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Choosing a Birth Control Method

(Updated June 2014)

Emergency Contraception

Description

Emergency contraception can prevent pregnancy after unprotected intercourse. Two forms of EC are available in the United States: pills or the Copper T IUD.

EC Pills

EC pills available in the United States are:

  • Plan B® One-Step – single 1.5-mg levonorgestrel pill
  • Next Choice One Dose® – single 1.5-mg levonorgestrel pill
  • My Way– single 1.5-mg levonorgestrel pill
  • Next ChoiceTM – two 0.75-mg levonorgestrel pills
  • ella® – single 30-mg ulipristal acetate pill

Emergency contraception

Use

  • The product labeling for Plan B One-Step, Next Choice One Dose, and My Way states that one pill should be taken within 72 hours after unprotected intercourse.100 Research indicates that they can be effective up to 120 hours after unprotected intercourse.101
  • ella is approved for use up to 120 hours after unprotected sex. While the effectiveness of progestin-only pills declines with delay in treatment, the effectiveness of ella does not (up to 120 hours).101

Dispelling Myths About Emergency Contraception

It's important for women and their providers to have accurate information about EC.

  • EC pills do not harm an existing pregnancy.102
  • EC pills and the copper IUD for EC do not cause an abortion.107
  • Provision of EC in advance is not associated with an increase in unprotected intercourse.103

Effectiveness*

  • The levonorgestrel formulations are equally effective in preventing pregnancy and have similar side effect profiles.101,104,105
  • When taken 72 to 120 hours after sex, ulipristal acetate (ella) prevents significantly more pregnancies than Plan B; the odds of getting pregnant after taking ella 72 to 120 hours after sex is about half the odds of getting pregnant after taking Plan B during a similar time period.106
  • The effectiveness of progestin-only pills declines with delay in treatment, whereas the effectiveness of ella does not (for up to 120 hours).102

*The exact effectiveness of emergency contraceptive pills is difficult to measure, and some researchers believe the effectiveness may be lower than that reported on package labels. To find out more about studies evaluating the effectiveness of emergency contraception, read our thorough and up-to-date academic review of the medical and social science literature here)

Risks, Contraindications, and Precautions

Given the single-dose nature of EC pills, most experts feel there are no risks considered to be contraindications.

Side Effects

Some women experience nausea, fatigue, and headache.

Advantages

  • Highly effective
  • Discreet

Disadvantages

  • Some products require prescription if younger than age 17 (and for all ages if ella is used). See www.mywaypill.com, www.mynextchoice.com, www.ella-rx.com, or www.planbonestep.com for more information.
  • No protection against STIs

Counseling Messages

  • Patients should obtain emergency contraception in advance and keep it available for use if needed. Visit Not 2 Late for more information.
  • Highly effective reversible on-going contraceptive options are available.

Copper IUD for EC

Use

If the time of ovulation cannot be estimated, the copper IUD can be used as EC up to 5 days after unprotected intercourse. If the time of ovulation can be estimated, the copper IUD can be placed more than 5 days after intercourse but not more than 5 days after ovulation.5 Only the Copper IUD (not the LNG 52 or LNG 13.5 IUS) may be used for EC.

Effectiveness

Copper IUD EC is more than 99 percent effective in reducing pregnancy risk.106, 107

Risks, Side Effects, Contraindications, and Precautions

Given the ongoing use of the copper IUD for contraception after EC use, the risks, side effects, contraindications, and precautions are similar to those described for contraceptive use of the copper IUD (see section on copper IUD). In addition, see the table below.

Medical Eligibility Criteria for for EC Use of Copper IUD*

Category 4

(unacceptable health risk if the contraceptive method is used)

  • Pregnancy

Category 3

(theoretical or proven risks usually outweigh the advantages of using the method)

  • Rape with high risk for STIs

Source: Reference 5

*Refer to the copper T IUC section for a list of contraindications and precautions for ongoing use.

Advantages

  • Highly effective
  • Reversible

Disadvantages

  • Requires placement by trained health care provider
  • No protection against STIs

Counseling Messages

  • The Copper IUD is a very effective reversible on-going contraceptive option.
  • This method does not protect against STIs.