The Morning After: The Truth About Emergency Contraception

One day, I walked home to find magazines strewn about the floor, a box of tissues tipped over, and my roommate conked out in her bed. I could tell bad emotions were afoot, so I grabbed my things and fled until the dust settled. When I returned later that night, I asked her what all that was about and she explained, “Oh, I was reading People when all of a sudden I got so mad that everyone in the magazines was so thin. It made me feel fat, so I started crying. Then I got angry, so I ripped them up, and threw them across the floor. That made me exhausted so I went to sleep. I think maybe the morning-after pill made me a little emotional.”
Will emergency contraception turn you into an emotional train wreck? Will it make you puke your guts out? Does it not work if you’re over a certain weight? Do you need a prescription to get it? The answer is: “Maybe?” Let’s take a closer look at emergency contraception.

What is emergency contraception?

Most importantly, emergency contraception (EC) is just that—to be used in emergencies. It should not be used as your primary form of birth control because it is not as effective as any form of birth control taken prior to sex (like the pill or condoms), does not protect against STDs, and has significant side effects. That being said, emergency contraception has a couple of forms. Most people immediately think of “the morning-after pill” (Plan B is arguably the most widely-recognized brand), but there are actually three different kinds of pills. Additionally, an IUD (intra-uterine device) is another form of emergency contraception.

Progestin pills: This is the most common form of EC pill due to effectiveness, availability, and lessened side effects. The kind of progestin used is levonorgestrel. It’s usually administered as a one-dose pill. For simplicity, I will now refer to this kind of pill as “Plan B.”

Ulipristal acetate pills: Also be known as a brand called ella, this pill contains ulipristal acetate and is also a one-dose pill. For simplicity, I will now refer to these kinds of pills as “ella.”

Estrogen and progestin pills: You may recognize this as the makeup of your birth control, and in fact, some types of birth control pills can be used as emergency contraception (dosage varies by brand). This method has been largely replaced as other forms are more effective and have fewer side effects.

All of the above pills must be taken as soon as possible after “the incident” for maximum efficacy. You can take EC up to 5 days after unprotected sex and it can still be effective, but it’s best to take it right away.

IUD: A copper IUD is a small T-shaped plastic rod wrapped in copper wire that’s inserted into your uterus by a medical professional. It can be put into place up to 5 days after unprotected sex to prevent pregnancy without losing effectiveness, making it the most effective method of emergency contraception (and one of the most effective methods of birth control). It can be left in up to 10 or 12 years and will prevent pregnancy during that time. There’s also a kind of IUD that releases progestin, but it’s not effective for EC. We have another article with everything you need to know about IUDs, but for this article we will only talk about copper IUDs as they apply to EC.

How does emergency contraception work?

Emergency contraception pills work by preventing ovulation. If an egg is not released from your ovaries, sperm (which, fun fact, can live inside of you for 3-5 days) cannot fertilize it (ella has a cute cartoon of this on their website).
For IUDs, the copper is toxic to sperm and inhibits mobility so it cannot join with an egg.

Is emergency contraception the same thing as abortion?

For pills—definite no. In fact, emergency contraception does nothing if you are already pregnant and is not detrimental to an embryo (though you still shouldn’t take it if you are pregnant). IUDs also should not be inserted if the woman is already pregnant; and they fall into a more sticky area of abortion. Since they may prevent implantation of the egg into the uterus, whether they cause an abortion kind of depends on your definition of when pregnancy starts. The most common definition says that pregnancy begins at implantation (which occurs 5-7 days after fertilization) so an IUD would not cause abortions using this definition. However, some people think that pregnancy begins as soon as an egg is fertilized, and preventing implantation of a fertilized egg = abortion. It’s worth mentioning that about 50% of fertilized eggs naturally do not implant into the uterus, which is part of the reason fertilization is not generally used as a definition of pregnancy.

What are the side effects of the morning-after pill? What are the risks?

It totally depends on your body, but EC carries side effects fairly similar to hormonal birth control. For EC pills, the most common side effects are a headache (about 20% of users experience this), painful periods or bleeding (14%), and nausea (12%—if you throw up within 2 hours of taking the pill, contact your doctor as you may need another dose), but these symptoms should go away in 1-2 days. There’s no data about it messing with your emotions (which, admittedly, would be pretty hard to quantify), but just like other side effects some women will be really affected (like my unfortunate roommate) and others will not. So, you may experience some pain, you may go on an emotional rollercoaster ride, but most likely you won’t feel any different, and if you do, you’ll probably feel better within 48 hours.

The general consensus is that the risks of an unintended pregnancy are much greater than the risks of emergency contraception. The good news is many women who are cautioned against hormonal birth control can safely use the pill form of EC (particularly Plan B or ella) due to low total hormone dose and short exposure time. This also means EC won’t have an impact on your weight. There are also no long-term side effects (no reports of death or serious complications), and while repeat doses of Plan B are safe (ella has not been tested long-term), it should only be used as a backup.

How effective is emergency contraception?

This depends on a lot of factors, like where you are in your cycle, time between unprotected sex and taking EC, and the type of EC you choose. If 100 women have unprotected sex during the middle 2 weeks of their cycle, approximately 8 would become pregnant. If taken within 72 hours, Plan B has an 88% effectiveness rate (meaning 7 out of 8 of those women will not become pregnant). ella is the most effective pill, and is 85% effective at 5 days after incidence (more effective if taken before). An IUD is 99.9% effective, and continues to be that effective as birth control. Remember, EC is not as effective as regular birth control and does NOT prevent STDs.

Does my weight affect which EC is best for me?

Yes. Plan B does not work as well in women who weigh more than 155 lbs, and ella may not work as well in women who are obese (BMI over 35, for someone 5’4 that would be over 200 lbs). However, IUDs are just as effective no matter how much you weigh.

Do you personally know anyone who actually uses an IUD?

Actually yes, and they LOVE it. IUDs have a high satisfaction rate. Copper IUDs do carry some side effects as well, including increased cramping, heavier periods, and other more serious (but rare) side effects, such as slippage.

How can I get emergency contraception? How much does it cost?

Plan B is now available to anyone (men and women) without a prescription (check the Family Planning aisle or ask the pharmacist). Generics of Plan B require a prescription for those under 17. Cost ranges from $30-$65. ella requires a prescription, and is about $40 (without insurance). An IUD must be inserted by a healthcare professional—call and explain that you need it right away for emergency contraception. Cost for an IUD can range from $500-$1000 over 12 years, but your insurance often covers a significant proportion of it and they may be available on a sliding scale cost at clinics like Planned Parenthood.

If I need emergency contraception, does that make me a slut?

First of all, your sex life is for only you to judge, but it doesn’t seem like using contraception to prevent an unintended pregnancy would make you a slut. I would argue being aware and informed enough to take EC is a sign of responsibility. You shouldn’t feel ashamed for taking it—shit happens that is completely out of your control. And you’re definitely not alone: CDC estimates about one in nine women between 15 and 44 have taken EC—over 5.8 million women. However, EC is not something you should depend on. If you find yourself having to use EC often, you should probably look into changing your primary form of birth control to something that works better for you.

There are no extra letters after my biology degree, so thank you to Dr. Chang and Dr. Alvi for fact-checking this article!

Sources!
Not-2-Late – Operated by Princeton University, everything you want to know and more about emergency contraception.
Emergency Contraception: A Last Chance To Prevent Unwanted Pregnancy (Nov 2013)
Reproductive Health Access – lots of studies and a beautiful chart.
Planned Parenthood – the classic

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