Emergency contraception: Understand the options

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Emergency contraception: Understand the options

Emergency contraception can be used to prevent pregnancy after you've had unprotected sex, whether you didn't use birth control, your method of birth control failed or you missed a birth control pill. To help choose the best type of emergency contraception for you, consider the following questions.

What types of emergency contraception are available?

You may be able to choose from several different types of emergency contraception, including:

  • Next Choice, Plan B One-Step or Ella. Also known as the morning-after pill, this type of emergency contraception contains the hormone levonorgestrel, a progestin, (Plan B One-Step, Next Choice) or ulipristal acetate, a progesterone agonist-antagonist, (Ella). Take one Next Choice pill as soon as possible and less than 72 hours after unprotected sex. Take the second Next Choice pill 12 hours later. Or take one Plan B One-Step pill as soon as possible and less than 72 hours after unprotected sex. (Plan B, which consists of two pills, is being phased out by its manufacturer.) If you use Ella, take one Ella pill as soon as possible and less than 120 hours after unprotected sex. Use a backup method of contraception for the rest of your menstrual cycle.
  • ParaGard. An intrauterine device (IUD) that's inserted in the uterus for long-term contraception, ParaGard can also be used for emergency contraception. ParaGard is a T-shaped plastic frame that continuously releases copper. To be used as emergency contraception, ParaGard must be inserted less than five days after unprotected sex. ParaGard can be removed after your next period or left in place for up to 10 years for continued pregnancy protection.
  • Combination birth control pills. Birth control pills that contain the hormones estrogen and progestin can also be used for emergency contraception. Take one dose of combination birth control pills — which may vary, depending on the brand of pill — as soon as possible and less than five days after unprotected sex. Take a second dose of combination birth control pills 12 hours after the first dose. Use a backup method of contraception for the rest of your menstrual cycle.

How do different types of emergency contraception work?

Depending on where you are in your menstrual cycle, emergency contraception can:

  • Prevent or delay ovulation
  • Block fertilization
  • Keep a fertilized egg from implanting in the uterus

If you're already pregnant when you take Next Choice or Plan B One-Step, the treatment will be ineffective and won't harm the developing baby. Don't take Ella, however, if you're already pregnant. In addition, if you're already pregnant when you have an IUD inserted, you could develop a serious infection or lose the pregnancy.

Is emergency contraception appropriate for everyone?

Emergency contraception isn't appropriate for everyone.

Your health care provider may discourage use of Next Choice, Plan B One-Step or Ella if you:

  • Are allergic to any component of the morning-after pill
  • Have unexplained vaginal bleeding

The morning-after pill may be an option if you have diabetes, but your health care provider will monitor you closely.

Your health care provider may discourage use of ParaGard if you:

  • Have uterine abnormalities that interfere with the placement or retention of ParaGard
  • Have a pelvic infection, such as pelvic inflammatory disease
  • Recently gave birth or had an abortion
  • Have uterine or cervical cancer
  • Have unexplained vaginal bleeding
  • Are allergic to any component of ParaGard
  • Have a condition that causes too much copper to accumulate in your liver, brain and other vital organs (Wilson's disease)
  • Have or are at high risk of a sexually transmitted infection
  • Have had previous problems with an IUD

Although combination birth control pills generally aren't recommended for routine contraception for women who have certain health conditions — such as a history of heart disease or blood clots — the benefits of combination birth control pills for emergency contraception generally outweigh the risks.

How effective is emergency contraception?

Emergency contraception is an effective option for preventing pregnancy after unprotected sex — an estimated 1 to 2 out of 100 women who have unprotected sex one time and correctly use emergency contraception will get pregnant. Still, emergency contraception isn't as effective as other methods of contraception and isn't recommended for routine use.

Using emergency contraception may delay your period by up to one week. If you don't get your period within three to four weeks of using emergency contraception, or you have abdominal pain or irregular or persistent bleeding, take a pregnancy test.

How do I obtain emergency contraception?

Availability depends on the type of emergency contraception:

  • Next Choice, Plan B One-Step or Ella. If you're age 17 or older, Next Choice and Plan B One-Step are available over-the-counter at most pharmacies. If you're age 16 or younger or you want to use Ella, you'll need a prescription from your health care provider.
  • ParaGard. You'll need to visit your health care provider to have ParaGard inserted. He or she will evaluate your overall health and do a pelvic exam before inserting ParaGard. You may need to take a pregnancy test as well.
  • Combination birth control pills. If you're already using combination birth pills but forgot to take them, consult your doctor about the correct dosage for emergency contraception. If you don't have a prescription for combination birth control pills, you'll need to contact your health care provider.

Some health care providers may also provide an advance prescription for emergency contraception, just in case.

What are the pros and cons of each type of emergency contraception?

Next Choice or Plan B One-Step

  • Pros. No prescription needed if you're age 17 or older. Can be used during breast-feeding.
  • Cons. Can cause nausea, vomiting, dizziness, fatigue, headaches, breast tenderness, bleeding between periods or heavier menstrual bleeding, lower abdominal pain, and diarrhea. Doesn't offer protection from sexually transmitted infections (STIs).

Ella

  • Pros. Can be taken up to 120 hours after unprotected sex.
  • Cons. Prescription required. Isn't recommended during breast-feeding. Can cause headaches, abdominal pain, nausea, fatigue and dizziness. Doesn't offer protection from STIs.

ParaGard (copper IUD)

  • Pros. Can be used as a long-term method of contraception.
  • Cons. Rarely, insertion can cause fainting, low blood pressure, a slower than normal heart rate, pelvic inflammatory disease — which can cause tubal damage and infertility — and partial or total perforation of the uterine wall or cervix. Can also cause cramps, severe menstrual pain and heavy bleeding, bleeding between periods, nausea, anemia, backache, painful sex, inflammation of the vagina, vaginal discharge and an itchy rash. Spontaneous expulsion of the IUD is possible. Doesn't offer protection from STIs.

Combination birth control pill

  • Pros. Can be used as a long-term method of contraception.
  • Cons. Can cause nausea, vomiting, dizziness, fatigue, headaches, breast tenderness, bleeding between periods and lower abdominal pain. Doesn't offer protection from STIs. Isn't recommended during breast-feeding, since estrogen is known to interfere with milk supply. Can increase the risk of blood clots and may cause high blood pressure when used long term.

What's the bottom line?

It's always a good idea to make a decision about birth control before having sex. However, emergency contraception can help prevent pregnancy when you don't plan ahead or contraception fails. If you have questions or concerns about emergency contraception, consult your health care provider. He or she can help you decide which type of emergency contraception is right for you.

Last Updated: 2010-08-19
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