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The Morning-After Pill: Everything You Need To Know About Emergency Contraceptive Pills

You wake up after a drunken hook-up with a frat boy and remember that you forgot to use protection the night before; you forgot to take your birth control pill — again, and realize you left them in your other purse back at the dorm, hours after checking into the hotel for a weekend trip; you notice that the condom broke, but it’s too late — if you’ve ever experienced one of these dreaded realizations, you know the panic that ensues. 

Accidents happen, but thankfully modern medical technology has provided us with a back-up plan, otherwise known as the morning-after pill. Many of us might still have fears and doubts about emergency contraception, so we asked those tricky questions and got the help of birth control experts to give us the answers.

So what is the morning-after pill, exactly?

The biggest misconception about the morning-after pill is that it is equivalent to an abortion. In reality, the morning-after pill prevents pregnancies from happening but does not cause harm to the woman or fetus if she is already pregnant.

Elizabeth Dawes, senior associate of programs and policy for Reproductive Health Technologies Project, a nonprofit organization that advocates for women’s reproductive freedom, explains: “Emergency contraception is often confused with a pill used to induce an abortion. EC [emergency contraception] should not be confused with Mifeprex®, also known as RU-486. EC and Mifeprex® are different drugs. Although ulipristal acetate [the drug found in the morning-after pill called ella] and mifepristone are both antiprogestins, they work differently. Ulipristal acetate, like other EC pills, helps to prevent pregnancy, while Mifeprex® terminates an early pregnancy.”

There are two types of U.S. Food and Drug Administration-approved emergency contraceptive pills: progestin-only pills (like Plan B One-Step and its generic counterparts Next Choice and Levonorgestrel tablets) and an antiprogestin pill with ulipristal acetate, called ella. They both work by preventing the ovary from releasing an egg.

“[Emergency contraception] is more effective in the first half of your cycle, so in the first couple of weeks after your period,” says Dr. Wendy Norman, a researcher at the Women’s Health Research Institute at B.C. Women’s Hospital and Health Centre.

When should you take it?

Despite its name, these pills aren’t strictly limited to next-morning use. Levonorgestrel products like Next Choice and Plan B One-Step can be used up to 72 hours after, and ella can be used up to 120 hours (five days) after unprotected sex. That being said, it is a good idea to take it as soon as possible because the quicker you use it the more effective it is. “There is no reason to delay treatment,” says Dawes.
How do you get it?

You don’t need a prescription for Plan B One-Step or Next Choice. You can get it at your university health center or just request it at the pharmacy and buy it over the counter (as long as you have your ID to prove that you are 17 or over). If you want ella, you will need a prescription no matter what your age. As for cost, it ranges from $35 to $60, according to Dawes, with ella costing approximately $5 to $10 more than Plan B One-Step.

Insurance plans vary, so check with your insurance company to see if your plan covers it. If you’re under your parents’ insurance and are concerned about them finding out, it’s a good idea to call your insurance directly and ask about their confidentiality policies.

Callie, a collegiette at Quinnipiac University, suggests students try getting emergency contraceptive pills through their school health services before going to a pharmacy because, in her experience, it was about half the price. Priya*, a junior at Tufts University, who also got the morning-after pill through her school health services, found the process easy and trouble-free.

Anne*, a collegiette at Douglas College, got Plan B from her local drug store’s pharmacy. “The pharmacist [explained how to use it] but I’m not going to lie, I read the whole [Plan B] website before even heading over to buy it to save myself from the embarrassment.”

How safe is it?

“I took the morning-after pill and had no problems,”
says Callie, who has taken it twice in her life. She has, however, heard various side effect stories from friends who have also taken emergency contraceptive pills. “The side effects from it really range depending on the person and [I] don’t think many people realize there are side effects,” says Callie.

Possible side effects you can experience include: nausea, vomiting, abdominal pain, fatigue, headache, dizziness, breast tenderness and menstrual changes.

Menstrual changes happen because the morning-after pill delays ovulation. You may have irregular bleeding because ovulation was originally meant to be in that cycle but, according to Dr. Wendy Norman, a researcher at the Women’s Health Research Institute at B.C. Women’s Hospital and Health Centre, you should settle into a normal period within the next cycle.

If you vomit within two hours of taking emergency contraceptive pills, call your health care provider; they might advise you to repeat the dose. In order to reduce the chances of nausea and vomiting, some providers suggest taking the pill with food or asking for anti-nausea medicine, according to the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals.

While the only side effect Priya experienced was a moderate breakout of acne on her face, Beth*, a senior at Kwantlen Polytechnic University, experienced a severe breakout of body acne that took a month to clear up. “I took it in March and it gave me the worst acne of my life. I broke out all over my body.” This is possible because the morning-after pill mimics pregnancy and it is not uncommon for pregnant women to have acne breakouts, says Dr. Norman.

Other than the side effects listed, there have been no serious complications associated with Plan B One-Step or Next Choice, according to Dawes. And although ella is a new drug, it has shown no serious side effects when tested in more than 2,700 women.
How effective is it?

“Overall, about eight percent of women for each episode of unprotected intercourse could achieve a pregnancy,” Dr. Norman explains. This depends on various factors such as your age (the younger you are, the more fertile you are), if you have any sexually transmitted infections and which phase you are at in your cycle.

Levonorgestrel pills
About 75 percent of those potential pregnancies could be prevented with the levonorgestrel pills. “Ideally, [if taken] within about six hours of unprotected intercourse, then you have about a three out of four chance of cutting down [your chances of] pregnancy,” says Dr. Norman.

Because it is more effective the sooner you take it, Dr. Norman suggests being prepared in case of an emergency situation in which you might not have quick access to emergency contraceptive pills. “Buy some in advance. Even if you might not need it, you should keep it in your purse in case a girl friend needs it.”

Ulipristal acetate
According to the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals, ella is more effective than the levonorgestrel pill. However, it is more expensive and might take longer to get ella because you need a prescription. Because ella is a newer drug, your pharmacy might not restock it as quickly. Make sure to call ahead of time to see if it’s in stock.

How will you know if you’re pregnant?

When you take a morning-after pill (up to three or five days after unprotected sex), pregnancy tests won’t be accurate so you won’t be able to tell whether or not you’re pregnant. According to Dr. Norman, you will have to wait a week to two weeks to take a pregnancy test.

It’s called Plan B for a reason

Remember that the morning-after pill should only be taken as a back up plan and not as regular birth control. According to the Office of Population Research at Princeton University: Emergency contraceptives are not as effective as birth control that’s used before or during sex, like the [birth control] pill or condoms. So if you are sexually active or planning to be, don’t use emergency contraception as your only protection against pregnancy.”

Besides, you wouldn’t want to experience the side effects every time after sex. It wouldn’t be fun constantly putting up with irregular cycles, nausea during class or abdominal pain on a date. Not to mention that emergency contraceptive pills are more expensive than regular birth control methods. Another thing to remember, says Dr. Norman, is that it doesn’t protect against or cure STIs so your best bet is to use condoms.

Get familiar with the types of emergency contraceptive pills and how they work so that you’ll be prepared, should a panic-filled moment of realization occur. And remember—it’s always a good idea to consult a health professional if you have any questions specific to your health or situation.

*= Name has been changed

Sarah Casimong is a graduate of Kwantlen Polytechnic University, with a bachelor's degree in journalism. She has written for the Vancouver Observer, Cave Magazine and Urban Pie. She is also the scriptwriter for Beautiful Minds Radio on Vancouver Co-op Radio 100.5 FM, and occasionally conducts interviews for the "personal story" segment of the show. In her spare time she enjoys British music and television, playing the Mass Effect and Dragon Age video games and getting lost in really good chick lits. You can follow her on twitter: @sarahcasimong