By Dr. Terez Yonan, adolescent medicine specialist at CHOC and Razleen Brar, pediatric resident at CHOC
Compared to other industrialized nations, the U.S. still has one of the highest teen birth rates in the world. Fortunately, these rates have decreased significantly in the last 20 years – this is largely due to the increased availability and ease of prescription birth control.
Another resource available to help prevent unintended pregnancy, emergency contraception (EC) is clouded in misinformation and myths. EC comes in three different forms, all of which help prevent pregnancy when used correctly. The most important things to know about EC are that these methods do not harm an existing pregnancy, do not cause abortion, and do not protect against sexually transmitted diseases.
There are many reasons why one may need EC to prevent unintended pregnancy:
- after unprotected vaginal sex
- condom slippage or breakage that leads to semen exposure
- contraceptive failure
- in the first week of starting a new birth control method if a backup method (condoms) is not used
- missing three consecutive doses of active birth control pills (not placebo or “sugar” pills)
- replacing birth control patch late or patch falling off for more than 24 hours
- forgetting to replace the vaginal birth control ring or leaving it out for more than three hours
- delayed or missed birth control injection
- IUD or hormonal implant (Nexplanon ®) dysfunction
- sexual assault
With each of these instances, EC should be used as soon as possible or within 72-120 hours (3-5 days). EC can also be safely used by transgender men while on testosterone, as testosterone can decrease ovulation but does not work as a birth control method; EC should not alter treatment with testosterone.
Emergency Contraceptive Options
The levonorgestrel pill (1.5mg oral pill: Plan B ®, Plan B One Step ®, Next Choice ®, commonly referred to as “the morning after pill”) is very effective in preventing pregnancy. This method carries limited side effects. This EC is available in most medical offices and by prescription at any age. It is also available over-the-counter without a prescription at any pharmacy to females 17 years or older or males 18 years or older (with proof of age provided). Over-the-counter costs range from $30-60. A pregnancy test is not needed before the use of levonorgestrel.
This pill is about 89 percent effective at preventing pregnancy. It is most effective in the first 72 hours (3 days), but can be used up to 120 hours (5 days) after sex to prevent pregnancy. Its effectiveness is also decreased in those who are overweight or obese. Alternative methods, listed below, are recommended for those whose BMI is over 25.
The effectiveness of levonorgestrel also decreases when someone has had multiple episodes of unprotected intercourse and has used the pill multiple times in the past. EC is not a good option for birth control. Talk to your medical provider about finding an effective method of birth control that meets your needs.
Ulipristal (Ella ®) is more effective than the levonogestrel pill for preventing pregnancy and is an option for those who are overweight or obese (BMI over 25). This EC requires a pregnancy test and a prescription. Ulipristal has increased potential adverse side effect including nausea, vomiting andabdominal pain compared to the levonorgestrel method. If you’re taking this form of EC because your primary method of birth control has failed, the pill, patch, or vaginal ring has to be paused (not taken or used) for five days, as these methods can interfere with this EC’s effectiveness in preventing pregnancy. On day six, birth control can be restarted with condoms as a backup method.
Before the levonogestrel pill or ulipristal were perfected, people were encouraged to use their prescribed oral birth control pills to prevent pregnancy when they needed EC. This was called the Yuzpe method. Medical providers no longer recommend increasing doses of the birth control pill as an EC as this was found to cause uncomfortable side effects, and there are now more effective methods.
The copper intra-uterine device (Paragard ®) is the best option for EC as it is over 99 percent effective at preventing pregnancy when EC is needed, and it provides long-term pregnancy prevention for up to 12 years. It can be used as EC when placed within five days of unprotected sexual intercourse. This IUD is placed by a trained medical provider during an outpatient procedure. Close follow up with your medical provider is a must.
The side effects of this method are few, but include: uterine cramping (which feels like bad menstrual cramps) during and up to 24-48 hours after the IUD is placed, and heavier menstrual bleeding and menstrual cramps for the first two or three menstrual periods after placement. Ibuprofen and heating pads are recommended at-home treatments for these side effects.
Acetaminophen vs. ibuprofen and how to administer both safely
Talk to your doctor for more information and for any questions regarding safe sex practices, sexually transmitted infection testing, birth control options, and emergency contraception. See your medical provider immediately after under protected or unprotected sexual activity for emergency contraception. Your medical doctor may also provide a prescription for emergency contraception to use as instructed in the future.