Emergency Contraception

Emergency contraception (birth control after sexual intercourse) is the use of a drug or device to prevent pregnancy after unprotected sexual intercourse. Emergency contraception can be used when a condom breaks, if a diaphragm or cervical cap slips out of place during intercourse, after a sexual assault, or any time unprotected intercourse occurs. Emergency contraceptive pills are sometimes called the “morning-after pill,” but they are usually effective if taken within 72 hours of unprotected sexual intercourse.   

Emergency contraceptives available in the United States include emergency contraceptive pills, which contain the same hormones found in birth control pills, and the Copper T380 intrauterine device (IUD). Both the Preven kit and the Plan B kit are pills marketed as emergency contraceptive pills.

Emergency contraceptive measures can be taken within the first 72 hours after unprotected sexual intercourse to reduce the possibility of pregnancy. A woman is most likely to become pregnant if sexual intercourse occurs in the few days before or after ovulation (release of an egg from the ovary). Emergency contraceptives should not be used as a contraceptive method in women who are sexually active or planning to become sexually active. They are not as effective as any ongoing contraceptive method.

Emergency contraception pills contain high doses of the same hormones that are in birth control pills. The high dose of hormones is short lived. Cases of deep vein thrombosis (blood clotting) have been reported in women using the emergency method. These pills are not designed to terminate an existing pregnancy and should not be confused with Mifeprex, also referred to as RU-486, which is used to terminate (abort) an existing pregnancy. Emergency contraceptive pills are taken in 2 doses, 12 hours apart. The Preven plan consists of 2 doses of pills, each containing a combination of estrogen and progestin, taken 12 hours apart.

The first dose should be taken within the first 72 hours after unprotected intercourse. Some studies show they are effective if taken after that time (up to 120 hours), but they are most effective in the first 72 hours. According to the Reproductive Health Technologies Project, Preven reduces the chance of pregnancy by 75% when used as directed.

Plan B is a progestin-only emergency contraceptive. Plan B should be used within 72 hours of unprotected intercourse. The first dose should be taken as soon as possible after unprotected intercourse, and the second dose is taken 12 hours later. The sooner it is used, the more effective it is. According to the Reproductive Health Technologies Project, Plan B reduces the chance of pregnancy by 89% when used as directed.  

Some other kinds of birth control pills can also be used for emergency contraception. The dosage depends on the brand. Consult your health care provider to learn about options. The sooner after intercourse that emergency contraceptive pills are taken, the more effective they are.

Emergency contraception pills are currently available by prescription only. Contact your health care provider or see the contact information in For More Information if you are seeking emergency contraception. Cost depends on the health care facility, and may be provided on a sliding scale based on income. Prices for emergency contraceptive pills generally range from $8 to $50.

The IUD used for emergency contraception is the Copper T 380A IUD (ParaGard). It can be inserted up to 5 days after unprotected sexual intercourse but should be inserted as soon as possible. The IUD can be removed after your next menstrual period, when it is confirmed that you are not pregnant. You can use the IUD for long-term birth control. The copper IUD can be left in place for up to 10 years for contraception, and it is a reversible form of birth control. Planned Parenthood cites emergency IUD insertion as being 99.9% effective.

After IUD insertion, you may wish to have someone drive you home and to rest afterwards. IUDs should only be inserted and removed by health care professionals. The costs associated with a ParaGard IUD generally are about $400 for exam, IUD, and insertion. This type of IUD can be left in place for up to 10 years.

Emergency contraception prevents pregnancy by stopping or delaying release of an egg (ovulation), blocking fertilization by affecting the egg or sperm, or preventing implantation by making the lining of the uterus inhospitable for pregnancy. Pregnancy is defined by the medical community as implantation of a fertilized egg in the lining of a woman’s uterus, so emergency contraception works before pregnancy has occurred. A pregnancy test is not useful because emergency contraception is used to prevent pregnancy rather than to abort an existing pregnancy. A woman who uses emergency contraception will never know if a pregnancy would have otherwise occurred. Fertility returns with the next cycle unless a birth control method is continued.

In order for emergency contraceptive pills to be effective, they must be taken as directed.

Emergency contraception can be obtained from many private doctors; college, public, and women’s health centers; Planned Parenthood centers; and in many hospital emergency departments. Obtaining emergency contraception quickly is important because the sooner it is used, the more effective it is. A hospital emergency department may provide emergency contraception if you are unable to reach your health care provider or if you have been sexually assaulted. IUDs should only be inserted and removed by medical professionals. Contact your health care provider for an appointment. For a list of providers of emergency contraception, you can call 888-NOT-2-LATE, or for Spanish, 866-en-3-dias.

Your health care provider may wish to meet with you or may be willing to provide a prescription without an office visit. He or she may ask simple questions such as the following:

• Is it possible that you are already pregnant?
  
  
• Do you use any sort of contraception regularly?
  
  
• Is it possible that you have been exposed to sexually transmitted infections?

It is important to be honest with your health care provider.

For an office visit, a physical examination, other than simple vital signs (temperature, pulse, blood pressure), may or may not be performed. Consider testing for sexually transmitted infections if you may have been exposed.

Your health care provider may write a prescription for emergency contraception pills. Take the pills exactly as directed.

For specifics regarding IUD placement, see Birth Control Intrauterine Devices.

Effectiveness: According to Planned Parenthood and the Reproductive Health Technologies Project, if taken within the first 72 hours of unprotected intercourse, emergency contraceptive pills are 75-89% effective in reducing the risk of pregnancy. The effectiveness rate of 75% does not mean a 25% failure rate. Instead, when considering 100 women who have had unprotected intercourse during the middle 2 weeks of their cycle, about 8 became pregnant. If those 8 had used emergency contraception, only 2 would have become pregnant. Emergency contraception pills work best when used as soon as possible after unprotected sexual intercourse. Planned Parenthood cites emergency IUD insertion as being 99.9% effective.

Advantages: Emergency contraception is a safe form of backup birth control if your birth control fails or if you have unprotected sexual intercourse. It is used after intercourse but before pregnancy has occurred. After use, fertility returns to normal unless a form of birth control is continued.

Disadvantages: Common side effects of emergency contraceptive pills are similar to those of birth control pills. They include nausea, abdominal pain, fatigue, headache, and menstrual changes. Breast tenderness, fluid retention, and dizziness may also occur. Many of these symptoms may be less severe with progestin-only or intrauterine forms of emergency contraception. Serious risks include heart attack, blood clots, and strokes. Emergency contraceptive pills do not continue to protect against pregnancy during the rest of the cycle. Emergency contraception may not prevent tubal pregnancy. If you experience severe abdominal pain, contact your health care provider immediately. Tubal pregnancy can be life threatening. Side effects of IUDs used for emergency contraception are the same as those for ongoing birth control IUDs. Emergency contraception does not protect against sexually transmitted infections, nor does it treat existing infections.

Women who should not use emergency contraception: Women who are pregnant, those with undiagnosed vaginal bleeding, and women with an allergy to the product should not use emergency contraceptive pills. IUD use for emergency contraception is not recommended for women who are not in an established monogamous relationship and those who have been raped. See Birth Control Intrauterine Devices for more information about IUDs.

If you experience severe abdominal pain, this could be a sign of tubal pregnancy, a condition that requires emergency medical care. Contact your health care provider immediately.

Emergency contraception pills are not 100% effective in preventing pregnancy, even when taken within 72 hours of intercourse. You still have a risk for pregnancy. You may need follow-up care if your normal menstrual cycle does not occur. Contact your health care provider if you do not have your period within 3 weeks of using emergency contraception or have symptoms of pregnancy.

Contraceptive pills do not provide any protection against sexually transmitted diseases. Consider testing for sexually transmitted infections if the unprotected intercourse may have put you at risk. You may need follow-up care in the next few weeks if you develop any symptoms of sexually transmitted infections, such as pain, itching, sores, or discharge.

Emergency contraception is not as effective as ongoing birth control. It should not be used routinely instead of birth control. If you are sexually active and wish to avoid pregnancy, you may wish to consider using a consistent form of birth control.

Many methods of birth control are available, both by prescription and over the counter. If you have questions about which is best for you, ask your health care provider or contact your local Planned Parenthood (800-230-PLAN).

Wide debate currently exists concerning oral regimens becoming available without prescription (over the counter). As of this writing, an advisory panel to the FDA has recommended that some emergency contraception pill regimens become available without prescription. However, final approval rests with the FDA; that decision is not likely to be made until at least 2005.

Emergency contraception can be obtained from many private doctors; college, public, and women’s health centers; Planned Parenthood centers; and in many hospital emergency rooms.

For a list of providers of emergency contraception, you can call 888-NOT-2-LATE, or for Spanish, 866-en-3-dias.

You can also contact Planned Parenthood. For the center nearest you, you can call 800-230-PLAN.

|Web Links|

American College of Obstetricians and Gynecologists, Emergency Contraception

American College of Obstetricians and Gynecologists, Information on Emergency Contraception Pills (ECPs)

Planned Parenthood, Emergency Contraception

National Women's Health Information Center, Emergency Contraception

Reproductive Health Technologies Project, Emergency Contraception

US Food and Drug Administration, Birth Control Guide

Office of Population Research and Association of Reproductive Health Professionals, Not-2-Late

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Author: Omnia M Samra, MD, Clinical Instructor, Department of Obstetrics and Gynecology, Medical College of Pennsylvania/Hahnemann University.

Editors: Bryan D Cowan, MD, Director, Division of Reproductive Endocrinology, Professor, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.