efficacy. And when taken as directed, ulipristal is more effective for preventing pregnancy than levonorgestrel (Plan B One-Step) or combined birth control. Ulipristal is available by prescription only.

Levonorgestrel (Plan B One-Step)

This progestin-only pill is a synthetic hormone that works in the same way: by delaying or preventing ovulation. It can be taken up to three days after unprotected sex, but can be effective if taken within five days. This pill is available over-the-counter without a prescription to anyone of any age and can be found at drug stores, grocery store pharmacies, and Planned Parenthood.

Combined birth control pills

These pills contain a combination of estrogen and progestin, and when taken in higher-than-usual amounts, this medication can be used for EC as well. Combined birth control pills should be taken as soon as possible after having unprotected sex but can be effective up to five days later. Like progestin-only therapy, birth control pills require a prescription. Combined birth control pills are the least effective form of EC and should always be considered a method of last resort.

Types of intrauterine devices (IUDs)

Copper IUD

The most effective form of EC, a copper IUD works by making sperm less able to fertilize an egg. When being used as EC, a copper IUD should be inserted within five days of unprotected sex. After that, you can rely on your IUD for long-term birth control and have it removed if and when you want to become pregnant. Inserting a copper IUD is an in-office procedure that requires a medical professional, usually an OB-GYN.

Levonorgestrel IUD (Mirena)

While copper IUDs have been the gold standard of EC for many years, recent evidence suggests IUDs that release progestin are also highly effective. These IUDs also need to be inserted within five days of unprotected sex by a medical professional to be effective but can serve as long-term birth control for years to come.

One important side note: Being overweight or obese can decrease the effectiveness of EC pills, so if your BMI is 30 or above, a copper or levonorgestrel IUD is likely the safest option since it works equally well in people at any weight.

Frequently asked questions about emergency contraception

How effective is emergency contraception?

• IUDs are the most effective form of EC and prevent more than 99% of pregnancies when inserted within five days of unprotected sex. IUDs are particularly good if you are looking for a long-term birth control method and if you have a BMI of 30 or above.
• After taking Ulipristal (ella), the risk of pregnancy is around 1%.
• If you take Levonorgestrel (Plan B One-Step), according to the American Academy of Family Physicians, your chances of becoming pregnant are approximately 4%.
• Taking a combination of birth control pills will lower your risk of pregnancy, but this medication is far less effective than other methods.

How soon after unprotected sex do you need to take EC?

• Ulipristal (ella) needs to be taken within five days (120 hours) after unprotected sex.
• Levonorgestrel (Plan B One-Step) should be taken within three days (72 hours) after unprotected sex but can be effective for up to five days.
• Combined birth control pills need to be taken as soon as possible after unprotected sex but can be effective for up to five days.
• IUDs should be inserted within five days (120 hours) after unprotected sex.

Can Plan B make your period late?

Maybe. After taking any EC pill, your next period may come sooner or later than normal. Most people will get their periods within a week of the expected date, but it might be heavier, lighter, more, or less painful than normal. You also might experience spotting (light bleeding) during the weeks following administration, which is harmless and will clear up on its own. If you don’t get your period within a week of its expected date, you should definitely take a pregnancy test.

Does Plan B affect fertility?

EC pills delay or prevent ovulation, but they don’t have any impact on fertility.

Are there any side effects to taking EC?

• EC pills don’t have any serious side effects, however your next period might be irregular and spotting can occur over the following month. Nausea and vomiting are the most common side effects, but this is more likely to happen with birth control pills rather than ulipristal or levonorgestrel. Other unlikely side effects include: headache, breast tenderness, abdominal pain, dizziness, and fatigue.
• IUDs can cause cramping and spotting for a few days following insertion, but these symptoms are usually mild and go away on their own.

Do I need to see a doctor after taking EC?

Normally, you don’t need to contact your provider after taking EC pills. However, if you experience bleeding or spotting that lasts longer than a week or develop severe abdominal pain, it’s a good idea to make an appointment as these can be symptoms of a miscarriage or ectopic pregnancy. Also, you should take a pregnancy test if you haven’t had a period within a week of your expected date.

Can emergency contraception be used multiple times in a month?

Yes. EC pills can be used more than once during a single menstrual cycle, but you shouldn’t rely on EC pills as a long-term birth control method with the exception of IUDs.

Be prepared, even in an emergency

So, there it is. Pretty much everything you need to know about EC. To review: If you have unprotected sex, use birth control incorrectly or experience a contraceptive fail, you have around five days to take some form of emergency contraception to prevent ovulation and pregnancy. EC pills are safe and effective, but they aren’t a guarantee and aren’t meant to replace regular birth control methods. IUDs are even more effective (and offer long-term birth control), but they require an in-office procedure for insertion. EC won’t affect fertility, but it might make your next period irregular. And remember: You can still get pregnant if you have sex after taking EC pills, so you’ll still need another form of birth control if you get busy before your next period. Oh, and while EC can prevent pregnancy, it can’t protect you from an STI…so use a condom and make sure your partner knows how to put it on correctly and keep it on. Because nothing kills the mood like an unexpected game of hide and seek with a Trojan in the dark.

If you’re interested in getting on birth control, switching birth control or learning more about your contraception options, sign up for Tia’s membership and book an appointment.