Maybe the condom split, perhaps someone forgot to take their pill, or you thought it would be okay to just this once skip your preferred barrier protection method. Enter emergency contraception! This magical medical advancement helps prevent over 95% of unintended pregnancies when taken within five days of unprotected intercourse. So, join us as we delve into the ins-and-outs of this essential aspect of modern reproductive healthcare.
Emergency contraception comes in two forms: insertion of the IUD (intrauterine device) and pill form. These methods aim to prevent fertilization from ever happening. The pills prevent or delay the release of an egg which means that even if sperm enters the vagina and swims up to the uterus, there will be no egg waiting there to be fertilized. The copper IUD impacts the way that sperm moves inside the uterus and, therefore, prevents fertilization from ever occurring. Since sperm can live in the vagina and womb for up to 5 days, emergency contraception is important even if you’re not fertile the day you have unprotected sex.
Since the pill methods prevent or delay the release of an egg, this critically implies that emergency contraceptive pills do not prevent pregnancy post-ovulation. For most people with a uterus, ovulation occurs around day 14 of the menstrual cycle; this is why taking the emergency contraceptive as soon after unprotected sex as possible is essential. Providers recommend that even if you think you've ovulated in the last five days, you should still take emergency contraception since it’s hard to know the exact time of ovulation.
The copper IUD is the most effective emergency contraception as it prevents the sperm from fertilizing the egg even post-ovulation. This method is over 99% effective as an emergency contraceptive and as regular birth control. Although someone may have it inserted as an emergency contraceptive, it can then remain in the uterus for 5-10 years, acting as regular birth control. The IUD should be interested within 120 hours (or five days) of unprotected sex to be effective. Current research suggests that medication does not interfere with the effectiveness of the IUD. The IUD presents the highest chances of success, but it then becomes a long-term form of birth control. Additionally, it comes at a high cost, with those uninsured paying up to $1300 out of pocket.
The well-known plan B pill and levonelle pill both contain levonorgestrel, which is an artificial progestin which blocks the release of an egg from the fallopian tubes. Although colloquially known as “the morning-after pill,” you don't have to wait till the next morning to take it: ideally the emergency contraceptive pill should be taken as soon as possible and within 72 hours of unprotected sex. Take note that some emergency contraceptive pills need to be taken in two doses, but this is highlighted in the instructions. Levonorgestrel pills have an 87% success rate at preventing pregnancy when taken within 72 hours and even higher if taken sooner. Plan B and its generic alternatives can all be purchased over the counter, which makes them accessible in an emergency.
The ella pill is another alternative which is estimated to be about 2.5x more effective than levonorgestrel alternatives within the first 24 hours. The ella pill contains ulipristal acetate, which modifies the behavior of progesterone and thereby delays ovulation. In comparison to Plan B and its generics, ella can be taken up to 120 hours (or five days) post unprotected sex—but of course, the chance of success decreases over time. A significant benefit of the ella pill, as opposed to the levonorgestrel alternatives, is that it also works equally well for those with higher BMIs. While some studies have shown levonorgestrel pills to be less effective on those with BMI values in the “overweight” range, the ella pill shows no sensitivity to weight or BMI. Unfortunately, ella is available only through prescription, making it more difficult to access in an emergency. However, it has a shelf life of three years, so it can be purchased preemptively.
The effectiveness of emergency contraception can be reduced as a result of a number of factors. Firstly, using a range of medications such as oxcarbazepine, bosentan, carbamazepine, and felbamate can reduce the chances of success of emergency contraception, and it is therefore important to tell your doctor if you take any medication. Vomiting within three hours of taking the emergency contraception may mean the pill has not yet dissolved into your system, and you may, therefore, require a second dosage. Other factors, such as weight, ovulation and time, have already been mentioned.
Although emergency contraception only slightly alters hormone levels, there can nonetheless be side effects—as with any medication. These include nausea, fatigue, stomach and headaches, vomiting, and menstrual changes. The pill methods may delay a period by one week, but if it does not return after three or four weeks, it is recommended to take a pregnancy test or consult a healthcare professional. Similarly, bleeding and spotting are normal, but if this persists over a week and is accompanied by abdominal pain, it might be a good idea to contact a healthcare provider. These symptoms can signify a miscarriage or ectopic pregnancy, in which a fertilized egg begins to develop in the fallopian tube.
Finally, let's set some things straight and clear up some common misconceptions surrounding emergency contraception. First off, emergency contraception is not an abortion. The insertion of the IUD or taking of the emergency contraceptive pill prevents fertilization from ever occurring. So, even if you believe that life begins at conception, the emergency contraceptive is still not an abortion. This is also why emergency contraception is not an alternative for pregnancy termination if someone is already pregnant. If you are interested in the workings of Plan C and abortion pills, check out our blog post on the subject.
Emergency contraception is neither a regular nor a primary form of birth control and shouldn’t be used as such. Both pill formats also change progesterone levels to delay or prevent the release of an egg and, therefore, to prevent adverse effects on hormone levels should not be used more than once per menstrual cycle and preferably not more than three times a year. If you regularly purchase emergency contraception, consider consulting your healthcare provider or family planning clinic about birth control options instead.
Significantly, emergency contraception seeks only to alleviate the risk of pregnancy associated with unprotected sex. This method cannot prevent or reduce the risk of STIs, and it is recommended that if you are not having sex with regular, previously tested partner(s), you should get tested after any unprotected sex. If you suspect this unprotected intercourse may have exposed you to HIV, contact your healthcare provider regarding PEP access; all other potential STIs should be tested for and treated.
As an accessible and effective solution, emergency contraception acts as a safety net for those who encounter unintended unprotected intercourse. The means should not be used as a substitute for routine contraception but can serve as a vital tool for those in need. Educating individuals on birth control, emergency contraception, and their options, should they become pregnant helps to foster an empowering environment that encourages individuals to make informed decisions about their bodies. Especially under a political administration that routinely threatens abortion rights, pregnancy prevention measures play a significant role in the fight for universal bodily autonomy.
Written by Ellen Gisto.