What a Doctor Wants You to Know About Emergency Contraception

By Scott G. Chudnoff, MD, as told to Camille Noe Pagán

A lot of people think emergency contraception (EC) is an abortion pill, but that’s not how it works. If you’re already pregnant and you use it, it won’t end your pregnancy. EC only reduces your odds of getting pregnant if you’ve had unprotected sex or your birth control failed you over the past several days.

Most forms of emergency contraception contain hormones that stop your ovary from releasing an egg. (Some examples of hormonal ECs are Plan B, Plan B One-Step, Take Action, and ella.) If you don’t release an egg, then sperm can’t fertilize it. That prevents pregnancy. But what many women don’t realize is that there’s a nonhormonal EC option available. It’s the Paragard copper IUD (intrauterine device). An IUD is a T-shaped device that’s put into your uterus through your cervix. Sperm don’t like copper, so they don’t get past Paragard to reach and fertilize an egg.

The thing about EC is that the sooner you use it, the better it works. That’s especially true if you’re close to ovulation in your menstrual cycle. Most women aren’t exactly sure when they ovulate, which is another reason why it’s best to take emergency contraception as soon as possible after you’ve had unprotected sex. If you do know you’ve just ovulated or are about to, then ella and Paragard are more effective than other forms of EC. Ella and Paragard are also more effective if it’s been more than 3 days since you’ve had unprotected sex. But they really work only within about a 5-day span. If it’s been longer than 5 days, they’re much less likely to work.

Ella requires a prescription, and you’ll need a doctor to insert Paragard. But most EC is available over the counter. That doesn’t mean you’ll find it sitting on the shelf at the pharmacy or grocery store, though. In many cases, you have to ask a pharmacist for it.

It’s always a good idea to speak with your doctor before taking a new medication, including emergency contraception. They might have specific advice that can help you. For example, if you’re overweight or are tall with a large frame, ella is more likely to work than Plan B. But when you call your doctor’s office, make sure you tell them you’re calling about EC, so they put you in touch with your doctor right away.

That said, if you’re on vacation or it’s a holiday or weekend and your doctor isn’t available, don’t wait to take EC. The longer you wait, the higher your odds of getting pregnant. Plus, research shows that EC is safe for women of all ages. The only real reason not to use it would be if you’re already pregnant or if you’ve had a negative reaction to EC in the past.

The most common side effects to hormonal EC are nausea and vomiting, while an IUD can cause cramping and bleeding. You might feel a little uncomfortable for a day or two after taking it. That’s normal. So is irregular menstrual bleeding afterward. Your next period might be heavier or lighter than it normally is. It might be later than usual, too, which might make you think you’re pregnant. If you’re worried, consider taking a pregnancy test. And trust your gut: If something seems wrong, such as really heavy bleeding, call your doctor or go to the emergency room.

Emergency contraception is for emergencies. It’s not a replacement for birth control. Unfortunately, doctors do see patients who rely on EC to avoid pregnancy because they don’t want to use, say, condoms. But you’re more likely to get pregnant if you rely on EC. Most EC is only 75% effective, whereas most birth control is closer to 90% to 98% effective.

Birth control tends to be less expensive than EC, too. The price for EC can vary, depending on where you live. Some over-the-counter EC can run as low as $10 a pill. But other types can cost up to $90 per pill. Most health insurance covers the full cost of an IUD. The bottom line is, if you don’t want to get pregnant, you should have a reliable form of birth control that you use consistently. Accidents happen, and emergency contraception is a great option for those. But it’s not for everyday use.