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Emergency Contraception (EC)
Emergency Contraception (EC) is one of VP's most frequent topics. This Vulvapedia entry contains comprehensive answers to some of the most common questions about EC.
Contents
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What is Emergency Contraception (EC)?
Emergency contraception (EC or ECPs), also sometimes called the morning after pill (MAP), is a high dose of hormones (usually progestin) taken to help a woman prevent pregnancy when she has had unprotected vaginal intercourse.
"Unprotected" can mean that no method of birth control was used. It can also mean that a birth control method was used but failed - like a condom break, forgotten birth control pills, or sexual assault.
How does EC work?
Emergency contraception works by delivering a short, high burst of synthetic hormones, disrupting the body's cycle. EC delays ovulation, and can alter the development of the uterine lining.
Is EC an an abortifacient?
No, the emergency contraception pill is not an abortifacient.
It is not an abortion pill, nor does it disrupt implantation of a fertilized egg. EC will not harm a pregnancy, but is not recommended for pregnant women.
Princeton University reports:
Use of emergency contraception (EC, "the morning after pill", or the "day after pill") does not cause an abortion. In fact, emergency contraception prevents pregnancy and thereby reduces the need for induced abortion. [...]Emergency contraceptives work before implantation and not after a woman is already pregnant. Additionally this report (PDF) from the Population Council explains studies that suggest EC works primarily to delay ovulation. While it is theoretically possible, there currently exists no evidence that EC disrupts implantation of a fertilized egg.
Does EC cause birth defects?
The general conclusion is that EC does not cause birth defects, although it's hard to say for sure without additional reliable studies.
According to Princeton University:
There have been no reliable studies of births to women who were already pregnant when they took ECPs ("morning after pills" or "day after pills") or following failure of ECPs to prevent pregnancy. However, there are two reasons for concluding that there should be no concern about birth defects.
First, ECPs are taken long before organogenesis (development of organs) starts, so that there would not be a teratogenic (harm to the fetus) effect. Second, studies that have examined births to women who have inadvertently continued to take oral contraceptives after they unknowingly were pregnant have found no increased risk of birth defects.
The FDA removed warnings about adverse effects of oral contraceptives on the fetus from the package insert several years ago.
When can I take EC?
EC is most effective if taken within 72 hours of unprotected intercourse, however it can be taken up to 120 hours after to reduce risk of unintentional pregnancy. EC reduces the risk of pregnancy most when taken as soon as possible - ideally within 24 hours.
Here is what Planned Parenthood has to say about EC effectiveness:
"Progestin-only EC reduces the risk of pregnancy by 89 percent if started within 72 hours of unprotected intercourse. For example, eight out of 100 women will become pregnant after having unprotected sex once during the second or third week of their cycles. But only one woman out of 100 will become pregnant after taking progestin-only EC."
Take note that Plan B, the most commonly prescribed and taken EC in the U.S., is progestin-only. However, in other countries there still exist EC brands that are a combination of two or more hormones. For those brands, they "reduce the risk of pregnancy by 75 percent if started within 72 hours of unprotected intercourse." For these reasons, it may be more beneficial to you to make sure you take a brand of EC that is progestin-only.
What different types of EC are there?
One particular brand of EC, Plan B, is available in the United States. Plan B consists of two .75mg levonorgestrel tablets, taken either together or 12 hours apart, though according to Princeton University, you can wait as long as 24 hours to take the second dose. Both methods are equally effective; it is thought that taking the tablets separately may reduce side effects. Taking them together is recommended primarily to ensure both are taken, as it can be difficult or stressful for a woman to remember the second pill after such a time lapse.
In addition to Plan B, many common oral contraceptive pills can be used as ECPs, although their manufacturers do not label the pills for this use. "Off-label" use of approved medication is legal and commonplace in American medicine.
Further, in February 1997, the FDA declared emergency use of birth control pills, following the Yuzpe regimen, to be safe and effective. At that time, six suitable pill brands were available on the U.S market (FDA, 1997). Currently, approximately 20 brands can be used as ECPs in the U.S.
Who should take EC?
This can be a hard question to answer. We encourage each person to decide her own comfort level with respect to pregnancy risk and to make informed choices in line with that. As a general guideline, the University of Wisconsin-Madison uses this list:
Reasons to consider EC include:
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In addition to determining your risk for pregnancy, there may be some other factors to consider to ensure that Plan B will be a safe and effective choice for you.
EC is appropriate if:
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The basic idea is that if you are worried about the possibility of pregnancy, or if you are not sure whether or not ejaculation did occur, ECPs will not do harm and may do some good, at the very least providing peace of mind.
How do I get EC?
In the U.S., Plan B is now over the counter for women and men 18 and older, due to an FDA ruling. If you are under 18, you can still go to a doctor, clinic, or Planned Parenthood to get a prescription for EC, or get a person who is over 18 to pick it up for you at the nearest pharmacy. If you don't know someone over 18 who can buy it for you, it is a good idea to get a prescription for EC or obtain it before you need it, so that if your protection is compromised you don't have to wait for an appointment before you can take EC. If you are in need of EC and don't have a prescription, visit Planned Parenthood to find a clinic, or visit this Princeton University site to see providers in your area who provide access to EC. You can also visit getthepill.com to order EC online if you are 18 or older.
Even though Plan B is supposed to be over the counter for women over 18, some pharmacists have chosen not to carry the drug for moral reasons. Pharmacists are not allowed to restrict your access to Plan B if they carry it in their pharmacy, but they are allowed to choose not to carry the drug itself. Places like Walgreens have issued statements saying that while they will respect their employees' religious beliefs, "management must take immediate action to ensure that the customer is not inconvenienced and the sale is completed in the store without delay. Comments about personal religious beliefs regarding a customer's purchase should NOT be made to customers or other employees. Engaging in such discussions is a violation of company policy and contrary to company standards for good customer service." It may be in your best interests to make yourself aware of the pharmacies in your area that pledge to carry EC before an emergency actually occurs, so you can obtain it quickly and without difficulty.
According to Princeton's website, "In 9 states (California, Washington, Alaska, Hawaii, New Mexico, Maine, New Hampshire, Massachusetts, and Vermont), legislation had been passed before the FDA's ruling allowing specially trained pharmacists to provide Plan B to women without a doctor's prescription. In addition, a few pharmacists in Montana provide Plan B under collaborative agreement with physicians. Specific pharmacy practices are regulated from state to state. The FDA ruling does not change these existing pharmacy access programs unless those states pass new legislation to change them. In pharmacy access states, women under the age of 18 will still be able to obtain Plan B without a doctor's prescription through specially trained and licensed pharmacists."
EC is also available over the counter in Canada. (Apologies to readers in other locales, we refer you to this site for more information.)
| A Note on Sharing EC
Because sharing of prescription medications is illegal, we ask that VP members not use VP as a platform to share such prescription medications as traditional hormonal birth control pills, patches, or rings. However, the FDA's August 2006 decision treats Plan B itself as an over-the-counter substance. It is because Plan B is now considered an over-the-counter medication, and because it is legal for adults to share over-the-counter substances with one another that VP can recommend organizations that dispense EC. |
Minors in the US can get EC without parental consent.
The price of EC varies--it can be free through some programs, and can cost up to $40 at a retail pharmacy.
What are some common side effects of EC?
EC is known to make menstrual cycles wonky. It can cause your period to come early or late. It can make your period heavy and crampy, or light and pain-free. It can cause typical hormone-induced side effects, including breast tenderness, headaches, fatigue and moodiness. EC may make you nauseous--if you are concerned, eat a light meal just before taking EC, or consider taking an anti-nausea medication.
These kinds of side effects are all normal and to be expected. Much less common, more severe side effects include severe abdominal pain, chest pain, shortness of breath, eye problems such as blurred vision, severe headaches, severe pain or numbness of the arms or legs. These kinds of severe side effects warrant medical attention--these kinds of things are why emergency rooms and urgent care centers exist.
You should have a period within a month of taking EC. If you miss your period, consult your doctor or clinic for follow-up care. It's possible, however, for some menstrual irregularities--such as the timing, length, heaviness, and crampiness of periods--to continue past the initial period for a few cycles though this is not something all women experience.
What do I do after I take EC?
You need to choose an ongoing method of birth control. EC will work to reduce the risk of pregnancy from the incident you are concerned about, but will not work for future sexual encounters. Taking EC on a Sunday and having unprotected intercourse on the following Tuesday is a Bad Idea (capital letters and all).
If you and your partner choose condoms, be sure that you're using them correctly. Most condom breakage and error stems from improper use or storage (cool dry place!).
If you feel that hormonal birth control is right for you, contact your local Planned Parenthood, doctor, or other reproductive health clinic. You may also benefit from reading our Hormonal Birth Control FAQ --it answers alot of common questions about HBC.
If you are on hormonal birth control, missed pills or took them incorrectly and that is why you are seeking EC, consult your medical provider about the missed pills, and make a plan that works for you for the future. There are non-pill birth control options that may work with your life more conveniently than the pill.
If you are a survivor of sexual assault and that is why you are seeking EC, we encourage you to visit VP's Crisis Help.
Do I continue taking my regular hormonal birth control as normal?
Yep. According to The INFO Project from the Johns Hopkins School of Public Health, a "continuing user [of hormonal birth control] who needed ECPs due to error can resume use as before."
If you're using a contraceptive patch (like Evra or Ortho Evra), the same site recommends starting a new patch. Users of all types of HBC are advised to use a back up method for 7 days.
Further Reading
- Princeton University
- Planned Parenthood
- 4woman.gov
- Feminist Women's Health Center
- emedicinehealth.com
On LiveJournal
- VPers on EC
- Emergency Contraception community, "a community for questions about ECP, news about breakthroughs, ways to be involved in making ECP available to everybody, and general discussion."
- Emergency Contraception Access, a community for those seeking to obtain or willing to help others obtain emergency contraception
NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.