Everything You Should Know About Emergency Contraception

Even if you're super careful, even if you always use a condom, even if you're usually so, so great at taking your birth control pill at the same time every day—everyone makes mistakes in the course of their sex-having lives. Condoms can't be perfect every time, sometimes you hit snooze on your daily birth control alarm, things just happen. It's nothing to be ashamed of or freaked out about, especially if you're prepared and know what to do when sex turns into a "where's the nearest Plan B" situation.

To create an easy guide to all the options available for emergency contraception, we spoke with Rebecca Brightman, a New York–based ob-gyn. The three methods available in the United States are arranged in order from most to least effective—although Plan B, the least effective option on the list, is still incredibly effective at preventing an unplanned pregnancy that might result from unprotected sex. And as with any drug, you should be sure to follow the directions that come with each option. This means: don't double up on Plan B or Ella, thinking it'll work better if you take two pills. The only two options that can be used together are the copper IUD and Plan B, or the copper IUD and Ella.

COPPER IUD

Widely praised as a highly effective form of contraception, the copper (or non-hormonal) IUD is also the most effective form of emergency contraception and can be left in for up to 12 years to help prevent future unwanted pregnancies.

How effective it is:

About 99.9 percent if inserted within five days.

If you can have your IUD inserted within five days, it's almost perfect at preventing a potential pregnancy from unprotected sex. And of course the big plus is that it can then be left in for up to 10 to 12 years as your daily form of birth control (the copper IUD is more than 99 percent effective as a birth control method too). Like the pill or basically any form of birth control aside from condoms, though, an IUD won't protect you from STIs, so you'll still need a barrier method.

How it works

The copper in the IUD immobilizes sperm, which keeps it from traveling up the fallopian tubes and fertilizing an egg.

The ParaGard site says the IUD works by interfering with sperm movement—the copper disrupts the way sperm travel (in a little zigzag motion), and makes them immobile and incapable of traveling up the fallopian tube. The copper in the IUD might also affect the chemistry in your uterus, which keeps a fertilized egg from implanting.

What's in it

A small amount of copper and plastic.

To be perfectly clear, the IUD that can be used as emergency contraception in the U.S. is the copper, non-hormonal, ParaGard IUD—not the Skyla or Mirena, both of which contain hormones. What's good about this is that it means the ParaGard is equally effective for all women, regardless of BMI. It's the most effective and best option for women who are obese or have a BMI greater than 35.

When you can use it: Within five days of unprotected sex.

If inserted within five days of unprotected sex, the non-hormonal IUD has about a 99.9 percent effectiveness rate of preventing a potential pregnancy. That's a larger time window and a greater effectiveness rate than Plan B or even Ella—but unlike Plan B, you can't just get an IUD over-the-counter (for obvious reasons).

The IUD is great option for emergency contraception if you're into the idea of using it as your method of birth control afterward, but Dr. Brightman says it's not exactly practical to use only as an emergency contraceptive—it could wind up being pretty uncomfortable and expensive. "I would keep it in for at least one or two full cycles to make sure that a woman isn't pregnant, but also to dissuade her from removing it," Dr. Brightman says. "In theory, after a normal period and a normal negative pregnancy test, an IUD can be removed."

Where you can get it

At your doctor's office (your gynecologist or some general practitioners), your college's health center, or most Planned Parenthood locations.

While you have five days to have the IUD inserted, there's a bit of effort and time involved. You'll need an appointment to have an insertion quickly, which, as Dr. Brightman explains, can be difficult in a lot of places around the country. Some doctors also might require a consultation before you have the IUD inserted. If you can make all that happen within the five-day timeframe, a copper IUD is a great option. But Dr. Brightman says that, just in her practice, she typically encourages people to take Plan B as soon as they can, and then you can always get an IUD if you want that. Because there are no hormones in the copper IUD, you can take Plan B or Ella as well as having an IUD inserted.

How much it costs

        Between $0 and $932.

Thanks to the Affordable Care Act, the ParaGard IUD is free under most insurance plansand Medicaid. If you're unsure whether your insurance covers the cost of the copper IUD, you can call your provider or use Bedsider's insurance guide. If you don't have insurance, a lot of low-cost clinics offer IUDs at a reduced price.

What to expect

No two women have the same exact experience with IUD insertion, but for an idea of how things can vary, you can read how 13 women felt during their own insertions. Some women say insertion (which involves slightly dilating the cervix—the sometimes painful part) feels like "just a pinch," others compare insertion to feeling like someone is shocking their cervix "with a Taser." But either way, insertion lasts only a few seconds and is over and done with for the next 10 to 12 years.

Once the IUD is in, some women say their periods get heavier and cramping is worse; others are unaffected. It really just depends on your body. Most things normalize within six to 12 months, and you're good to go with an almost foolproof method of birth control for a decade.

ELLA

A bit harder to get than Plan B, Ella is a single-pill emergency contraceptive that a doctor can prescribe after you have unprotected sex.

How effective it is

About 93 to 94 percent effective within five days.

It's best to think of Ella's effectiveness in comparison to Plan B's. Both are equally effective if taken with the first 25 hours, but the big difference is that Ella remains just as effective up until day five—two days longer than Plan B is effective.

It's more effective than Plan B, but Ella is slightly less effective in people who are obese or have a BMI greater than 35. The copper IUD is the best option for women with higher BMIs.

How it works

By blocking ovulation for up to five days.

Although it does the same thing as Plan B, the reason Ella isn't available over the counter is because it doesn't just contain progestin like Plan B and its competitors do. Ella contains something called ulipristal acetate, which does the same thing as progestin-only pills but achieves that effect in a different way. Dr. Brightman says the "mechanism of action" is the same in Ella and Plan B, but Ella acts as an "agonist-antagonist." This means that Ella suppresses progesterone, instead of mimicking it like Plan B does. By suppressing your body from releasing progesterone, Ella delays ovulation for up to five days, enough time for sperm to die before an egg is released. Depending on where you are in your cycle, Ella also slightly thins your uterine lining, so a fertilized egg has a harder time implanting and becoming a pregnancy.

What's in it

30 milligrams of ulipristal.

The generic drug name for Ella is ulipristal acetate, which is a drug that suppresses progesterone in your body. It's important to note that, while suppressing progesterone is the same function the abortion pill (mifepristone) has, Ella is not an abortion pill. The two pills have very different dosages. If you're already pregnant and take Ella, it won't terminate your pregnancy and research shows that Ella doesn't cause birth defects if you take it without knowing you're already pregnant.

When you can use it

Within five days (or 120 hours) of unprotected sex.

Where you can get it

Most pharmacies with a prescription, Planned Parenthood, most urgent care centers and emergency rooms, or online through PRJKT RUBY and KwikMed(after an online consultation).

The benefit of Ella is that it's effective two days longer than Plan B, but that benefit comes with a cost—you can't get it nearly as easily as you can Plan B. Dr. Brightman says that if you don't live in a major city where pharmacies are likely to keep Ella in stock, you should call ahead and make sure the pharmacy you're planning on going to has it in stock before your doctor writes the prescription, to save time. A prescription isn't a guarantee that your pharmacy has the pill, and as with all emergency contraceptives, time is of the essence with Ella.

As with Plan B, there are no age restrictions for Ella—anyone can get it. If you're worried about using your parents' insurance to get Ella, consider ordering online from PRJKT RUBY or KwikMed. A nearby Planned Parenthood health center might also have it available at a lower cost. You can always call ahead to check.

How much it costs

At least $50 in most pharmacies, or $67 through PRJKT RUBY and KwikMed.

Because you need a prescription to get Ella, it's likely covered by your insurance, though you should call your provider and check to make sure. The $67 fee through PRJKT RUBY and KwikMed includes next-day delivery, if you're well within the five-day timeframe Ella is approved for.

What to expect

Like Plan B, some women experience a few side effects and others experience none. Some you may expect, in descending order, are: headache, stomach pain, nausea, cramping, tiredness, and dizziness. The Ella website warns that if you become pregnant or have lower abdominal pain after you take Ella, you should call a doctor to rule out an ectopic pregnancy. Also like Plan B, Ella might affect when you get your next period—delaying ovulation means delaying your period. Still, if you don't get your period within three weeks of taking Ella, you should take a pregnancy test to be sure.

PLAN B ONE-STEP

Probably the most well-known form of emergency contraception, Plan B (and other generic, progestin-only emergency contraceptive pills) is a single-dose pill you can take after unprotected sex to prevent pregnancy.

How effective it is

95 percent within the first 24 hours, or about an 88 percenteffectiveness rate, on average, within 72 hours.

According to Princeton University's emergency contraception site, which has researchers dedicated to measuring effectiveness rates of various emergency contraceptive options, the exact effectiveness of Plan B and related pills is hard to measure. Plan B itself says that "about seven out of every eight women who would have gotten pregnant will not become pregnant after taking Plan B," which is about an 88 percent effectiveness rate overall, within the 72-hour timeframe. This does not mean that 12 out of every 100 women who take Plan B get pregnant. It means that if 100 women who absolutely would have gotten pregnant from unprotected sex took Plan B, about 12 of them would likely still get pregnant after taking the pill.

Although this isn't the use it's FDA-approved for, Dr. Brightman believes (and Bedsidersays) you can take Plan B potentially up to five days after unprotected sex, although Dr. Brightman isn't sure what the effectiveness rate is between days three and five. She emphasizes that "you want to take it as soon as possible." But if you are outside of that 72-hour window and don't have access to a doctor who can prescribe Ella (a stronger emergency contraceptive available only by prescription), taking Plan B won't hurt. It just won't be as effective as it would be within the first 24 or 72 hours.

Plan B and other progestin-only pills decrease in effectiveness in people who are obese or have a BMI greater than 35. Ella (the prescription-only emergency contraceptive) is a better option, but the copper IUD is the best option for women with a BMI over 35.

How it works

By interfering with egg transport, initially blocking ovulation, or interfering with implantation of a fertilized egg.

The synthetic hormone in Plan B mimics progesterone and tricks your body into thinking it's pregnant by stopping the release of an egg (preventing ovulation).

What's in it

A synthetic version of progesterone, which is a hormone you have naturally in your body.

On the Plan B box, you'll see that it contains something called levonorgestrel, which is just a long-used, popular type of progestin (a form of synthetic progesterone). Technically speaking, progestin-only pills (like Plan B) were the ones approved for over-the-counter purchase for people of all ages. Dr. Brightman emphasizes how safe these pills are. "The fact that Plan B is so readily available means it's safe, it's very safe," she says, and added that Plan B will "absolutely not" render you infertile if you take it as instructed.

When you can use it: From immediately after unprotected sex to up to 72 hours after unprotected sex.

While Plan B and progestin-only competitors (Next Choice, My Way, Take Action, and several others) all work better the sooner you take them after having unprotected sex, they are approved for use by the FDA for up to 72 hours. So that gives you three days (one day longer than the time it takes to receive something from Amazon Prime) to take the single-dose pill for peak effectiveness.

Where you can get it

Anywhere with a pharmacy—CVS, Walgreens, Rite Aid, Duane Reade, Target, Walmart, and major grocery stores, or online from Amazon, NURX, or Lemonaid. You can also get it at Planned Parenthood and, most likely, your campus health center.

Plan B and its generic competitors are all now available over the counter, without a prescription, to people of all ages in the United States. This is good for a lot of reasons, but one of the biggest ones is that it means you can order or buy Plan B ahead of time, without any pressing reason, just to have on hand in case something ever happens.

Something to keep in mind is that not all pharmacies or stores will always have Plan B or a similar pill in stock. Walmart, Target, and Walgreens all offer the ability to check and see if the pill is available in your local store through their websites. Plan B's website also has a toolthat lets you enter your zip code to find the closest store that has the pill in stock.

How much it costs

Name-brand Plan B ranges from about $32 (on Amazon) to $50 at CVS or Walgreens. Other brands of progestin-only contraception range start around $25 (on Amazon).

You might find that Plan B is generally a bit cheaper online than in stores. Because it's available over the counter, it's highly unlikely your insurance plan will cover the cost without a prescription. However, because of the Affordable Care Act, your insurance will cover emergency contraception like Plan B without a copay if you do get a prescription. Just keep in mind that this will take more time than simply buying it over the counter and prevents you from buying it ahead of time to keep at home in your medicine cabinet.

What to expect

The side effects of progestin (there are just 1.5 milligrams of it in Plan B) vary from person to person. Some women have none, and others may have a few mild symptoms like breast tenderness or a headache. Dr. Brightman says that women might experience light nausea, drowsiness, cramping, or a bit of irregular bleeding, and depending on where you are in your cycle when you take the pill, your period might be thrown off a bit. Because Plan B can block ovulation, you may get your period a few days late (which, I know, is nerve-racking in times like these). Dr. Brightman encourages getting a pregnancy test if you miss your period but says it's "not unusual" to not get your period after taking Plan B, even if it does work correctly.

Source: http://www.elle.com/beauty/health-fitness/a38608/emergency-contraception-guide/