Emergency contraception

Examples

Medicines

Progestin

Generic Name	Brand Name
levonorgestrel	Plan B

Combination birth control pills

Generic Name	Brand Name
estrogen and progestin	Alesse, Aviane, Levlen, Levlite, Levora, Lo-Ovral, Low-Ogestrel, Nordette, Ogestrel, Ovral, Tri-Levlen, Triphasil, Trivora

Note:

Plan B is specifically packaged for emergency contraception. You can buy Plan B in most drugstores. If you are 18 or older, you can get Plan B from a pharmacist, without a prescription. Bring proof of your age. If you are younger than 18, you can get Plan B with a prescription from a doctor.

Emergency contraception is used after unprotected sex to prevent a pregnancy from starting. It is most effective when it is used as soon as possible after intercourse. It is not necessary to take a pregnancy test before using emergency contraception.

How to take emergency contraception

Birth control experts recommend having emergency contraception pills, or a prescription for them, on hand in case you ever need them.¹  Emergency contraception is most effective when used as soon as possible after unprotected sex.  Your risk of becoming pregnant increases as time passes.

Two-dose Plan B is the first-choice method for emergency contraception.¹ It requires fewer pills, is slightly more effective, and is unlikely to cause nausea and vomiting, compared with estrogen and progestin pills.

If you are using a type of regular birth control pills (named below), take only the active hormone pills. Be sure to avoid the inactive sugar pills in the pack, which are a different color.

Emergency contraception

Brand name and color of hormone pills	First dose*	Second dose
Plan B (white)—containing levonorgestrel	Take 1 pill.	12 hours (or less) after the first dose, take 1 more pill.
Plan B (white)—containing levonorgestrel	Take 2 pills at once.	None
Ogestrel or Ovral (white)—containing estrogen-progestin	Take antinausea medicine. One hour later, take 2 hormone pills.	12 hours after the first dose, take 2 more pills.
Low-Ogestrel (white); Lo-Ovral (white); Levora (white); Levlen (light orange); Nordette (light orange); Triphasil (yellow); Tri-Levlen (yellow); Trivora (pink)—containing estrogen-progestin	Take antinausea medicine. One hour later, take 4 hormone pills.	12 hours after the first dose, take 4 more pills.
Alesse (pink); Levlite (pink); Aviane (orange)—containing estrogen-progestin	Take antinausea medicine. One hour later, take 5 hormone pills.	12 hours after the first dose, take 5 more pills.
*The first dose may be taken up to 120 hours, or 5 days, after unprotected intercourse.

Intrauterine device (IUD)

As another option, a copper-bearing intrauterine device (IUD) can be inserted within 5 to 7 days after unprotected sex.

Generic Name
Copper T 380-A (intrauterine device)

How It Works

Emergency contraception pills work by preventing ovulation, fertilization, or implantation.

Emergency contraception hormones may prevent fertilization by stopping the ovary from releasing an egg (ovum). They also make the fallopian tubes less likely to move an egg toward the uterus. Emergency contraception is also thought to thin the lining of the uterus, or endometrium. The thickened endometrium is where a fertilized egg would normally implant and grow.

A copper IUD makes the uterus and fallopian tubes produce fluids that kill sperm and prevent fertilization. These fluids contain white blood cells, copper ions, enzymes, and prostaglandins.² As emergency contraception, a copper IUD also prevents an already fertilized egg from implanting in the uterus.¹

Emergency contraception does not protect against sexually transmitted diseases (STDs).

Why It Is Used

Emergency contraception is meant to be used as a backup method for preventing pregnancy. For regular protection, be sure that you have:

• A birth control method that you know you can use every time you have sex.
• Condoms for protection from sexually transmitted diseases (STDs) every time you have sex.

You can use emergency contraception if you are not confident that you were protected against pregnancy during intercourse. This can happen if:

• You have unplanned sex without birth control.
• Your usual birth control method fails. For example:
  • A barrier method, such as a condom or diaphragm, has torn or dislodged.
  • You have missed taking birth control pills.
  • An IUD has come out, either completely or partially.
• You are taking other medicines that may affect contraception medicines. These include some antiseizure, antibiotic, and antifungal medicines, and the herb St. John's wort.
• You are raped. Some emergency rooms offer emergency contraception as part of sexual assault care. Others will provide emergency contraception when they are asked for it.

Be sure to plan with your doctor for your birth control needs.

How Well It Works

Emergency contraception effectiveness varies according to the method used.¹

• A copper-bearing IUD is rarely followed by pregnancy—fewer than 1% of users become pregnant (6 out of 1,000).
• Plan B (progestin-only) is rarely followed by pregnancy—about 1% of users become pregnant (12 out of 1,000).
• Combined birth control pills (estrogen and progesterone) are more likely than Plan B to be followed by pregnancy.

The sooner pills are used after unprotected sex, the more likely they are to prevent pregnancy.

Side Effects

Hormonal methods of emergency contraception

Side effects of hormonal methods include the following:

• Nausea or vomiting is most likely when using special doses of birth control pills with estrogen plus progestin. Nonprescription antinausea medicines, such as Dramamine or Pepto-Bismol, can prevent or reduce nausea. Plan B (progestin-only pills) seldom causes nausea, so antinausea medicine is not usually recommended.
  • Caution: If you vomit within 2 hours of taking a dose, call your doctor for advice. You may need to repeat the dose.
• Pregnancy is possible after using emergency contraception. Although your next period may be slightly late, a delay of 3 weeks or longer may be a sign of pregnancy. If this happens, call your doctor to see whether you need a pregnancy test.
• Some women have breast tenderness, fatigue, headache, abdominal pain, or dizziness after taking emergency contraception.

Call your doctor if side effects, such as headache, dizziness, or belly pain, continue for longer than 1 week after using emergency contraception.

IUD method of emergency contraception

Side effects during the first few days after having an IUD inserted include:

• Uterine cramping.
• Vaginal bleeding.

See your doctor if you do not have your period within 21 days after using emergency contraception.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Some pharmacists refuse to fill emergency contraception prescriptions based on their personal beliefs. If this happens to you, ask for the location of a pharmacist who will fill the prescription, or contact:

• http://ec.princeton.edu.
• The Planned Parenthood clinic nearest you, or call 1-800-230-PLAN (1-800-230-7526).

Advantages

All of the methods for emergency contraception effectively prevent an unintended pregnancy after unprotected sex. Each has different advantages.

• Experts recommend Plan B (progestin) as the top choice for emergency contraception. It requires fewer pills, is less likely to cause nausea and vomiting, and is slightly more effective than pills with both estrogen and progestin in them.
• Women who can't take estrogen for health reasons are advised to use Plan B.
• The combination of estrogen plus progestin is the least expensive emergency contraception method and is more widely available.
• Plan B and estrogen-progestin do not help or hurt an embryo if you are already pregnant.¹
• Insertion of a copper-bearing IUD is the most effective and the most expensive emergency method.

Disadvantages

Emergency contraception use is not recommended if you know or suspect you are already pregnant. If you may already be pregnant, see your doctor.

Hormonal

• If you have a history of blood clots, use Plan B, which is a progestin-only pill. (Estrogen makes blood clots more likely.)
• If you are having a migraine headache at the time that you need emergency contraception, use Plan B. Use of estrogen-progestin is not recommended. (Estrogen can start migraines or make them worse.)

If hormonal emergency contraception does not work and a pregnancy develops and grows, there is no known risk to the embryo.¹

IUD

• If you have a pelvic infection, including any kind of sexually transmitted disease (STD), an IUD is not the right emergency contraception for you. Inserting an IUD can spread infection into your uterus and fallopian tubes, causing pelvic inflammatory disease.
• If you have been pregnant for 5 to 7 days or longer, inserting an IUD is dangerous. It can cause a miscarriage and a serious infection in the uterus (septic abortion).
• Inserting an IUD is expensive. But if you are planning to leave it in for long-term birth control, an IUD becomes cost effective as time goes by.

In countries other than the United States, these emergency contraception choices and other choices may be available or regulated differently.

If emergency contraception is not available or you are early in an unplanned pregnancy, talk to your doctor about medical pregnancy care options and/or abortion as soon as possible.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Author:	Bets Davis, MFA	Last Updated: May 22, 2008
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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