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Using emergency contraception is a lot like changing a tire: You probably don’t spend much time thinking about it until it’s really necessary. While straightforward instructions for how to change a tire are a quick Google search away for those who need them, it’s a little harder to separate the facts from the popular myths when it comes to emergency contraception. Here are seven emergency contraception myths you may have come across and the truth behind them.
Myth #1: There’s only one kind of EC.
When you think of emergency contraception, the morning-after pill might come to mind. But there’s more than one pill form of emergency contraception, and there’s even a non-pill method too.
There are two main types of morning-after pills. Plan B One-Step and its generic versions are available as a single pill containing 1.5 milligrams of levonorgestrel, a form of the hormone progesterone. People in need of EC most commonly rely on this method, according to the American College of Obstetricians and Gynecologists (ACOG). The other form of oral emergency contraception is a 30-milligram pill of ulipristal acetate (ella). Both emergency contraceptive pills reduce the chances of unintended pregnancy by preventing or delaying ovulation.
But there’s another type of emergency contraception that isn’t a pill. Paragard is a copper intrauterine device (IUD) that can also be used as an emergency contraceptive. This tool is implanted in the uterus, where the copper wrapped around it harms sperm so they can’t function well enough to fertilize an egg. In addition to its use as emergency contraception, the copper IUD is recommended as long-term birth control for up to 10 years.
Here’s a lot more detail about how each of these methods works as emergency contraception.
Myth #2: You should take the morning after pill…the morning after you have unprotected sex.
You should actually use emergency contraception as soon as possible for the best odds of preventing pregnancy, even though the maximum recommended usage times vary.
Let’s discuss the oral emergency contraceptives first. Levonorgestrel is recommended for use up to 72 hours after sex. Ulipristal acetate’s recommended use is longer: up to 120 hours (five days) after sex. But you should aim to take either form as soon as you can.
“The most important thing about emergency contraception that I really stress is that the sooner you take it, the better,” Tina Raine-Bennett, M.D., M.P.H., an ob/gyn and senior research scientist at Kaiser Permanente department of obstetrics and gynecology and division of research, tells SELF.
That’s because the sooner you take an emergency contraceptive pill, the sooner it can start working to prevent the hormone surge that triggers ovulation, Kelly Cleland, M.P.H., a research specialist at Princeton University, coordinator of the American Society for Emergency Contraception (ASEC), and consulting associate at reproductive health advocacy organization Gynuity, tells SELF.
Levonorgestrel decreases in efficacy over time and doesn’t work as effectively after a sharp uptick of luteinizing hormone (LH) tells one of your ovaries to release an egg for fertilization. This usually happens around day 14 of a 28-day menstrual cycle. Ulipristal acetate’s efficacy remains stable over the five days after you take it, and it’s more effective than levonorgestrel after that LH increase—but it still works best when taken as quickly as possible.
“Just because we … say these products are good for up to 72 hours or even 120 hours, you don’t know if you have that much time,” Donald Downing, B.S.Pharm., a pharmacist and clinical professor at the University of Washington Seattle, who was part of the team that developed the original Plan B, tells SELF.
This is why experts recommend stocking up on emergency contraceptive pills in advance if you think you’ll ever need them. “Just like having a fire extinguisher in your kitchen in case of a fire, if you are sexually active and want to prevent pregnancy, you should consider having emergency contraception in your bathroom cabinet,” Alison Edelman, M.D., M.P.H., professor of obstetrics and gynecology at Oregon Health & Science University, tells SELF.
As for the copper IUD, like ulipristal acetate, it can be used as emergency contraception up to 120 hours after unprotected sex. It is actually the most effective EC, but experts still recommend getting it as soon as possible after unprotected sex to inhibit as much sperm as you can.
Myth #3: EC causes an abortion.
Emergency contraception is capable of preventing pregnancy, not ending a pregnancy that has already started. The mechanisms of EC are not the same as the pills used in medication abortion, which is approved up to 10 weeks after your last period.
“[Oral] emergency contraception prevents or delays ovulation; if there’s no egg, pregnancy isn’t possible,” Cleland explains. In contrast, medication abortion terminates a pregnancy by reducing the thickness of the uterine lining so an embryo can no longer stay attached, then causing uterine contractions to expel the embryo, the Mayo Clinic explains. Even the copper IUD, which may prevent implantation of a fertilized egg into the uterine lining, does not end implantation that has already taken place.
“There’s a common belief out there that two seconds after you’ve had sex, you’re either pregnant or you’re not,” Downing says. But sperm can live for up to five days in a person’s body after ejaculation, so it can take up to that long for fertilization of an egg to occur. The various forms of emergency contraception can work for different lengths of time in this window to prevent unintended pregnancy—not end one.
“Access to both emergency contraception and medication abortion is important so that everyone can decide when and if to have children, [but] we want to make sure that people understand the difference between these two reproductive health options,” Cleland says.
Myth #4: You need a prescription to get any form of EC.
You can actually get levonorgestrel without a prescription, while ulipristal acetate and copper IUDs both require one.
When the U.S. Food and Drug Administration (FDA) approved levonorgestrel as emergency contraception in 1999, it was prescription-only. Thankfully, that changed in 2013. “There are no restrictions on sales of levonorgestrel emergency contraception,” Cleland says. “Anyone of any age or gender [should be] able to pick it up and purchase it without having to answer questions or show ID.” However, this can be more difficult in practice than it sounds. While levonorgestrel is often in the family planning aisle of pharmacies, sometimes it’s in other areas, like with the period products, which can be confusing. The box may be right on the shelf or kept in a locked box or plastic case that you need a store employee to open, and not all pharmacies will have it in stock at all.
Since ulipristal acetate is relatively new (it was approved by the FDA in 2010) you still need a prescription to get it. You can get this prescription at any age, as long as you can find a provider, Dr. Raine-Bennett says. But a lot of pharmacists and doctors are less familiar with this newer option and may not prescribe or stock it if you don’t ask directly.
Also, some states have enacted laws enabling pharmacists to refuse to dispense emergency contraception. The Guttmacher Institute lays out emergency contraception prescription laws state by state. (These hurdles are part of why experts recommend keeping emergency contraception on hand if you might need it, since trying to find it after sex may use up precious time.)
Finally, you do need to see an ob/gyn for a prescription for the copper IUD, not to mention for an actual appointment to get it inserted.
Myth #5: EC will definitely make you feel really sick.
You may feel nauseated after taking oral EC, but it’s not a guarantee. “The majority of people do not get violently sick or have terrible nausea and vomiting,” Dr. Raine-Bennett says.
In the FDA’s clinical trials for levonorgestrel, 14 percent of people experienced nausea, while 12 percent of those using ulipristal acetate had the same effect. Other possible side effects for oral EC include things like heavier periods, lower abdominal pain, fatigue, headache, and dizziness.
If you do have side effects, Cleland says, they will usually wear off on their own. But if your nausea gets so bad that you vomit within two hours of taking levonorgestrel or three hours of taking ulipristal acetate, you should call your health care provider to find out if you need to take another dose.
Myth #6. Once you take the morning-after pill, you can safely have more unprotected sex.
Both levonorgestrel and ulipristal acetate only work to protect you against getting pregnant from unprotected sex that you’ve already had—not future acts of unprotected sex after taking oral emergency contraceptives. Beyond that, they do not affect long-term fertility.
This makes sense when you think about how sperm can live for up to five days in your body, but EC works best within three to five days after sex. Taking EC and then having unprotected sex in the next few days could mean you miss the medication’s most effective time period. (Unless you’re taking EC literally right before having unprotected sex, which doesn’t make too much sense for a few reasons we’ll discuss below.)
You may need to be even more on top of your regular birth control after taking EC, Downing says. Since these medications can potentially delay ovulation instead of entirely preventing it in that cycle, you might release an egg later than usual, meaning you could still get pregnant after taking EC, Downing explains.
A few quick words on post-EC birth control: You can immediately go on regular hormonal birth control after taking levonorgestrel, Dr. Edelman says, but its progestin may interfere with the action of ulipristal acetate. This is why doctors recommend waiting at least five days after taking this medication before starting hormonal birth control. If you’re already taking hormonal birth control, you should use a barrier method like condoms for the rest of your menstrual cycle after taking ulipristal acetate, according to its prescribing instructions.
(Using the copper IUD as emergency contraception will protect you from pregnancy long-term, but it may still not be safe to have unprotected sex if your partner has not gotten tested, which could leave you vulnerable to sexually transmitted infections. Talk to your doctor for guidance on that front.)
Myth #7: There’s nothing wrong with using the morning-after pill as your long-term birth control method.
Actually, there are a few reasons why this isn’t a great idea, but none of them have to do with long-term health effects. As we mentioned, taking emergency contraception will not harm your fertility. Still, there are better long-term birth control options out there.
“Emergency contraception is a great option for someone who has had unprotected sex, but if you find yourself using emergency contraception frequently and worrying about pregnancy, you can reduce your stress by starting an ongoing contraceptive,” Cleland says.
While there are many types of birth control, they all work to prevent pregnancy every single day, not just after one instance of unprotected sex. When taken according to the prescribing information, birth control that uses the hormones estrogen and progestin (like the combination pill and vaginal ring) reliably suppresses ovulation, thins the uterine lining, and beefs up cervical mucus to obstruct sperm. Progestin-only birth control such as hormonal IUDs and the implant are all about that uterine lining and mucus action. As a bonus, these “set it and forget it” methods are recommended for years, and it’s hard for you to mess up taking them (unless you blow past the recommended removal dates).
Also, trying to regularly use emergency contraceptive pills as birth control can really add up. Both levonorgestrel and ulipristal acetate can run you around $40 to $50 a dose, although that can depend on factors such as if you’re getting brand-name levonorgestrel with a prescription, which may be less expensive. Depending on your insurance, you may be able to get birth control for free or at an extremely reduced cost (including expensive forms, like the copper IUD, which can cost over $1,000 without insurance). Even using condoms during sex every time is cheaper than using oral emergency contraception after each instance of sex.
Now you know the truth.
All of the experts SELF spoke to were keen to spread the word that emergency contraception can be a safe and effective option for people with ovaries who want to exert control over their reproductive futures. Now that you know how to use emergency contraception in a way that gets the best results, consider it a good safety net you can turn to when necessary.
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