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Emergency contraception

Definition

Emergency contraception is a birth control method to prevent pregnancy in women. It can be used:

  • After a sexual assault or rape
  • When a condom breaks or a diaphragm slips out of place
  • When a woman forgets to take birth control pills
  • When you have sex and do not use any birth control
  • When any method of birth control is not used correctly

Alternative Names

Morning-after pill; Postcoital contraception; Birth control - emergency; Plan B; Family planning - emergency contraception

Information

Emergency contraception most likely prevents pregnancy in the same way as regular birth control pills:

  • By preventing or delaying the release of an egg from a woman's ovaries
  • By preventing the sperm from fertilizing the egg

The two ways you may receive emergency contraception are by:

  • Using pills that contain a man-made (synthetic) form of the hormone progesterone called progestins. This is the most common method.
  • Having an IUD placed inside the uterus.

CHOICES FOR EMERGENCY CONTRACEPTION

Two emergency contraceptive pills may be bought without a prescription.

  • Plan B One-Step is a single tablet.
  • Next Choice is taken as 2 doses. Both pills can be taken at the same time or as 2 separate doses 12 hours apart.
  • Either may be taken for up to 5 days after unprotected intercourse.

Ulipristal acetate (Ella) is a new type of emergency contraception pill. You will need a prescription from a health care provider.

  • Ulipristal is taken as a single tablet.
  • It may be taken up to 5 days after unprotected sex.

Birth control pills may also be used:

  • Talk to your provider about the correct dosage.
  • In general, you must take 2 to 5 birth control pills at the same time to have the same protection.

IUD placement is another option:

  • It must be inserted by your provider within 5 days of having unprotected sex. The IUD that is used contains a small amount of copper.
  • Your doctor can remove it after your next period. You may also choose to leave it in place to provide ongoing birth control.

MORE ABOUT EMERGENCY CONTRACEPTIVE PILLS

Women of any age can buy Plan B One-Step and Next Choice at a pharmacy without a prescription or visit to a health care provider.

Emergency contraception works best when you use it within 24 hours of having sex. However, it may still prevent pregnancy for up to 5 days after you first had sex.

You should not use emergency contraception if:

  • You think you have been pregnant for several days.
  • You have vaginal bleeding for an unknown reason (talk to your provider first).

Emergency contraception may cause side effects. Most are mild. They may include:

  • Changes in menstrual bleeding
  • Fatigue
  • Headache
  • Nausea and vomiting

After you use emergency contraception, your next menstrual cycle may start earlier or later than usual. Your menstrual flow may be lighter or heavier than usual.

  • Most women get their next period within 7 days of the expected date.
  • If you do not get your period within 3 weeks after taking emergency contraception, you might be pregnant. Contact your provider.

Sometimes, emergency contraception does not work. However, research suggests that emergency contraceptives have no long-term effects on the pregnancy or developing baby.

OTHER IMPORTANT FACTS

You may be able to use emergency contraception even if you cannot regularly take birth control pills. Talk to your provider about your options.

Emergency contraception should not be used as a routine birth control method. It does not work as well as most types of birth control.

Gallery

Intrauterine device
The intrauterine device shown uses copper as the active contraceptive, others use progesterone in a plastic device. IUDs are very effective at preventing pregnancy (less than 2% chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexually transmitted disease. IUDs are prescribed and placed by health care providers.
Intrauterine device
The intrauterine device shown uses copper as the active contraceptive, others use progesterone in a plastic device. IUDs are very effective at preventing pregnancy (less than 2% chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexually transmitted disease. IUDs are prescribed and placed by health care providers.
Hormone-based contraceptives
The pill works in several ways to prevent pregnancy. The pill suppresses ovulation so that an egg is not released from the ovaries, and changes the cervical mucus, causing it to become thicker and making it more difficult for sperm to swim into the womb. The pill also does not allow the lining of the womb to develop enough to receive and nurture a fertilized egg. This method of birth control offers no protection against sexually-transmitted diseases.
Birth control methods
Artificial contraception methods work in different ways to decrease the likelihood that sexual intercourse will result in pregnancy. Barrier methods such as condoms (male or female), diaphragms (with or without spermicide) and sponges (with spermicide) have as their first line of defense the physical blocking of the sperm's entry into the uterus. If sperm cannot get into the uterus it cannot fertilize an egg, and pregnancy cannot occur. An IUD works in a different way, by making the uterus toxic to sperm and by disturbing the lining of the uterus so that it won't allow egg implantation. The hormones in oral contraceptives and hormone implants fool the ovaries into refraining from ovulation, and without a fertile egg, pregnancy will not occur. IUDs and oral contraceptives and hormones may be used as emergency contraception in the case of unprotected sex, but neither one will protect against sexually-transmitted disease.

References

Allen RH, Kaunitz AM, Hickey M, Brennan A. Hormonal contraception. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 18.

Rivlin K, Davis AR. Contraception and abortion. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

Winikoff B, Grossman D. Contraception. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 225.

Last reviewed January 10, 2022 by John D. Jacobson, MD, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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