How to choose the right emergency contraception for you
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How to choose the right emergency contraceptive
If you recently had unprotected sex and want to prevent an unplanned pregnancy, emergency contraception is an effective and safe option. There are a variety of emergency contraception (EC) options available ranging from pills to intrauterine devices (IUDs). We’ve outlined what you need to know about the different types, effectiveness, and top considerations to help you pick the right one for you.
What are emergency contraceptives?
Emergency contraceptives are used after unprotected sex, ideally within
3 or 5 days, to help prevent an unwanted or mistimed pregnancy. Emergency contraceptives are generally used as a backup option after unprotected sex or when other birth control options have failed, like a condom tearing or missing more than two active birth control pills in a row.
What to consider
If you’re trying to decide between emergency contraception options, there are some key considerations to keep in mind, including how much time has passed since you had unprotected sex, your weight or BMI, and whether or not you can get an immediate appointment with a healthcare provider.
Which EC is right for me?
*All forms are most effective when used ASAP after unprotected sex
Timing for emergency contraceptives
It’s always best to take emergency contraceptives as soon as possible. Here are the time frames to keep in mind:
-Get the copper IUD (Paragard) inserted by a trained healthcare provider up to 120 hours (5 Days) after unprotected sex. The IUD will work as well on day 5 as it would on day 1 and can also be used as an effective form of birth control for at least 10 years. This is the most effective type of emergency contraception (works over 99% of the time) and is not impacted by weight.
-Get the levonorgestrel IUD (like Mirena) inserted by a trained healthcare provider up to 120 hours (5 days) after unprotected sex. Once inserted it can remain in place for up to 8 years and is a very effective form of birth control. This is one of the best forms of emergency contraception (works over 99% of the time) and is not impacted by weight.
-Take Ella® within 120 hours (5 days) of having unprotected sex. Ella® is more effective than the morning-after pill for people who weigh more than 165 pounds, but studies have shown it to be less effective for people who weigh over 195 pounds. This medication requires a prescription.
-Take the Morning-After Pill within 72 hours (3 days) of having unprotected sex. Some studies show that it is effective up to 120 hours (5 days) after unprotected sex, but it has the best chance of working the sooner you take it. Common over-the-counter morning-after pill brands: Plan B, Julie, Take Action, My Way. No prescription or ID required.
While the copper IUD, levonorgestrel IUD and Ella® are very effective options, they require seeing a doctor or nurse, which isn’t always feasible given the short timeframe following unprotected sex. If you’re having trouble getting an appointment, see if there’s a Planned Parenthood near you that can help get you in sooner.
Which emergency contraceptive is the most effective?
1.
Both forms of IUD (including Paragard, the copper IUD, and Mirena, a type of levonorgestrel IUD) are the most effective because they reduce the risk of pregnancy by over 99% if inserted within 120 hours (5 days) of unprotected sex. IUDs are the only emergency contraceptive option that are not impacted by weight, meaning that they are just as effective for someone with a BMI of 20 as with someone of a BMI of 35. Once inserted, the IUD can protect you from pregnancy for at least 10 years or until you get it removed.
2.
Ella® is a unique type of morning-after pill available by prescription only (in the United States). It works when taken up to 120 hours (5 days) after unprotected sex and has a 1.8% percent chance of pregnancy for those with a BMI under 30. Unfortunately, it becomes less effective for those with a BMI over 30.
3.
Over-the-counter morning-after pills like Plan B, Julie, Aftera, My Way and Next Choice all contain the same active ingredient, Levonorgestrel. The morning-after pill is 89% effective at preventing pregnancy if taken within 72 hours after unprotected sex.
Efficacy goes down as weight increases. For example, it has a 2.5% risk of pregnancy for a BMI from 25 to 29.9 and a 5.8% risk of pregnancy for a BMI over 30.
Where to get emergency contraception
Morning-after pills sold over the counter like Julie, Plan B One-Step, and Aftera are available at retail chain stores and pharmacies such as Walmart, Target, CVS, Walgreens, and Rite-Aid in all 50 states. You can also find it online. Amazon offers two-day rush delivery on some pills (check your location for details). The OTC morning-after pill is safe, legal, and FDA-approved. No ID, credit card, or parental consent is required for purchase.
Both ella and IUDs are only available through medical providers. To get an ella pill, you may be able to simply call your doctor’s office for a prescription while other doctors may require an in-person visit. You can also get a prescription through Planned Parenthood or order ella online through PRJKT RUBY or NURX.
IUDs can be more difficult to get because you need an appointment with a trained medical provider to insert the IUD within 5 days after unprotected sex. If you’re unable to get a timely appointment with your medical provider, reach out to Planned Parenthood.
Cost of emergency contraception
OTC morning-after pills can cost anywhere from $20 to $50 depending on the brand. Regardless of the brand or price, all OTC morning-after pills work the same way and contain the same amount of levonorgestrel (1.5mg).
ella contains a different medication, ulipristal acetate, and can cost anywhere from $50-$90.
The IUD can be the most expensive option because they require a medical procedure. The cost ranges from $0 to $1300 depending on your insurance. Many healthcare plans, Medicaid, and government programs offer IUDs for little to no cost depending on the plan. After insertion, IUDs can remain in place and serve as regular birth control for 8-10 years, depending on the type of IUD.
Many health insurance plans cover emergency contraception, making it low-cost or free. Be sure to check your plan for details.
Does weight impact emergency contraception?
Both types of emergency contraception pills are affected by weight, while the IUD is not. There hasn’t been enough conclusive research to accurately explain why this happens, but here’s what we do know:
-Some studies have shown that morning-after pills containing levonorgestrel, like Plan-B One Step or Julie, are less effective for people with a BMI over 25.
-ella® is more effective than levonorgestrel pills for people with a BMI over 25, (risk of pregnancy is 1.8% compared to 2.5% for levonorgestrel) but its efficacy decreases for people with a BMI over 30.
-Neither copper nor levonorgestrel IUDs are affected by weight. In fact, they are the most effective forms of emergency contraception regardless of weight and reduces your chance of getting pregnant by 99% if inserted within 5 days of unprotected sex.
Breastfeeding
OTC morning-after pills and the IUD have no effect on breast milk.
If you take Ella® it is recommended that you pump and dump (discard) breast milk for 24 hours after taking it.
How Emergency Contraception Works
All three types of emergency contraception work a little differently.
The most common type of emergency contraception is the over-the-counter morning-after pill containing levonorgestrel. That’s because they’re easy to access and don’t require a prescription or ID. Some popular brands are Plan B One-Step, Julie, and Aftera. Another pill, Ella®, contains ulipristal acetate and requires a prescription. The third option is an intrauterine device (IUD), which must be inserted into the uterus by a healthcare provider.
How the IUD works
An IUD is a small t-shaped plastic rod that is either wrapped in copper coils (Paragard) or contains a high dose of levonorgestrel (Mirena, Liletta). The IUD is inserted into the uterus by a medical professional. One way that it helps to prevent pregnancy is by preventing the sperm from reaching the egg. It has also been proposed that IUDs prevent pregnancy by interrupting fertilization of an egg and implantation of a fertilized egg into the wall of the uterus.
Effectiveness
Copper IUDs have the highest efficacy out of all the emergency contraception options. It’s up to 99% effective at preventing pregnancy! IUDs can be inserted up to 5 days after unprotected sex. It’ll have the same efficacy on day 5 as it would have on day 1.
When to use
If you had unprotected sex within 5 days and want the best chance of not getting pregnant, the IUD is a great solution. The IUD is not impacted by weight, so it’s a great option for people with a BMI over 30.
IUDs can be inserted up to 5 days after unprotected sex. Once inserted, it will continue protecting you from pregnancy for 8 to 10 years, depending on the brand.
Who can take
Almost anyone with a uterus can use an IUD. Its efficacy is not impacted by weight or BMI. However, an IUD must be inserted by a clinician within 5 days of unprotected sex.
Cost
IUDs can cost anywhere from $0 - $1300. Some healthcare plans, Medicaid, and government programs offer IUDs at a low cost or for free.
How the morning-after pill works
The morning-after pill helps to prevent pregnancy by delaying ovulation and preventing the release of an egg. If there is no egg to meet sperm in the fallopian tube, then it cannot be fertilized, and a pregnancy cannot occur.
The morning-after pill is not an abortion pill. These pills can only help prevent pregnancy; they cannot impact an existing one.
Types of morning-after pills
Medication: Levonorgestrel (1.5mg)
Available at CVS, Target, Walmart and online
Cost: $42.44
Medication: Levonorgestrel (1.5mg)
Available at pharmacies and online
Cost: $46.99
Medication: Ulipristral acetate (30mg)
Available by prescription
Cost: $50 - $70
Medication: Levonorgestrel (1.5 mg)
Available at pharmacies
Cost: $29.99
Effectiveness
Levonorgestrel pills have an efficacy rate of 89% if taken within 72 hours of unprotected sex. However, if you have a BMI over 25, the OTC morning-after pill may not be as effective.
Ella® is 85% effective at preventing pregnancy if taken within 5 days. It works better than Levonorgestrel pills for people with a BMI over 25, but it may not work as well for people with a BMI over 30.
When to use
OTC morning-after pills with levonorgestrel are most effective if taken as soon as possible, especially within 72 hours (3 days). Ella® should be taken within 120 hours (5 days) of unprotected sex or as soon as possible.
Who can take
Anyone with a uterus who has had unprotected sex can take either an OTC morning-after pill, like Julie or Plan B, or Ella®. Both types of pills are safe and easy to use.
Cost/Where to buy
OTC morning-after pills can cost anywhere between $20 - $50 depending on the brand. You can also get them for free from Planned Parenthood or through Julie’s donation partners. You can find these pills at major retailers like Walmart, Target, CVS, Walgreens, Rite-Aid or any pharmacy in all 50 states. These pills are safe, legal, and FDA-approved. No ID, age requirement, or parental consent is required for purchase. Anyone can purchase the OTC morning-after pill—you, your friend, your partner, etc.
Ella® can cost between $50 - $90 and requires a prescription for purchase. To get an Ella® pill, you may be able to simply call your doctor’s office for a prescription while other doctors may require an in-person visit. You can also get a prescription through a provider at Planned Parenthood or order ella online through PRJKT RUBY or NURX.
Most insurance plans cover emergency contraception, making either pill low-cost or free. Be sure to check your plan for details.
