What You Need to Know About Emergency Contraception

By Michael (Bob) MacDonald, MS, CHES, manager, Sexual Health and Responsibility Program (SHARP), Navy and Marine Corps Public Health Center

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What can a woman do to prevent pregnancy if she had unprotected sex? If a woman has had sex without using birth control or if something happened (such as a condom broke), she can use emergency contraception to reduce her risk of becoming pregnant. In the U.S., there are three types of emergency contraceptive pills (ECP), sometimes called the “morning after pill”:

1. The emergency contraceptive pill containing a hormone called progestin. Progestin-only pills can reduce your risk of getting pregnant by 88%. You are also less likely to have side effects if you use these pills for emergency contraception, as compared with combined pills. In the U.S., different brands of pills are sold with different regulations, so it can be quite confusing.

Plan B One-Step is sold on the shelf of drug stores (check the family planning aisle) with no age restrictions. That means anyone can buy it without having to show ID. Plan B One-Step is also available at no cost and without a prescription (but ID required) in Navy pharmacies, and is available some on Navy ships.

• In many locations, the generic one-pill products called Next Choice One Dose and My Way may be available on the shelf next to Plan B One-Step, but you need to be 17 to buy them. Be prepared to show ID to buy these products.

• The generic two-pill products Levonorgestrel Tablets are available only at the pharmacy counter. Women and men aged 17 or older can buy them without a prescription. If you are 16 or younger, you need a prescription.

2. Combined emergency contraceptive pills containing both the hormones progestin and estrogen. Many brands of the combined daily birth control pill can be used for emergency contraception. These pills cut your chances of getting pregnant by 75%, and you are more likely to experience side effects like nausea and vomiting. These pills may also be available on some Navy ships.

3. Ella is the emergency contraceptive pill containing ulipristal acetate, and is available by prescription only. It can be taken up to 5 days after unprotected sex, and is believed to be more effective than levonorgestrel pills. Ella is sold by prescription only, regardless of age. You can also order Ella through an online prescription service with next-day shipping.

Facts about emergency contraceptive pills. The mechanism of action of emergency contraceptive pills is not fully understood. They may work by disrupting ovulation, fertilization, or implantation. These pills are not effective once the fertilized egg has implanted in the uterus and will not harm an established pregnancy.

Emergency contraceptive pills:

• do not protect against sexually transmitted infections.

• are not intended for frequent use.

• should not be taken before unprotected sex.

• are not recommended as the primary form of contraception, because ECPs are not as effective as many other forms of contraception.

How effective are emergency contraceptive pills? Emergency contraceptive pills containing progestin only, such as PLAN B One-Step, reduce the risk of pregnancy by up to 81 to 90% – which means the number of women who would be expected to become pregnant after unprotected sex drops from 8 of 100 without any contraception to about 1 of 100 when PLAN B® is taken within 72 hours of the unprotected sex. Use of ECPs containing combined estrogen and progestin reduce the risk of pregnancy by 75%. Timing is important – these types of ECPs are more effective when taken sooner.

Ella remains highly and equally effective through day 5 after the sexual encounter.

What will happen when I take emergency contraceptive pills? Side effects may include nausea, vomiting, stomach pain, headache, dizziness and breast tenderness and may cause spotting or changes in the amount, timing or duration of the next menstrual period. These are similar to the side effects of regular prescription-only birth control pills.

Are emergency contraceptive pills the same as the “morning after pill”? Yes. However, the words “morning after” are misleading, because emergency contraceptive pills can be used up to 72 hours after sex (or 120 hours after sex with Ella), not just the next morning.

Are emergency contraceptive pills the same as “abortion medications”? No. Abortion medications are used to terminate an established pregnancy and must be prescribed by a doctor.

Where can I get more information? For detailed information, counseling, and access to birth control options, contact your health care provider. For further information regarding contraception, visit the Sexual Health and Responsibility Program at: http://www.med.navy.mil/sites/nmcphc/health-promotion/reproductive-sexual-health/Pages/contraception.aspx