A Morning-After Pill: How to Choose

Just as oral contraception is often referred to as “The Pill,” even though there are many types of birth control pills, emergency contraception is often referred to as “The Morning-After Pill,” even though there are a number of different pills that serve the same purpose.

The first morning-after pill which was invented, Plan B One-Step, was approved by the FDA as a prescription drug in 1999, and it took a number of years and federal court judges to finally allow it to be sold over the counter, and without age restrictions.

Since the invention of Plan B One-Step, other morning-after pills have been created: Those that contain the same synthetic hormone as Plan B — levonorgestrel — and a non-hormonal pill that contains ulipristal acetate (brand name “ella”) that does require a prescription.

Purpose

The morning-after pill is meant to be used in the event that a woman has unprotected sex, is sexually assaulted, or if the method of birth control used was faulty. Doctors do not recommend using a morning-after pill as your main form of birth control, rather, it should be used only as emergency contraception — hence the brand name, “Plan B.”

How does it work?

The sooner you take the morning-after pill after having unprotected sex, the better. Depending on where you are in your cycle, the pill can either prevent or delay ovulation, or interfere with the fertilization of an egg.

Plan B One-Step versus ella

Plan B One-Step is a progestin-only pill. In addition to being able to be purchased without a prescription, Plan B One-Step is most effective if taken within 72 hours (3 full days) of unprotected sex, while ella is effective up to 120 hours (5 full days) after unprotected sex. There is also some evidence that Plan B One-Step might not be as effective in overweight or obese women, in which case, ella would be a better choice.

It is important to note that neither of these morning –after pills is an abortion pill (also known as Mifeprex or RU-486). In other words, if you are pregnant, these pills do not abort the baby. They only take preventative action. In fact, if you are pregnant, it is recommended not to take ella, since the effects on a developing fetus are unknown. If you take Plan B when pregnant, the fetus won’t be harmed — the pill simply won’t do anything.

If it is important for you to have emergency birth control available, speak with your doctor about which choice is best. While Plan B One-Step is easier to procure, you might want the extra few days of leeway that ella provides. Speak to your doctor about how fast you would be able to get a prescription if necessary.

Effectiveness

Studies have found that when Plan B One-Step (and other progestin-only pills) is taken within 24 hours of having unprotected sex, it reduces your chance of becoming pregnant by 95%. If you take ella within 24 hours of unprotected sex, the risk of pregnancy is about 65% lower than the risk after taking progestin-only pills, making ella the more effective option.

Side Effects

The most common side effects of morning-after pills are nausea, abdominal pain, fatigue, headache, and menstrual changes. If the side effects persist for more than a week, contact your doctor. Or, if you don’t get your period within 4 weeks after you’ve taken a morning-after pill, take a pregnancy test. There is always the slim chance that the pill wasn’t effective.

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