Emergency Contraception - The Morning After Pill

The emergency contraceptive pill is a safe and effective way to prevent pregnancy after unprotected sex, contraceptive failure or a sexual assault. Millions of women have safely used the emergency contraceptive pill and there have been no reports of serious complications or side effects. However, as with all drugs, there are directions for safe and effective use that must be followed.

The emergency contraceptive pill is frequently referred to as “The Morning After Pill” but this is a misnomer, as women do not have to wait until the morning after sex to take the emergency contraceptive pill. Actually, the emergency contraceptive pill is more effective the sooner you take it – as soon as possible after unprotected sex.

The emergency contraceptive pill has been referred to as the ‘abortion pill’, but the emergency contraceptive pill cannot cause an abortion if a woman is already pregnant, and it is only effective if used before a pregnancy is established. Emergency contraceptive pills have no action to terminate an already established pregnancy.

There are many valid reasons why emergency contraception may be needed. Some of these reasons include:

  • When a contraceptive method was desired but not used
  • If there is a contraceptive failure, for example, condom, diaphragm, or cervical cap breakage or slippage
  • If birth control pills, patches, rings or injections are started late or dislodged
  • If there is failed withdrawal
  • If there is expulsion of an IUD or implant
  • Sexual assault

If you should miss your period by more than one week, you should have a pregnancy test.

How does the emergency contraceptive pill work?

Levonorgestrel, the medication found in Plan B One Step and Next Choice prevent pregnancy by preventing or delaying the release of the egg from the ovary. Emergency contraceptive pills may also alter the cervical mucous or reduce the ability of the sperm to bind to an egg. Recent research in Europe suggests that levonorgestrel emergency contraceptive pills may not be fully effective in those who weigh over 176 pounds - pregnancy prevention may fail. Teva Pharmaceuticals, the U.S. manufacturer of Plan B One Step, has not made the same label changes, but the FDA is reviewing the scientific data and will determine if label changes are required.

Ulipristal, the progestin found in the emergency contraceptive pill ella, works to prevent pregnancy by blocking the natural hormone progesterone from occupying its receptor site in the body. It blocks the body’s own progesterone.

Are there any side effects with the emergency contraceptive pill?

Emergency contraceptive pills are very safe to use. Side effects, if they occur at all, are usually short-term and mild. Nausea has been reported in about 18%, or 18 out of 100 women using levonorgestrel emergency contraception. Vomiting may also occur in about 4% of women. If vomiting should occur within three hours of taking an emergency contraceptive pill, women should contact their healthcare provider as a repeat dose may be needed.

Other side effects include irregular bleeding or spotting and other short-term side effects like headache, breast tenderness or stomach pain.

Additionally, studies have shown that emergency contraception pill use does not increase the risk to the developing fetus in women who may already unknowingly be pregnant. However, the emergency contraceptive pill should not be taken by a woman who knows that she is pregnant.

Women who normally cannot use combined birth control pills because of medical conditions such as migraines, heart or liver conditions, or breastfeeding can still safely use the emergency contraceptive pill as it is just a one-time dose.

Emergency Contraceptive Pill Products

The emergency contraceptive pill regimen recommended by the World Health Organization and The American College of Obstetrics and Gynecology is 1.5 mg of levonorgestrel up to 5 days (120 hours) after unprotected sex. Levonorgestrel is the generic name of the progestin that is found in emergency contraceptives such as Plan B, Plan B One Step, and Next Choice. Plan B, the original two-tablet regimen is being phased out and is being replaced with Plan B One-Step, the one tablet regimen; however, the two tablet regimen is still available by the name of Next Choice or the generic levonorgestrel and may be more affordable.

In the U.S., the levonorgestrel emergency contraceptive pill (Plan B One-Step) can be obtained over-the-counter (OTC) without a prescription or age restrictions.

Another emergency contraceptive pill, ella, which contains a different progestin (ulipristal) is also available, but women must contact their physician as a prescription is required for Ella.

Emergency Contraceptive Pills

Generic name Brand name(s) Prescription required? Dose regimen
Levonorgestrel 1.5 mg, one tablet regimen Plan B One-Step No Take one tablet as soon as possible after unprotected sex. The manufacturer recommends to take within 72 hours (3 days) after unprotected sex, but studies have shown moderate efficacy still exists if taken up to 120 hours (5 days) after unprotected sex.
Levonorgestrel 0.75 mg, two tablet regimen -Next Choice
-generic levonorgestrel options
-Plan B (phased off market in U.S.)
Not available OTC; may still be stocked in pharmacies Take one tablet as soon as possible after unprotected sex, then take the second tablet 12 hours later OR take both tablets at once as soon as possible after unprotected sex and within 120 hours (5 days) after unprotected sex
Ulipristal ella Yes, prescription required from health care provider Take tablet as soon as possible or up to 120 hours (5 days) after unprotected sex

Dosing of the Emergency Contraceptive Pill

Plan B One-Step

Plan B One Step is available OTC as a single tablet of 1.5 mg of levonorgestrel. The tablet in Plan B One-Step should be taken as soon as possible up to 5 days after unprotected sex. The manufacturer recommends that Plan B One-Step be taken within 72 hours, or 3 days of unprotected sex, but studies have shown it can still be moderately effective up to 120 hours, or 5 days after unprotected sex. As with all emergency contraceptive pills, they are more effective the sooner they are taken.

Next Choice or generic levonorgestrel emergency contraceptive pill

Next Choice and its generic version both come as a 2-tablet regimen of 0.75 mg of levonorgestrel. There are 2 dosing options for Next Choice and the generic levonorgestrel. The first tablet should be taken as soon as possible after unprotected sex, and then the second tablet 12 hours later, as noted in the package insert. Or, if preferred or recommended by your healthcare provider, both tablets can be taken at the same time.

The manufacturer recommends that Next Choice or generic levonorgestrel emergency contraceptive be taken within 72 hours, or 3 days of unprotected sex, but studies have shown it can still be moderately effective up to 120 hours, or 5 days after unprotected sex. In either case, the regimen should be started as quickly as possible and within 5 days of unprotected sex.

ella

In addition to the emergency contraceptive pills known as Plan B One Step and Next Choice, there is another type of emergency contraceptive pill called ella that can also be used up to five days after unprotected sex. ella contains 30 mg of ulipristal, and it works to prevent pregnancy by blocking the natural hormone progesterone from occupying its receptor site in the body. It blocks the body’s own progesterone.

ella requires a prescription from your doctor. You cannot get it at the pharmacy without having a prescription first.

Like other emergency contraceptive pills, ella can be used up to 5 days after unprotected sex or a contraceptive failure but should be taken as soon as possible, as it is more effective the sooner it is taken.

How often can I use the emergency contraceptive pill?

If unprotected sex should occur again, even within the same cycle, it is safe to use the emergency contraceptive pill again if needed. However, a health care provider or clinic should be contacted as soon as possible so that a regular form of birth control can be initiated for ongoing, use. You should not use the emergency contraceptive pill as a regular method of birth control, because:

  • it can be costly and inconvenient
  • it is not as effective as other options for birth control
  • it may expose the woman to higher total levels of hormones
  • it may lead to continued side effects, such as irregular periods or breast tenderness

Are there other options besides the emergency contraceptive pill?5

Another option for emergency contraception is the insertion of the copper intrauterine device (IUD) up to 5 days after unprotected sex or a contraceptive failure. The copper IUD is a T-shaped, hormone-free device that is inserted by a healthcare provider into the uterus to prevent pregnancy.

The copper IUD form of emergency contraception may be a good choice for women who would like to leave the IUD in place as continuous, long-term birth control. Pregnancy should be ruled out prior to insertion of a copper IUD. Women should discuss this option with their physician.

Mirena, an IUD that contains levonorgestrel cannot be used as an emergency contraceptive.

How much do emergency contraceptives cost?

Prices will vary, but in general the cost of one regimen of emergency contraceptive pill runs between $30 and $60 per package. If generics are available, they would typically cost less, and you can ask your pharmacist if a lower cost option is available.

The copper IUD is expensive initially, but if continued as a long-term form of birth control, it can be very cost-effective. It is also convenient, as there is no need to remember to take a pill each day. The copper IUD can be left in place for up to ten years. Some insurance plans may pay for the IUD, as well, so women may want to check with their insurance company. The cost for an IUD, including insertion and office visit, may run between $500 and $1,000.

See Also:

References: Emergency Contraception

  1. Rodrigues I, Grou F, Joly J. Effectiveness of emergency contraceptive pills between 72 and 120 hours after unprotected sexual intercourse. Am J Obstet Gynecol 2001;184:531-7. Accessed June 25, 2012.
  2. Trussell J, Raymond E. Emergency Contraception: A Last Chance to Prevent Unintended Pregnancies. Princeton Univeristy 2012. Acessed June 27, 2012.
  3. Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit. CEU Statement (May 2011). Missed Pill Recommendations. Accessed July 22, 2012.
  4. American College of Obstetricians and Gynecologists. Practice Bulletin. Emergency Contraception. Number 112. May, 2010. Accessed July 22, 2012.
  5. World Health Organization. Media Center. Emergency Contraception. Fact Sheet No. 244. July 2012. Accessed July 22, 2012
  6. Next Choice Package Labeling. Watson Laboratories. August 2009. Accessed July 22, 2012.
  7. Plan B One Step Package Labeling. DuraMed Pharmaceuticals. August 2009. Accessed July 22, 2012.
  8. ella Package Labeling. Watson Pharma. August 2010. Accessed July 22, 2012.

Last updated: 2013-08-27 by Leigh Anderson, PharmD.

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