Emergency Contraceptives

November 23, 2022 | Written by Rheanna Summer (She/Her)

Here at Marlow, we’ve chatted a lot about birth control – which is pretty sweet. Whether it be a brief history on birth control, the various options to choose from, or tips on how to speak to your doctor about it, the subject of contraceptives is important and understandably valuable to unpack. However, one key aspect to sexual health that has yet to be touched on (by us, at least) is emergency contraceptives. The truth is, this method of preventing an unwanted pregnancy can carry its fair share of shame and stigma. But, for me, the one thing that I find most valuable when writing these sexual health blogs is the hope that I get from breaking down topics that are frequently hush-hush. The fact is, emergency contraceptives are here to stay - we might as well learn about what they are, how they work, and when to use them efficiently and effectively.

There’s Plan A, and Then There’s Plan B

Let’s face it, accidents happen all the time. As uncommon as it may seem, the reality is that condoms can slip or break, we can make a heated in-the-moment decision to not use condoms, birth control can be faulty, and the margin of human error during sex is unfortunately pretty large. And for when pregnancy is just not in the cards for you right now (or ever), Plan B can be a solution for when Plan A goes sideways. Emergency contraceptives, when used properly, can “prevent up to over 95% of pregnancies”. But what does it mean to be used “properly”? Let’s compare and contrast the three primary types of emergency contraceptives found in North America.

In the Market for An Emergency Contraceptive – What Are the Options?

In North America, there are primarily three choices to choose from when considering emergency contraceptives. According to Planned Parenthood’s website, these 3 include specific IUDs that can be inserted within 5 days of having unprotected sex, an oral emergency contraceptive referred to as ella which can also be taken within 5 days of unprotected sex, and Plan B, which is considered to only be most effective within 3 days after having unprotected sex. So, let’s break down the key differences and pros and cons between these 3 different choices and the certain circumstances that could impact their relative effectiveness. 

Comparing and Contrasting Three Forms of Emergency Contraceptives

IUDs as an Emergency Contraceptive

How it works: Post unprotected sex, inserting a copper IUD will stop the sperm from moving any further towards an egg. It is also possible that inserting an IUD will stop an egg entirely from “implanting” into the uterus.

Pros:

• Proven to be the most effective emergency contraceptive: “Less than 1% of women who use the IUD get pregnant”
• Can work “as well on day one as on day five”
• After being used as an emergency contraceptive, IUDs can remain in place as a valid form of birth control

Cons:

• Paragard (the copper IUD) is currently the sole emergency contraceptive offered
• a hormonal one is not currently available as an emergency contraceptive option
• It’s not a very cost-effective solution. IUDs can be quite expensive, especially for those who do not have insurance plans
• Comparatively, it is the most invasive process to undergo as a form of an emergency contraceptive. Insertion is known to be painful for some individuals, and the recovery period can be uncomfortable
• Potential side effects may include more painful and heavier periods and moderate to severe cramps.

ella as an Emergency Contraceptive

How it works: Ella contains ulipristal acetate, which is used to either prevent or delay the release of an egg from an ovary into the uterus. It is a selective progesterone receptor modulator (blocks progesterone). 

Pros:

• Between the two oral emergency contraceptives, this one is the most effective
• You can take up to 5 days after unprotected sex
• Effective for people who weigh up to 195 pounds
• As an oral pill, it is relatively easy to take

Cons:

• Requires a prescription from a nurse or a doctor, making it somewhat less accessible
• Becomes less effective for people who weigh less than 195 pounds
• If breastfeeding, the milk that is pumped must be discarded “for 36 hours after taking [ella]”
• Will not work if you’re already pregnant
• Can only be taken once per month
• Potential side effects may include: headache, tiredness, nausea, stomach / menstrual pain

Plan B as an Emergency Contraceptive

How it works: Levonorgestrel, a derivative of progesterone, is a key component of Plan B. This form of emergency contraceptive works to stop ovulation and prevent fertilization of an already released egg. 

Pros:

• Can be purchased over the counter at a drugstore or pharmacy, no prescription needed
• Most effective when taken within 3 days after unprotected sex, but can still be taken up to five days as well
• Relatively easy to take
• Can take as many times as needed

Cons:

• May not work or be as effective for people who weigh above 165 pounds
• Will not work if you’re already pregnant
• Potential side effects may include: nausea, feeling lightheaded / dizzy, general fatigue, menstrual changes

Keep in mind, emergency contraceptives are not effective against an already fertilized and implanted egg. Once pregnant, emergency contraceptives will not cause an abortion therefore they cannot be used as a method to terminate a pregnancy - emergency contraceptives and birth control can only prevent a pregnancy. While emergency contraceptives are tools which can be used as a means to fix an accident, it is best to look into the various methods of birth control if you are consistently sexually active and looking to consistently prevent pregnancy. Some of the misinformation and misunderstanding that we see today surrounding emergency contraceptives comes down to people believing that they are being used as a valid form of birth control. However, with all of the current birth control options to choose from, this is seldom the case.

Combating Misinformation – One Step (see what I did there) At a Time

At the risk of sounding pessimistic, we are truly living in sad and transformative times. Following the overturn of Roe v Wade, the limit to understanding when life is conceived and who gets to decide these things has been cast into the public realm. Anti-abortion advocates have begun calling on certain contraceptives along with abortion as a whole to be criminalized. There is a general misconception within anti-abortion propaganda that if an emergency contraceptive is taken whilst already pregnant then it will harm the pregnancy. However, thus far there is no scientific evidence to back this claim up. Furthermore, Plan B claims that their emergency contraceptive will stop a fertilized egg from attaching to a uterus. However, anti-abortionists believe that based on “moral grounds”, Plan B is stopping the natural process of life to occur, and some definitions of when life is conceived can be pinpointed to the point before an egg becomes fertilized. Therefore, according to anti-abortionists, Plan B and IUDs could be considered “abortifacients”.  However, this notion could not be further from the truth, given Plan B and IUDs are essentially trying to prevent needing an abortion in the first place.

Don’t Let Misinformation and Anti-Abortionists Stop You

Given that there can be shame and stigma associated with emergency contraceptives, now is more important than ever to combat misinformation in the hopes that people feel less embarrassed or ashamed to access resources like Plan B. As I mentioned previously, accidents do happen! It is simply just a reality of life and being sexually active.  And, in my opinion, it’s amazing that we have resources like these emergency contraceptives to be able to stay in control of our reproductive rights. So next time you are needing a Plan B to your Plan A, seek out support from people you trust. Ask a friend to come with you to your local pharmacy, and then grab a coffee after – make it a day trip. Emergency contraceptives do not need to be intimidating, especially when so many people have experience using them and they are perfectly safe. And, as always, it is best to seek out the advice of a medical professional. Speaking to your local or family doctor may be the most informative, because more times than not, they are able to tell you the facts as opposed to the fiction.