Emergency Contraception Explained & Compared: Plan B vs. Copper IUD vs. Ella

Emergency contraception operates by disrupting the ovulation process, halting the release of an egg from the ovary. It can also alter the uterine lining, reducing the chance of pregnancy. Importantly, emergency contraception is distinct from an abortion pill; it does not terminate an existing pregnancy.

The three main types of emergency contraception are Plan B, the Copper IUD, and Ella.

Plan B, also known as the morning-after pill, contains a hormone called levonorgestrel. It's most effective when taken within 72 hours after unprotected intercourse but can be used up to five days later. Its effectiveness diminishes over time.

The Copper IUD, a small device inserted into the uterus by a healthcare professional, offers a long-term contraception solution but can also function as emergency contraception. When inserted within five days of unprotected sex, it is extremely effective in preventing pregnancy. Its mechanism involves releasing copper ions that are toxic to sperm, thus preventing fertilization.

Ella, a prescription-only pill in Canada, contains ulipristal acetate, which blocks the effects of key hormones necessary for conception. It remains effective for up to five days after unprotected sex and is considered more effective than levonorgestrel-based pills (e.g. Plan B), especially for women with a higher body mass index (BMI).

What is the most effective type of emergency contraception?

The Copper IUD ranks as the most effective type of emergency contraception, reducing pregnancy risk by over 99%. In the category of pills, Ulipristal acetate (Ella) is slightly more effective than Levonorgestrel (Plan B), particularly when used later in the 5-day window following unprotected sex. However, obtaining a Copper IUD involves a visit to a local sexual health clinic, as pharmacists in Ontario do not provide this service. The Copper IUD's superior effectiveness stems from its ability to create an inhospitable environment for sperm and potentially preventing fertilization. Its immediate insertion post-unprotected sex offers long-term contraception as well.

Morning-After Pills: Ella vs. Plan B

Ella, also known as Ulipristal acetate, is an alternative to Plan B and often favored for emergency contraception due to its higher efficacy. Clinical studies have demonstrated that Ella generally has a lower failure rate, usually between 0.9% to 2.1%. This contrasts with Levonorgestrel-based contraceptives, which show slightly higher pregnancy rates in trials.

Ella's distinct advantage lies in its effectiveness during the initial hours after unprotected sex. Research indicates that Ella's ability to reduce pregnancy risk surpasses that of Levonorgestrel, especially within the first 24 to 72 hours post-intercourse. This heightened efficacy in the critical early period post-exposure positions Ella as a particularly dependable option for emergency contraception.

Can emergency contraception fail?

Emergency contraception is a valuable tool in preventing unintended pregnancies, but it is not foolproof and can fail.

How soon should emergency contraception be taken after unprotected sex?

For optimal effectiveness, emergency contraception should be administered as soon as possible after unprotected sex. Emergency contraceptive pills (ECPs) are more effective the earlier they are taken. Specifically, Levonorgestrel-based pills (like Plan B) should ideally be taken within 72 hours (3 days), whereas Ulipristal acetate pills (such as Ella) can be taken within 120 hours (5 days). The Copper IUD, notable for its high efficacy, can be inserted up to 5 days after unprotected sex.

The timing of these emergency contraception methods is critical. Levonorgestrel pills gradually lose effectiveness as time passes, making prompt usage crucial. Ulipristal acetate maintains its efficacy slightly longer, but its performance is also best within the initial hours. The Copper IUD, due to its mechanism of action, remains a reliable option for up to five days after unprotected intercourse.

Can emergency contraception be used as a regular form of birth control?

Emergency contraception is not intended for regular use as a primary form of birth control. Its effectiveness is lower compared to standard contraceptive methods, and crucially, it does not offer protection against sexually transmitted infections (STIs). This type of contraception is specifically designed for occasional use in situations such as unprotected sex or contraceptive failure.

Regular contraceptive methods, like birth control pills, condoms, or long-term devices like IUDs, not only provide more reliable prevention of pregnancy but also, in the case of condoms, offer protection against STIs. Emergency contraception should be viewed as a backup option, not a routine method. Its role is to provide a safety net in circumstances where regular contraception is either not used, misused, or fails.

How often can you take emergency contraception pills?

Plan B: This emergency contraceptive pill contains levonorgestrel and is intended for occasional use only. While there is no strict limit on the number of times a person can take Plan B, it's not designed for regular contraceptive use. Frequent usage of Plan B can lead to menstrual irregularities, such as changes in the menstrual cycle length and unexpected bleeding. It's also less effective than regular birth control methods and does not protect against sexually transmitted infections (STIs).

Ella: Ella, containing ulipristal acetate, is also meant for emergency use and not as a regular contraceptive method. Similar to Plan B, there's no set limit on how many times Ella can be used, but frequent use can disrupt menstrual cycles and may reduce its overall effectiveness over time.

Can you take EC pills while on birth control?

Yes, it is possible to take emergency contraception pills like Plan B or Ella while on birth control in certain situations. This may be considered in cases where the regular birth control method may have failed or was used incorrectly. For instance, if a dose of birth control pills is missed or a condom breaks, using emergency contraception can provide an additional safety measure against unintended pregnancy.

Plan B: This contains levonorgestrel, a hormone also found in many birth control pills. Taking Plan B while on birth control is safe, but it can lead to temporary side effects like nausea or changes in your next period. It does not impact the effectiveness of your regular birth control.

Ella: Ella contains ulipristal acetate, which can interact with hormonal birth control methods. It's advised to consult with a healthcare provider before taking Ella if you're on hormonal birth control. After taking Ella, you may need to use a backup method of contraception, like condoms, for a short period, as directed by a healthcare provider.

Are there any side effects of taking emergency contraception?

Emergency contraception is generally safe for almost all women to use. It is designed to provide a safe means of preventing pregnancy after unprotected sex or contraceptive failure. However, it is important to note that individual health conditions can influence the type of emergency contraception (EC) that is recommended.

For instance, women with certain medical conditions or who are on particular medications might find one form of EC more suitable than another. The Levonorgestrel pills (like Plan B) and Ulipristal acetate (Ella) may have different interactions or contraindications based on a woman's health history. In contrast, the Copper IUD, being a non-hormonal option, is often a viable alternative for those who cannot use hormonal emergency contraceptives.

Taking emergency contraception can lead to certain side effects, although these are generally mild and temporary. Common side effects include nausea, tiredness, headaches, breast tenderness, and changes in the timing or flow of the next menstrual period. These reactions typically do not last long and are a part of the body's response to the hormones in the emergency contraceptive.

However, it's important to be vigilant for more serious symptoms. Severe abdominal pain after taking emergency contraception can be a sign of a significant health issue, such as an ectopic pregnancy, and requires immediate medical attention. While emergency contraceptives are safe for most women, any intense or prolonged side effects should prompt a consultation with a healthcare provider.

How does body weight affect the efficacy of emergency contraception?

Body weight plays a significant role in the efficacy of emergency contraceptive pills. Studies have shown that for individuals with a higher body weight, particularly those with a BMI (Body Mass Index) over 35, the effectiveness of these pills may be reduced. This reduction in efficacy is a critical consideration for those seeking emergency contraception, as it may influence the choice of method.

In contrast, the effectiveness of the Copper IUD as an emergency contraceptive option is not impacted by body weight. This makes it a reliable choice for individuals of any body weight. The Copper IUD's consistent effectiveness across different body weights is due to its mechanism of action, which involves creating a hostile environment for sperm in the uterus, thereby preventing fertilization.

Can emergency contraception cause an abortion?

Emergency contraception does not cause abortion. Its function is to prevent or delay ovulation, or to prevent fertilization of an egg. It operates by intervening before pregnancy begins. If fertilization and implantation have already occurred, emergency contraception will not terminate the existing pregnancy. This distinction is crucial in understanding how emergency contraceptives work.

The misconception that emergency contraception induces abortion stems from a misunderstanding of its mechanism of action. Emergency contraceptives like Levonorgestrel (Plan B) and Ulipristal acetate (Ella) work primarily by inhibiting or delaying ovulation. The Copper IUD, when used as emergency contraception, may prevent fertilization by creating a spermicidal environment in the uterus. None of these methods affect an embryo that has already implanted in the uterine lining.

Is emergency contraception effective if taken during ovulation?

Emergency contraception's effectiveness can diminish if taken during or after ovulation. Emergency Contraceptive Pills (ECPs) are most effective when used before ovulation. This is because their primary mechanism is to prevent or delay the release of an egg from the ovary. If ovulation has already occurred, the chance of these pills preventing pregnancy decreases.

For instance, Levonorgestrel-based pills (like Plan B) and Ulipristal acetate (Ella) are designed to inhibit or postpone ovulation. Their ability to do so is compromised if the body is already in the process of ovulating or has ovulated. In contrast, the Copper IUD, which can be inserted as emergency contraception, works differently. It creates an intrauterine environment hostile to sperm and fertilization, offering a level of effectiveness that is less dependent on the ovulation cycle.

Therefore, timing plays a crucial role in the effectiveness of emergency contraception, especially for ECPs, underscoring the importance of taking them as soon as possible after unprotected intercourse.

Does emergency contraception protect against sexually transmitted infections (STIs)?

None of the emergency contraception methods offer protection against sexually transmitted infections (STIs). Its primary and sole purpose is to prevent pregnancy after unprotected intercourse or contraceptive failure. This is an important distinction to understand, especially for individuals relying on EC as a method of contraception.

See our FAQ for additional details on emergency contraception.

In Conclusion

It's essential to recognize that while EC is a crucial tool in preventing unintended pregnancies, it is not a substitute for regular contraceptive methods, nor does it protect against STIs. It's crucial to consult with a healthcare provider to determine the most appropriate and safe form of emergency contraception based on their individual health circumstances. Such consultations ensure that the chosen method of EC is not only effective but also aligns with one's overall health needs.

Disclaimer: This blog post is intended for educational purposes only and should not be taken as medical advice. Always consult your healthcare provider for personal health concerns.