Last year, Emergency Contraceptive Pills otherwise known as “The Morning After Pill” was approved by the FDA for over the counter (OTC) sales beginning in August 2013. Since then, there has been some confusion as to how to get it and who can get it in different states. In fact, one state, Oklahoma this over the counter policy has been blocked pending the outcome of litigation. So try not to forget to take your pill in Oklahoma.
How is a responsible vagina owner supposed to know what the policy is in her state? There’s conflicting information even with the most specific of Google searches and a difference of opinion among pharmacists that I’ve asked over the last six months. It’s been very confusing to say the least.
Thank goodness for The Guttmacher Institute whose mission statement is all about promoting reproductive health.
In their latest brief released this month, The Guttmacher Institute provides s a grid of 35+states Emergency Contraception policy. Regardless, if you are in need of Emergency Contraception and you’re under 17 years of age, make sure you call your pharmacy ahead of time to make certain they have Plan B One Step in stock and to find out their age restrictions (if applicable).
So, what if your best friend was in need of Emergency Contraception (EC) or “back-up birth control” would you know what to tell her? Would you know what kind to advise her to get and which is the most appropriate in her circumstance? EC can be a confusing maze to navigate, I’m going to try and break it down as best I can:
First, a few things you might want to be aware of:
1) Emergency Contraceptive Pills (ECP’s) can be purchased and used by people across the gender spectrum as people who don’t identify as female may still be able to get pregnant.
2) If you think you may already be pregnant, ECP’s, will not terminate the pregnancy nor has it been shown that taking an ECP would harm the fetus.
3) Even after taking an ECP you CAN get pregnant. If you have unprotected sex right away, use another method, like a condom, just in case.
4) Some people can have certain side effects like nausea, cramps, headache, etc.
5) Your next period may come sooner or later than expected
6) Some medications and/or alternative medicinal supplements may interfere with the effectiveness of not only your regular birth control pill, but your ECP.
7) The sooner you take an ECP the better they work.
WHAT EMERGENCY CONTRACEPTIVES ARE NOT:
1) Emergency Contraceptives are NOT meant to be birth control. EC’s should not be used in place of standard birth control methods and ONLY as a back up incase you forget your daily pill, forget to insert your ring, the condom breaks, etc.
2) Emergency Contraceptives are NOT the same thing as the “abortion pill.” Emergency Contraceptives work by delaying ovulation. The “Abortion Pill” or RU-486, otherwise known as the brand Mifeprex works by literally terminating an early pregnancy.
3) EC’s will NOT protect you from HIV/AIDS or STI’s. End of story. Always use a barrier method such as a male or female condom if you want to protect yourself from infection.
Now that that’s out of the way, let’s get to the good stuff. Here’s a some basic information that might make choosing what kind of Emergency Contraception works best for you (or your best friend), easier. Of course, don’t take my word for it … always read the full directions and contraindications that come with any medicine to make certain that the drug is safe for you:
NAME: Plan-B One Step - Emergency Contraception Pill
AVAILABLE: Over the counter without a prescription or proof of age*
KIND: Levongestrel/Progestin based meds
WHAT IS IT?: Levongestrel is the effective ingredient in this ECP. It works by suppressing ovulation and therefore inhibiting fertilization. Plan B-One Step is the only form of ECP that is currently available for sale to anyone, regardless of age or gender over the counter at a pharmacy without a prescription. There are generic options, Next Choice, My Way, One Dose, Postinor (which will soon be available at your pharmacy) but these are currently only available from your doctor, clinic or other health care provider and only if you are 17 years old or older.*
If your pharmacy or health care provider gives you ECP’s which contain 2 pills (usually Next Choice or even an older version of Plan B), take both pills together. The Association of Reproductive Health Professionals (ARHP) recommends that you take the pills immediately and at the same. This method has been proven safe and effective by the ARHP and numerous studies.
WHAT YOU NEED TO KNOW: You need to take this within 3 days/72 hours of unprotected sex. In fact the sooner you take it, the more effective it is, as each day you wait the potentcy declines. Taking Plan B et al after 3 days/ 72 hours, the product cannot be guaranteed to work effectively (although it has been known to work for up to 120 hours/5 days).
If you have a BMI of 25 or over, or weigh more than 155- 165 lbs, this may not the Emergency Contraceptive for you. Recent studies done in Europe have shown that the efficacy of the pill wanes for women beyond this measurement, in fact it the risk of pregnancy is three times greater than with women under a BMI of 25, which sucks, because about half of the fertile women in the U.S. fall into this range.
Used as instructed Plan B and other Levongesterel based ECP’s have an 88% effective rate.
NAME: ella – Emergency Contraception WITH a Prescription
AVAILABLE: With a prescription. Prescription and purchase can be done on the ella site.
KIND: ulipristal acetate – progesterone receptor
WHAT IS IT?: You do need a prescription for ella, but that is relatively easy to get from a health care provider, Planned Parenthood or even ella’s own website. KwikMed.(which ella’s website will direct you to) will allow people
WHAT YOU NEED TO KNOW: You do not need to show proof of any age to get a prescription from one of their doctors online, and overnight ella to you. ella is the only ECP that is approved to be taken up to 5 days after unprotected sex, and it’s effectiveness is the same on the fifth day as it is on the first. This is great news, as sperm can live up to 5 days inside the body. ella is also considered to be more effective than the over the counter Plan B One Step or Levongestrel ECP’s.
ella does have a weight/BMI warning and though it’s a little more forgiving than other ECP’s. For ella to be effective you must not have a BMI over 35 or have a weight (approx.165 lbs or more). If you weigh over 175 lbs. contraceptive efficacy is reduced if you weigh 165 or more and was not effective in women weighing 176 or more.
NAME: The Yuzpe Method (Combined Birth Control Pill Method)
AVAILABLE: Prescription from healthcare provider
KIND: Progestin & Estrogen
The Yuzpe Method is taking a combination of certain monthly birth control pills in specific amounts and in a specific order. This method can be up to 75% effective, if taken as instructed within 72 hours of unprotected sex. You need to see your healthcare provider before you try this one, as only certain birth control pills are viable for emergency contraception.
WHAT YOU NEED TO KNOW:
You will need to use a back-up method, like condoms to guard yourself against pregnancy, especially if your usual method of birth control is the pill.
NAME: Paragard Copper IUD (Intrauterine Device)
AVAILABLE: Must be inserted by a Medical Provider
KIND: Copper Intrauterine Device (non-hormonal)
WHAT IS IT? Paragard, is a copper IUD (intrauterine device) which does not contain any hormones. Paragard is, by far, the most effective option for anyone who needs Emergency Contraception, or as a regular means of contraception regardless of weight. The copper IUD 99-100% effective—meaning it prevents at least 99 out of 100 pregnancies that normally would have occurred. Paragard it can be inserted up to 5 days after unprotected sex with the same effectiveness on Day 5 as on Day 1. No other IUD on the market works as Emergency Contraception - Mirena and Skyla, cannot be used as an emergency contraceptive. ParaGard is the only copper IUD available in the U.S. and prevents pregnancy for up to 10-12 years after insertion.
WHAT YOU NEED TO KNOW: Some women experience cramping, heavy and longer periods and have spotting in between periods after the IUD is inserted, but for most women, this usually goes away within 2-3 months as your body adjusts to the IUD. It’s important to note, that other hormone containing IUD’s, like Skyla & Mirena cannot be used for emergency contraception. Also, something to consider with the copper IUD is that some women report that their periods have a slightly heavier flow than they’re used to and that cramping can be more pronounced than before.
Women who might not be a candidate for an IUD would be women who are allergic to copper, women with abnormalities of the uterine cavity (ie; T-shaed uterus), inflammation/infection of the pelvis or cervix, some types of endometriosis or a rare disorder called Wilson’s disease that stops the body from getting rid of copper. However, you should always check with your medical provider if you have any concerns about your candidacy for an IUD. When getting your IUD inserted, ask your doctor if he/she will be using an analgesic to ease the discomfort, if not you can certainly askParaguard does not stop your period. In fact it can give you longer periods. However, it’s the perfect choice for women who are sensitive to hormones, who want sexual spontenaity, women who want their natural menstrual cycle and it’s a birth control method that is easily reversible.
*** If you’re a trans man who takes hormones, you should talk with your doctor and see what they recommend when it comes to taking emergency contraception. Unfortunately, right now there isn’t enough research that tells us how hormonal EC will affect you, so your best choice may be the non-hormonal ParaGard IUD.
More on Emergency Contraception:
Bedsider has an EC search with locations providing EC if you’re not sure where to get it in your area.
New rules for Emergency Contraception: CLICK HERE
To find out where to get contraception, CLICK HERE
* This chart from the Guttmacher Institute shows what most individual states allow regarding OTC sale of Emergency Contraceptives CLICK HERE
To see a video on how ECPs work, see below:
Not 2 Late: www.not-2-late.com
Most recent published paper on Emergency Contraception by Princeton: http://ec.princeton.edu/questions/ec-review.pdf
Planned Parenthood – Weight and EC:
Healthcare in Our Hands: http://ecotc.tumblr.com
FDA Data on ella: http://www.accessdata.fda.gov/drugsatfda_docs/label/2012/022474s002lbl.pdf
Guttmacher Institute on EC as of 2/14: http://www.guttmacher.org/statecenter/spibs/spib_EC.pdf
Bedsider.org on EC: http://bedsider.org/methods/emergency_contraception#alternatives_tab
Quick YouTube video from AsapSCIENCE: