What You Should Know About the Morning-After Pill

You probably think of emergency contraception as the “morning-after pill,” but that’s actually a bit of a misnomer. There are different kinds of emergency contraception that a woman can use as many as five days after unprotected sex, and some of them aren’t actually pills.

Ob/Gyns don’t recommend using emergency contraception as a primary form of birth control, but in an unexpected or emergency situation, there are options.

Ob/Gyn Diedre McIntosh, MD, addresses some common and important questions.

Q: What are options for emergency contraception?

A: There are currently four available methods:

• Levonorgestrel (Plan B One-Step ® and generics). These pills contain a synthetic hormone called progestin and are available over-the-counter. They prevent pregnancy by delaying the release of the egg from the ovary to prevent fertilization. They will not work if you are already pregnant.
• Ulipristal acetate (ella®). This medication also suppresses or delays ovulation but is only available by prescription. It will not work if you are already pregnant.
• Copper-releasing IUD. Once it’s placed in the uterus by a healthcare professional, it offers additional pregnancy protection for as long as you keep it in, up to 10 years.
• Yuzpe regimen. This method calls for a woman to take multiple birth control pills that total 100 mcg of estrogen and 1 mg of progesterone twice in a 12-hour period. It is the least effective method of emergency contraceptive, and will not work if you are already pregnant.

Q: How long can you wait to take the morning-after pill?

A: It’s ideal to take Plan B One-Step® within 72 hours (that’s three days) of having unprotected sex. You can take it up to five days after, but there’s a higher failure rate the longer you wait. Ella® can be taken up to five days later without a drop-off in effectiveness.

The copper IUD can also be placed up to seven days later. The Yuzpe method is best used within three days of unprotected sex.

Q: How does the copper IUD work as an emergency contraceptive?

A: It’s the most effective form of emergency contraceptive. It causes an inflammatory reaction in the uterus, so it creates an unfavorable environment for sperm and for implantation to occur.

The one big difference with the IUD is that it could disrupt a good pregnancy. If a woman is considering a copper IUD and has had abnormal periods, she should make sure to do a pregnancy test first.

Q: Can the morning-after pill make you spot?

A: Yes. Emergency contraceptive pills tends to delay ovulation, so you might have a delay in your regular menstrual cycle and have irregular bleeding for that first month afterward.

Q: Can the morning-after pill make your period late?

A: Yes, you might find that your period is pushed back one or two days.

Q: Does the morning-after pill make you sick?

A: It can make people nauseous, but most people tolerate it pretty well. If you vomit within an hour of taking it, contact a healthcare professional.

Q: Can you take the morning-after pill twice in one month?

A: You can take it more than once a month, but we do not recommend using it as a main form of birth control – not only because of the cost but because you will have irregular cycles.

Additionally, with the pills there’s a higher failure rate the greater your BMI. So for women with a BMI over 30, those medications will be less likely to be effective.

Your Ob/Gyn can help you find the most appropriate contraceptive option for you.