All About Emergency Contraception
Written By: Bonnie
Emergency contraception (EC) reduces the chance of pregnancy after vaginal contact with semen. It may be used if someone forgets to take their pill, a partner didn’t pull out in time, or a condom breaks or if there was no form of birth control used. Whatever the circumstance, if there’s a chance of pregnancy when it’s not wanted, this is a time when emergency contraception may be useful.
What Is It?
Emergency contraception is different from hormonal birth control (HBC) in that it is only used in cases of accidents, when a person’s normal form of contraception has failed. Unlike HBC, it is not taken everyday. It is a different dose than HBC and is most often used to prevent or delay ovulation, so that the sperm never joins an egg. This is why it’s often called “plan b;” Plan A should be your normal form of contraception, while emergency contraception is a backup plan.
It’s important to note that if contact with sperm happens and someone has already, recently ovulated, most of these forms of emergency contraception are less likely to prevent pregnancy.
Plan B (Active Ingredient: Levonorgestrel)
This is the brand name of the most common form of emergency contraception. It contains a high dose of levonorgestrel, which is a synthetic form of progesterone. The goal is that by taking this dose, it delays ovulation long enough to prevent having the sperm join the egg, avoiding fertilization and causing a pregnancy. It also temporarily thickens cervical mucus, which blocks sperm from being able to enter the cervix (the bottom of the uterus) and traveling upwards to meet the egg.
Plan B most effective within 72 hours (3 days) and moderately effective up to five days after the exposure to sperm, outside of this window it is not effective.
Plan B’s efficacy is 89% if taken within 24 hours, and drops the longer you wait. If someone weighs more than 165 lbs, it can be less effective. Remember, the sooner you take it, the more likely it is to work.
You do not need a prescription for Plan B, and can walk into a pharmacy such as Walgreens and buy it over the counter. It generally runs about $50 for the brand name version (Plan B), but off brand versions contain the same ingredient (levonorgestrel) at the same dose (1.5 mg), and are much cheaper.
Brands such as “My Way” and “Second Choice” are offered on Amazon for as low as $7. Local reproductive justice groups, birthing centers, and mutual aid groups also may be able to supply or reimburse the cost.
Plan B does not last in the body for very long, so it does not have long-term effects.
It can, however, cause temporary side effects, such as breast tenderness, nausea or vomiting, headache, fatigue, dizziness, and lower abdominal cramps. It can also delay a person’s period. If someone takes it and becomes pregnant, it does not have any impact on the pregnancy.
Ella (Active Ingredient: Ulipristal Acetate)
Ella is another form of emergency contraception containing ulipristal acetate, which is a progesterone-receptor modulator. This means that this substance binds to the receptors for progesterone in our body, temporarily changing their activity. The result is that ovulation is delayed or altogether prevented for that cycle.
When used within 120 hours (5 days) Ella is 98% effective, and the sooner it is taken, the more effective it is. It does not list a weight limit, but may be less effective for people weighing more than 195 lbs.
However, Ella requires a prescription, which means that when someone is in a position to need it, the time constraint of making an appointment with a provider and then waiting for the prescription to be filled can be a barrier. It can be helpful to already have on hand – consider it a first aid item and add it to your toolkit ahead of time.
It costs about $50 out of pocket, but less if you have insurance. The side effects are similar to that of Plan B.
Yuzpe Method
This is a DIY method of emergency contraception and involves taking two doses of your combination hormonal birth control pill in one day. Combination HBC means that it needs to contain both estrogen and progestin. The doses should be taken 12 hours apart, and each dose should contain at least .1 mg of ethinyl estradiol and either .5 mg of levonorgestrel, or 1 mg of norgestrel.
You’ll need to check your specific birth control to see if it contains these ingredients, and you’ll have to look at the amount of these ingredients in each pill. You’ll have to calculate how many pills you’ll need per dose to equal the recommended amount of each.
This method is considered to be about 74% effective. If used, the regimen should be started within 120 hours (5 days) of the potential exposure to sperm. The side effects are similar to the above options.
IUDs
Certain IUDs can work as emergency contraception if placed by a healthcare provider within 120 hours (5 days) after the exposure. The Mirena and Liletta hormonal IUDs contain a high enough level of levonorgestrel that they act the way Plan B does–by delaying or preventing ovulation.
Paragard, the copper IUD, does not contain hormones and is considered the most effective Emergency Contraception when placed within 5 days of sperm exposure.
The copper releases ions that are toxic to sperm, slowing or preventing sperm from being able to join the ovulated egg. The copper also causes a low level of local inflammation to the uterine lining, preventing a fertilized egg from being able to implant.
Using an IUD as emergency contraception is about 99% effective.
One reason people choose this option is that not only is it highly effective, but it also provides long-term birth control (up to 10 years) and can be removed anytime the person wishes to become pregnant.
Daucus Carota
Wild carrot, or Queen Anne’s Lace, is a plant that often gets touted as the “herbal plan b.” There’s a lot of conflicting information and scientific studies about it, and the best information out there has come from lived experience and community-based research. We are still learning about how it works, but the current understanding is that it temporarily alters progesterone levels, impacting the integrity of the uterine lining. By doing so, it can prevent the implantation of a fertilized egg into the uterine wall. The seeds and/or flower heads are used, and there are different dosages for each.
While wild carrot can be a helpful ally as emergency contraception, using them comes with nuance. Like the other methods, wild carrot must be taken within 72 hours of potential semen exposure.
It can be hard to source, as most local apothecaries do not carry it, and it can only be harvested during certain times of the year. Ordering it online means there is a wait time for it to be packaged and shipped, so if you think you’d like to work with wild carrot, it’s best to order before it’s needed and keep it in the medicine cabinet to use as soon as possible after exposure.
It's important to remember, it is not realistic to think plants can be substituted for pharmaceutical medicine and expect it to work the exact same way.
Plants contain varying amounts of medicinal constituents depending on the geographical location, seasonal variations of water and weather, the species, and the harvesting method. They are living entities, and plant medicine often works best when we cultivate a relationship with them. It’s important to know that while we have seen many cases of wild carrot being used effectively, it is also the least guaranteed method of emergency contraception, so a backup plan is important. This option is often best used when someone already has it in their toolkit instead of scrambling to find it after the fact.
Order organic, small batch wild carrot tincture here.
The Bottom Line
Emergency contraception can be a helpful option, most effective when someone is aware of when they have ovulated and implemented as soon as possible after sperm exposure.
All of the current options work by either delaying or preventing ovulation, thickening cervical mucus, slowing or killing sperm, and/or preventing implantation. Like normal birth control, all of these options have a failure rate, so it is possible to still need to use a back up option if pregnancy occurs.
If your period is more than a week late from what you expect it to be, following up with a pregnancy test is suggested.
If the pregnancy test is positive, none of the pills mentioned above have been shown to harm the fetus or effect the pregnancy.
Emergency contraception is not a replacement for long term birth control, so if you find that you’re wanting to use it more than once a month, it may be time to figure out a more appropriate form of contraception.
About the Authors:
Bonnie is a clinical herbalist, flower essence practitioner, and full spectrum doula. She practices on the land of the Ute, Arapaho, and Cheyenne out of Denver, CO. She believes that reclaiming our connection to plant medicine and our bodies is a profound act of resistance, and her work focuses on all aspects of reproductive health, with a particular passion for abortion, miscarriage, and birth. She brings herbalism, nutrition, and ritual together to provide a client-centered experience.