Emergency contraception is one of the greatest inventions of all time. The fact that there are several different safe and effective ways to prevent a pregnancy after unprotected sex, a condom break, or failure of another birth control method has been a real game-changer.
However, all forms of emergency contraception rely on getting and using it as quickly as possible. And there are barriers to accessing it, including cost, the need to see a doctor or get a prescription (for some options), and the availability of over-the-counter products.
Now, with the reversal of Roe v. Wade, some retailers are either running out of Plan B, the most well-known brand, or imposing limits on how much you can buy after a surge in demand thanks to the newfound threats to our reproductive rights.
Dr. Barbara Wilkinson, an OB-GYN at Brigham and Women's Hospital and instructor at Harvard Medical School, said it’s a good idea to always have emergency contraception on hand just in case. “I think Plan B is a wonderful drug, and I think it's a great thing for women to have a dose of at home so that they're ready in case they feel like they need it.” (That said, she did recommend always having a contraceptive plan in place, or a plan A, before you get to the point of needing Plan B.)
“A visit with your friendly local neighborhood OB-GYN to talk about long-term contraceptive planning right now I think should be on a lot of women’s to-do list,” she said. She acknowledged that some people want an appointment to make this plan but may have a hard time getting one, which is another reason to explore your options.
Here’s what you should know about emergency contraception, including how it works, when to take it, how much it costs, and what options are out there besides Plan B.
How emergency contraception works
Just as the name implies, emergency contraception is a form of birth control, not a type of abortion. It won’t end an already established pregnancy.
Depending on the type, emergency contraception generally delays or inhibits ovulation or disables or blocks sperm to prevent fertilization.
The only brand most people know is Plan B, which was first approved in 1999 and became available over the counter without age restrictions in 2013. It contains levonorgestrel, a hormone in the progestogen family. It’s a 1.5-milligram pill intended to reduce your chance of getting pregnant if taken within 72 hours of unprotected sex. It does so by delaying or inhibiting ovulation, which then prevents fertilization from taking place, and it’s said to be 75% to 89% effective when used properly. It costs about $50 for that one pill, and it should be available at drugstores like CVS, Rite Aid, or Walgreens, stores like Walmart and Target, and online retailers like Amazon.
Plan B doesn’t contain estrogen, the component of traditional birth control pills that can be dangerous for people who have certain medical conditions, like high blood pressure or a history of blood clots. The side effects of Plan B tend to be mild and can include nausea, dizziness, cramping, breast tenderness, and changes in your period.
Many people are more comfortable buying brand-name versions of products, but Wilkinson said that as long as the chemical formula is the same, you should be fine going with a generic option.
If you thought Plan B was your only option, you might be surprised to find out that there are many other over-the-counter levonorgestrel products. They include Take Action, My Way, My Choice, Aftera, AfterPill, New Day, and others.
These identical alternatives also have the added bonus of being less expensive, ranging from $15 to $40.
If your birth control fails and you are able to schedule a last-minute visit with your doctor, another option is Ella, which is only available via prescription. It uses a selective progesterone receptor modulator known as ulipristal acetate to do the same job as the levonorgestrel; research suggests it’s even more effective than levonorgestrel and can be taken later, too. Ella can also cost $50 or more, although it may be covered under some insurance plans.
Ella is effective when taken up to five days after unprotected sex, which offers a bit more flexibility than Plan B. As with any emergency contraceptive, the sooner you take it, the better, though Ella has shown to lower your chances of getting pregnant by 85% if you take it within that five-day window.
The problem with both Plan B and Ella, according to Wilkinson, is that it won’t help you if ovulation has already occurred just prior to sex.
“The medication prevents ovulation, and if you have already ovulated that day, then you're sort of stuck,” she said. “That's one reason why there's benefit to thinking about something like the Mirena IUD or the Paragard copper IUD, because those should prevent implantation. So even if the ovulation event has occurred, you may still be protected by the IUD placement.”
The copper IUD is a very reliable emergency contraceptive when placed three to five days after unprotected sex. However, Wilkinson said, newer data has shown that Mirena, a levonorgestrel IUD, can work just as well when it’s placed in that same time frame. It can cost $500 to $1,300 to get an IUD if you don’t have insurance, although some health centers like Planned Parenthood can help reduce the cost.
“I would consider that as an excellent option if you can get in to see a physician,” she said. “And that would also give you longitudinal contraception moving forward, which would be excellent.”
What is the Yuzpe method of emergency contraception?
One option that Wilkinson mentioned is known as the Yuzpe method of emergency contraception. It involves taking a higher dose, or several pills, of regular birth control to match the level of levonorgestrel in branded emergency contraception products.
“This requires some math, some resourcefulness, and preexisting access to combined oral contraceptive pills,” she said. “It essentially involves taking several days’ worth of traditional estrogen- and progesterone-containing birth control pills to approximate 100 micrograms of ethinylestradiol and 0.5 milligrams of levonorgestrel or another progestin, and then repeating that dose 12 hours later.”
There are charts available online outlining how many pills you should take with the most commonly used brands.
Though this method can work for resourceful patients with limited options, she wouldn’t recommend it if other forms of emergency contraception are available since it’s less effective and has more side effects.
Where to get emergency contraception
Aside from potential drugstore stock issues with Plan B and its generic kin, there are some other limitations to obtaining emergency contraception. For example, you need to be able to schedule an appointment with a physician to have any IUD placed, which may be difficult if it has to be on short notice.
For Ella and even the Yuzpe method, you also need access to a doctor who can write you a prescription. However, if you’re not able to see a doctor in person, there are some apps and websites that allow you to videoconference or chat with a prescribing physician.
For many women, a virtual visit with a qualified physician can be a safe way to obtain emergency contraception, Wilkinson said.
While she can’t speak to the quality of any of these services in particular, she said she has had many patients use them to get started on birth control before they can get an appointment at her practice.
When it comes to over-the-counter emergency contraception, Nurx offers overnight shipping in certain states, and Wisp can have a generic 1.5-milligram levonorgestrel tablet delivered to you in three to five days. A reproductive health company called Stix also makes its own levonorgestrel pill called Restart with free overnight shipping.
Another service offering a levonorgestrel pill is Favor, formerly known as the Pill Club. Favor accepts insurance, which could be hugely helpful for those who are covered.
The moral of the story is that things are bad and likely to get worse when it comes to reproductive rights, but for now there are available outlets to access emergency contraception when your go-to Walgreens is sold out or enforcing limitations.