Have you ever had a pregnancy scare? The condom broke in the middle of the action, or you were too swept away (or drunk) to even think about protection? Or you forgot to take your pill? If you aren’t ready to be a parent the rest of your life, or to face decisions about termination or adoption, a pregnancy scare can be terrifying.
The good news is it may not be too late.
Back in the day, we had the morning-after pill, so named for pretty obvious reasons. Now the technical term is emergency contraception, and it isn’t just a pill. There are several options.
First, let me say that you are far better off preventing pregnancy in the first place. Regular use of contraception is much more effective than emergency contraception. Please do not rely on EC as a birth-control method. This information is for that hopefully rare slip-up.
Pregnancy happens when sperm meets egg. This only happens if egg is available, i.e. around ovulation. Ovulation, the releasing of the egg from the ovary, happens about midway between menstrual periods. Pregnancy rates are highest when sex happens one or two days before ovulation. Specifically, pregnancy rates are 15 percent three days before, 30 percent one or two days before, 12 percent on the day of ovulation and near 0 percent after that.
Pregnancy is fertilization of the egg and implantation of the fertilized egg in the uterus lining.
What follows is a brief review of the different types of emergency contraception, how they work and how good they are.
Estrogen and progesterone pills
Regular birth control pills contain both of these hormones, and it is possible to use regular birth control pills as emergency contraception. You basically take several at a time within a few days after the accident. This method, called the Yuzpe regimen, has gone out of favor for a number of reasons. How many pills to take varies depending on which regular birth control pill you are on, and the side effects of taking a lot of estrogen at once are nasty. Oodles of vomiting. I don’t recommend this.
Progesterone pills
You may have heard of Plan B. This, along with Take Action, Next Choice One Dose, AfterPill and My Way, are brand names for emergency contraceptives that are made of levonorgestrel, which is a kind of progesterone. When taken before ovulation, progesterone delays ovulation. This way, by the time the egg drops, the sperm have died, so no pregnancy. This is best used within 72 hours of unprotected sex, the sooner the better. You can get this one without a prescription. Just ask your friendly pharmacist.
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Ulipristal, brand name Ella
This is what is called a progesterone agonist/antagonist. It is stronger and more effective than the progesterone pills. It delays ovulation and also thins the endometrium, or the lining of the uterus, making implantation of the fertilized egg more difficult. This one can be taken up to five days after unprotected sex but again, the sooner the better. You do need a prescription for this one. When you call for an appointment, make sure you tell the clinic what the appointment is for so you get in right away.
IUD
That’s right. You probably think of an IUD as a prevention method and it is, but it is also the most effective form of emergency contraception, up to 99 percent, compared to 50 percent for Plan B and 66 percent for Ella. It can be inserted up to five days after the accident. The IUD works by altering sperm motility, preventing them from getting to the egg. It may also interfere with implantation. The nice thing about this is that you now have a very effective birth control method that is good for up to ten years. Of course this is not a do-it-yourself method, since it goes inside the uterus. You need to see a medical provider. We can do this for you at SHAC. Call 277-3136. Again, let us know why you are calling.
Most women tolerate EC pills quite well, with minimal side effects, but possible side effects include nausea, headaches, dizziness, abdominal pain, fatigue and change in your period quality or timing. You shouldn’t take EC pills if you are taking certain other medications. Ask the pharmacist or doctor. Also, if you are a plus-sized woman with a body mass index greater than 30, EC pills don’t work as well as they do for BMI under 30. If you use EC pills, you can start regular birth control pills afterward if you want.
Plan B costs $35 at SHAC. Ella costs $55 without insurance, and some companies cover it. The IUD costs $574 for the device alone, but since the Affordable Care Act became law, insurance is supposed to cover this as well.
With all methods, you should get a period within three weeks of using EC. If you don’t, you need to check for pregnancy.
In summary, please practice contraception on a regular basis. If you have a lapse, get to the clinic or pharmacy as soon as possible for a pill or an IUD.
Thanks to SHAC Women’s Health Clinic for the info for this article and for all you do for UNM women.
Dr. Peggy Spencer is a physician at Student Health and Counseling. She is also co-author of the book “50 Ways to Leave Your 40s.” Email your questions directly to her at pspencer@unm.edu. All questions will be considered, and all questioners will remain anonymous.
