By Riya Parikh, Temple University School of Pharmacy

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Emergency contraception is a way to prevent pregnancy after unprotected sex or contraceptive failure. Currently, there are three different types of emergency contraception approved for use by the FDA. Continue reading to learn more about their similarities and differences, and most importantly, what kind of emergency contraception is best for you.

What is Emergency Contraception? Why is Emergency Contraception Important?

Emergency contraception is used to prevent you from becoming pregnant if you had sex without any birth control, or if your birth control method failed to work properly. Emergency contraception is an important way to prevent pregnancy and is the only method that shows effectiveness after sex. 

What are the 2 Types of Emergency Contraception?

Currently, the FDA has approved two forms of emergency contraception - oral tablets and intrauterine devices (IUD). There are two different oral tablets: Plan B and ella, and three intrauterine devices: Paragard, Mirena and Lillete, that can be used to prevent pregnancy after unprotected sex. 

Levonorgestrel Options: Plan B vs One-Step vs Take Action vs My Way vs Option 2

Levonorgestrel is a progestin hormone based oral tablet known by different names such as Plan B One-Step, Take Action, My Way, Option 2, Aftera, EContra, etc. It prevents pregnancy after unprotected sex by blocking the release of the egg from the ovaries and can also prevent the embryo from attaching to the uterine wall. 

Taking levonorgestrel within 72 hours (3 days) of unprotected sex or contraceptive failure can be very effective in preventing pregnancy. It is less effective if you take it within 5 days after unprotected sex. Levonorgestrel may not be effective if you weigh over 154 pounds. If you suspect that you are pregnant, levonorgestrel  will not work in stopping the pregnancy. It is not an abortion pill. It does not require a prescription and can be readily purchased over the counter without any age restrictions. 

What is Ella (Ulipristal Acetate)?

Ella is the brand name of the medicine ulipristal acetate. Ella contains a 30 mg dose of ulipristal acetate that prevents pregnancy by causing a delay in release of the egg from the ovaries, so that fertilization cannot occur. Ella delays the process of ovulation by 5 days, and within this duration, all of the sperm dies. You will need a prescription from a medical provider to purchase ella. It can be taken within 120 hours (5 days) of having had unprotected sex, but it is best to take it as soon as you can. It may not be very effective if you weigh over 194 pounds. Similar to levonorgestrel, ella should not be used if you think you are pregnant, since it cannot stop an existing pregnancy, but instead, can cause harmful complications to the fetus.

Intrauterine Devices (IUDs): Hormonal vs Copper IUDs

IUD, known as an intrauterine device, is a small T-shaped device made of flexible plastic that fits inside the uterus and prevents pregnancy by blocking the sperm from reaching the eggs. There are two different types of IUDs approved for use by the FDA: hormonal (Mirena, Kyleena, Liletta, Skyla) and copper (Paragard). 

In addition to blocking the sperm, the hormonal IUDs, like the progesterone hormone in the body, prevent pregnancy by preventing the release of eggs from the ovaries. IUDs are extremely effective contraceptives and work for years even after using them for emergency contraception. IUDs can only be inserted by a healthcare provider. 

When inserted within 120 hours (5 days) of unprotected sex, both hormonal and copper IUDs are over 99% effective in preventing pregnancy, and are fully effective for 7-12 years. Unlike the emergency oral contraceptives such as levonorgestrel and ella, IUDs work very well, regardless of how much you weigh. It is important to note that only the Paragard, Mirena and Liletta IUDs can be used for emergency contraception after unprotected sex. 

Most Common Side Effects of Emergency Contraception: Plan B vs Ella vs IUDs?

Both levonorgestrel (brand Plan B) and ella are very safe for use as emergency contraceptives after unprotected sex and show no long term side effects, or serious reactions. You may experience headaches, nausea, stomach pain, menstrual cramps, tiredness and dizziness, along with a change in how soon you get your period. You may also experience breast tenderness and vomiting. Both Plan B and ella  also have interactions with some anti-seizure medicines that can make them less efficient: phenobarbital, carbamazepine, oxcarbazepine, phenytoin, topiramate, efavirenz, etc. 

IUDs are extremely safe for use and rarely show any serious complications. You may experience mild to moderate pain while having the IUD inserted, and some cramps within the next few days. Paragard can cause you to have a heavier period and more frequent cramps, while Mirena and Lilette may cause your period to be light, irregular, or even absent. The pain and cramping associated with IUDs is temporary and will resolve once the body becomes habituated to the IUD in 3-6 months after insertion.

Does Weight (BMI) Affect Emergency Contraception for Plan B, Ella or IUDs?

Weight does have an impact on how well Plan B pills work in preventing pregnancy. If you weigh more than 150 pounds or have a body mass index (BMI) of over 25, Plan B may not be as effective. If your BMI is between 25-30, ella is very effective in preventing pregnancy. However, if your BMI is 35 or higher, ella will not be effective for emergency contraception. IUDs approved for emergency contraception, such as Paragard, Mirena and Lilette are more than 99% effective in preventing pregnancy in patients, regardless of their weight. 

What Emergency Contraception is Best if You Are Overweight: IUDs vs Ella vs Plan B?

If you are overweight, i.e. weigh over 150 pounds or have a BMI of 25-30, ella or IUD can be extremely effective in preventing pregnancy. If you have a BMI greater than 30 or weigh more than 195 pounds, ella will not be effective. IUDs can be used for emergency contraception at any weight, and are an effective option in overweight and obese people. If you weigh over 150 pounds, or have a BMI between 25-30, Plan B may not be as effective in preventing pregnancy. 

Can Emergency Contraceptives Plan B, Ella, or IUDs Cause Infertility?

Plan B and ella do not affect infertility, and can be safely taken more than one time. IUDs prevent pregnancy for 7 to 12 years, and can be removed from the uterus when you decide to start a family, without long term impacts to fertility after they are removed. 

Will Emergency Contraception Protect me Against Any Sexually Transmitted Diseases/HIV (AIDS)?

No emergency contraception provides protection for any sexually transmitted diseases or HIV and hence safe sex practice, such as using a condom, is necessary. Testing for STI and AIDS should be done after having unprotected intercourse with a partner that may be infected with these diseases.

Can I Use Plan B, Ella and IUDs Together?

Plan B (levonorgestrel) should not be used in combination with Ella due to two different kinds of  mechanisms of actions. Using Plan B and Ella together may lower the effectiveness of emergency contraception.

IUDs are over 99% effective in preventing pregnancy. The use of Ella or Plan B while you have an IUD will not increase the effectiveness of emergency contraception. If you are already pregnant, using or combining any of the emergency contraceptives will not be helpful in stopping the pregnancy. As a result, if you have an IUD, you do not need to use either Plan B or Ella together with the IUD. 

Where Can I Get Emergency Contraceptives?

You can get Plan B over the counter at any superstore, pharmacy, drugstore, and at Planned Parenthood. You can get ella only through a doctor’s prescription at any pharmacy or at Planned Parenthood. You can only get an IUD inserted at a doctor’s office or at Planned Parenthood.