Medically reviewed by Sophia Yen, MD, MPH – Written by Pandia Health Editorial Team
70% of people with uteri between the ages of 15 and 44 are at risk of unintended pregnancy. Because the average childbearing person only has 2 children in their life, she will have to spend almost 30 years of her life preventing pregnancy.
When you have difficulties taking or accessing birth control (e.g. you miss 3 days of the birth control pill, patch, or ring in a row, or not getting a Depo-Provera shot on time or the condom breaks), emergency contraception (EC) can come to the rescue by preventing an egg from being released and/or fertilized, and implanted in the uterus.
Pandia Health can prescribe emergency contraceptive pills! If you’re signing up to get your birth control prescribed by our expert birth control doctors, we’ll throw in a prescription for Ella or Plan B generic so you’re ready in case of a contraceptive emergency
How long out can emergency contraception be used?
The “morning after pill” is a misnomer because it can be used for up to 5 days after a contraceptive failure or sexual assault. However, Pandia Health’s expert doctors recommended that you take EC pills ASAP because these pills do not work as well after ovulation occurs (when the egg comes out).
When should I use emergency contraception?
- The condom broke during sex four days ago
- I forgot the last three days of oral contraceptive pills in a row and had sex today
- I went to the bathroom after sex and my NuvaRing® fell out into the toilet, and I couldn’t get another NuvaRing for thre days.
- I just realized I forgot to get my Depo-Provera shot and had sex last night
- I was date-raped four days ago
- TLDR: if you had a contraceptive accident within the past 5 days.
What can you do if…
- You are worried that your birth control method has failed
- You didn’t use contraception
- You were forced to have sex against your will
If any of those situations happen, people with uteri still have options to prevent pregnancy. There are four types of EC, and they all prevent ovulation, fertilization, and implantation. Here they are from MOST to LEAST effective:
#1a Copper IUD
The copper IUD is 99.99% effective as an EC method. It requires a visit to a doctor’s office or Emergency Room as well as a doctor/nurse practitioner to put it in. The good news is that you can then use the copper IUD for long term contraception for up to 10-12 years after.
Know the 2 major side effects of the copper IUD as a long term contraception are more bleeding with periods and more cramps. If your Body Mass Index (BMI) is greater than 35, the copper IUD is the only EC option that works. For BMIs 35 or greater, the pill EC options do NOT work.
#1b Hormonal IUD (Liletta or Mirena)
The hormonal IUD can also be used for EC and also works for any BMI. As EC, the hormonal IUD has a 1/317 pregnancy rate = 3/1000 = 0.3%.
#2 Ella® = ulipristal acetate = a Prescription pill that is MORE effective than the over-the-counter pill.
The second most effective EC is Ella® or ulipristal acetate. It is more effective at preventing pregnancy at every time point than Plan B® and its generics. Under the Affordable Care Act, it should be available under most insurances for “free” (i.e. no copay, no deductible).
You must get a doctor’s prescription for this one. Hint: All customers of Pandia Health’s telemedicine service are offered a prescription for EC at NO extra charge so you are covered in case of an emergency!
#3 Plan B® and its generics a.k.a. Levonorgestrel, the over-the-counter emergency contraception pill
The third most effective EC is Plan B® and its generics which can be purchased over-the-counter at most pharmacies, drug stores, or health clinics. The person buying does not have to prove their age nor show I.D. to buy levonorgestrel emergency contraceptives over-the-counter. However, if your BMI is 26 or greater, Plan B and its generics are NOT effective. For this reason, ella is the preferred emergency contraception pill.
#4 Yuzpe Method
Lastly, there’s the Yuzpe method. You need to get 100mcg of ethinyl estradiol and 1mg of norgestrel now and again in 12 hours. This has HALF the efficacy of Plan B® and its generics with TWICE the side effects. But, if you are in the middle of nowhere and only have a pack of pills, this is your best bet. You can look up on the internet exactly what pills you have and how many of which color/row you must take to get to the recommended dose.
“All heterosexually active men and anyone with a uterus of any orientation keep emergency contraceptives on-hand in case of an accident or sexual assault for those with uteri. The longer you wait after unprotected sex or a birth control failure, the less likely the pill versions of emergency contraception will work. The copper IUD has the same efficacy throughout the 5 days.”
Dr. Yen, CEO and Co-Founder of Pandia Health
Is emergency contraception the same as the “abortion pill”?
No. Emergency contraceptive pills mainly work by preventing an egg from being fertilized. If you are pregnant and you take the emergency contraception pills, NOTHING will happen. Emergency contraception pills are: Plan B and its generics and Ella (ulpristal acetate). The abortion pill, also known as RU486 or mifepristone/misoprostol or “plan C”, is a prescription medication that is given to women within the first 10 weeks of pregnancy to induce a miscarriage (a.k.a. abortion). If you have a positive pregnancy test and want to terminate the pregnancy, you need abortion pills (mifepristone/misoprostol) or surgical abortion NOT emergency contraception.
How do emergency contraceptive methods work?
Emergency contraceptives are often referred to as “morning-after pills.” However, 1. You can use these up to 5 days after contraceptive failure and 2. people with uteri can also have a copper or hormonal IUD inserted as EC which prevents sperm from fertilizing an egg and forming a zygote.
EC pills work by delaying or blocking ovulation, which is when the egg pops out. Ulipristal acetate, the active ingredient in ella, is a selective progesterone receptor modulator; progesterone is the hormone that maintains pregnancy and ella acts by preventing this hormone from acting.
EC pills work by delaying or blocking ovulation, which is when the egg pops out. EC pills can also work by decreasing sperm motility, preventing the sperm from connecting with the egg. Ulipristal acetate, the active ingredient in ella, is a selective progesterone receptor modulator; progesterone is the hormone that maintains pregnancy and ella acts by preventing this hormone from acting.
Plan B and its generics are forms of progesterone which trick your body into thinking you’re already pregnant and stop your egg from being released. If the egg has already been released, Plan B and its generics are not as effective. For EC pills, the sooner a person takes them, the more effective it will be to prevent pregnancy.
Over-the-counter emergency contraceptives are most effective if taken within the first 72 hours, or 3 days, after a birth control failure. All EC pills (prescription and over the counter) CAN work up to five days, but Dr. Yen says, “If the condom pops at 3 a.m., we want EC in the woman’s mouth by 3:10 am. No cuddling, huddling, waiting until ‘the morning after’ because once the egg pops out, the emergency contraceptive won’t work.” Most important to know about over the counter EC is that they are NOT as good if your BMI is 26 or greater. Please check your BMI before using Plan B and its generics. That’s why at Pandia Health, we recommend Ella instead of Plan B and its generics because Ella works better at every time point and up to BMIs of 35.
Are there any side effects to using emergency contraceptives?
Emergency contraceptive pill side effects include: nausea, breakthrough bleeding, and menstrual cycle arriving late or early. After placement, copper IUDs can cause cramping, breakthrough bleeding, and heavier or longer periods.
Emergency contraceptives do NOT cause congenital defects, infertility, or protect against sexually transmitted infections (STIs). EC is also not as effective as birth control used before or during (i.e. condoms) sex. For maximum protection against STIs and unintended pregnancy, couples should use hormonal birth control methods before sex and male or female condoms during sex.
Emergency contraceptive pills should be just that, used in case of an emergency, and not in place of a regular birth control method. Regular birth control – such as the IUD with hormone, implant, shot, ring, patch, pill are all more effective than emergency contraception.
Pandia Health offers affordable (and sometimes FREE) emergency contraceptives, birth control pills, patches, and rings to those with uteri with and without insurance coverage.
If you’re interested in fully protecting yourself from unintended pregnancy, the expert birth control doctors and Patient Care Advisors at Pandia Health are happy to assist you with your birth control needs. Please contact us today to explore your options for having birth control delivered straight to your door.
Disclaimer: The above information is for general informational purposes only and is NOT a substitute for professional medical advice. Always seek the advice of your doctor/primary care provider before starting or changing treatment.