Plan B: Your Backup Plan

Backup plans are always a good idea, especially when it comes to health concerns like unintended pregnancy – which is why emergency contraception is available in most drugstores across the U.S.!

There is a lot of confusing information and misinformation floating around about emergency contraception, so let’s get clear on what it is, what it isn’t, how it works, and how to make it a regular part of your backup plan.

What is Emergency Contraception?

Emergency contraception can help prevent pregnancy if a safer sex method fails, like a condom breaking or forgetting birth control, or if a condom or birth control wasn’t used in the first place. Some people use emergency contraception along with the safer sex methods [LINK TO ARTICLE 1] they choose for an added layer of risk reduction. That is why many people refer to it as a “morning after pill” and also why it is recommended as a backup plan.

There are three forms of emergency contraception:

Levonorgestrel is the most common and available option, and it is often called Plan B, which is just one brand of many. (Other brands include My Way, Next Choice, and EContra One-Step.) It primarily works by preventing ovulation, which is the process of an egg moving from the ovary to the uterine tube, if it hasn’t already happened. Without an egg present, pregnancy is impossible no matter how many sperm might be present. Levonorgestrel also can thicken the mucus that covers the cervix. It works similarly to how hormonal birth control like the pill, the ring, the patch, or the hormonal IUD work.

Levonorgestrel only works if it is taken within 5 days of exposure to sperm (75% effective) and works best if taken within 3 days (89% effective).¹ If someone takes it and they have already ovulated, then it will not work. If someone takes it and they are pregnant without realizing it, levonorgestrel will not impact or end the pregnancy.

Levonorgestrel is available over the counter in the U.S., which means it can be purchased in drugstores and grocery stores without a prescription and without an age minimum. Some stores make it more difficult to get because they keep it behind the counter and require asking an employee to bring it to you. Some stores unfairly will refuse to sell levonorgestrel because of their own personal beliefs about it. Fortunately, it can be easier to purchase online and have shipped to your home or to a safe place.

KEEP IN MIND:

Levonorgestrel is less effective for people who weigh more than 155 pounds. A 2014 study found that in users who were overweight or obese there was a 5% increase in pregnancy.²
The sooner you take it, the better it works. This is why it’s recommended to buy levonorgestrel ahead of time like you would condoms or lubricant, so it’s there when you need it without delay.
Because it only works if you haven’t ovulated yet and you take it within 5 days, levonorgestrel is not recommended as a replacement for pregnancy prevention methods like birth control or external or internal condoms. (Sometimes it’s the most accessible pregnancy prevention method, though.)
Levonorgestrel may not work as well if you are also taking these medications: the vitamin St. John’s Wort, the antibiotic Rifampin, the antifungal Griseofulvin, certain HIV medications, certain anti-seizure medications, including ones that are also used to treat psychiatric disorders.
Levonorgestrel does not prevent STIs, so if that is important to you, using external or internal condoms is important along with whatever other safer sex methods you use.
There is a lot of misinformation about emergency contraception like levonorgestrel online. Keep an eye out.

Ulipristal is a prescription-only method that has only one brand (as of this posting), which is called Ella. It can also be prescribed and purchased through online pharmacies. It works similarly to levonorgestrel but with a few differences. Ulipristal prevents pregnancy by stopping ovulation if it hasn’t happened already, and may also change the thickness of the uterine lining.
Ulipristal only works if it is taken within 5 days of exposure to sperm (85% effective) and works best if it is taken within 24 hours. If someone takes it and they have already ovulated, then it will not work. If someone takes it and they are pregnant without realizing it, levonorgestrel will not end the pregnancy.³

KEEP IN MIND:

Ulipristal is less effective for people who weigh more than 195 pounds. Taking more than one dose will not increase its effectiveness and is not recommended.⁴
Because it requires a prescription, ulipristal is more difficult to get than levonorgestrel.
The sooner you take it, the better it works. This is why it’s recommended to have ulipristal ahead of time so it’s there when you need it without delay.
Because it only works if you haven’t ovulated yet and you take it within 5 days, ulipristal is not recommended as a replacement for pregnancy prevention methods like birth control or external or internal condoms.
Ulipristal may not work as well if you are also taking these medications: the vitamin St. John’s Wort, the antibiotic Rifampin, the antifungal Griseofulvin, certain HIV medications, certain anti-seizure medications, including ones that are also used to treat psychiatric disorders.
Ulipristal does not prevent STIs, so if that is important to you, using external or internal condoms is important along with whatever other safer sex methods you use.
There is a lot of misinformation about emergency contraception like ulipristal online. Keep an eye out.

The IUD is a prescription birth control method that can also be used as emergency contraception.⁵ The copper IUD is the most common method, but hormonal IUDs can also be used.⁶

It works by preventing pregnancy if it is inserted within 5 days of exposure to sperm. IUDs can lower the chances of getting pregnant by more than 99% if you have not ovulated yet. This is the best option for people who weigh more than 195 and/or have concerns that emergency contraception in pill form might not work for them.⁷

KEEP IN MIND:

The IUD is a T-shaped device that is implanted into the uterus through the cervix, and they can take a few weeks or months to get used to.
The IUD insertion process can be painful, though it’s usually quick. Plan ahead by taking pain medicine or requesting local anesthetic.
Getting an IUD for emergency contraception requires an in-clinic appointment. Depending in where you live, it might take longer than 5 days to get an appointment.
IUDs are long-term birth control options that are 99% effective and last between 3 and 12 years, depending on the type you choose.

So What is Plan A?

For pregnancy prevention, our ideal Plan A is using external or internal condoms combined with prescription birth control, but ideal is not always realistic. Only you can decide what you use, and it often depends on cost and availability. For some people, emergency contraception ends up being the most accessible option for a variety of reasons, despite it being more expensive (if used regularly) and less effective than prescription birth control.

The added benefit of using external and internal condoms as Plan A is that they offer pregnancy prevention and also STI prevention, which emergency contraception like Plan B can’t. And external condoms are low cost and easy to find – sometimes even for free. Plus they don’t require a prescription, doctor visit, or procedure.

There are many options when it comes to preventing unintended pregnancies and we are fortunate to have emergency contraception as one of them. We ultimately have to choose and use the risk reduction and prevention methods that are available to us.

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References:

¹https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-plan-b-morning-after-pill

² https://pubmed.ncbi.nlm.nih.gov/25528415/

³ https://www.ella-now.com/faqs/what-if-i-am-already-pregnant-and-use-ella/

⁴ https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/whats-ella-morning-after-pill

⁵ https://www.cdc.gov/reproductivehealth/contraception/mmwr/mec/appendixj.html

⁶https://www.nichd.nih.gov/newsroom/news/020421-levonorgestrel

⁷https://www.plannedparenthood.org/learn/morning-after-pill-emergency-contraception/how-do-iuds-work-emergency-contraception