Emergency contraception, or the “morning-after-pill” as many call it, is not something that most of us spend much time thinking about in our day-to-day lives. I mean, we know it exists and many of us are very glad that it exists as a potential extra layer of security against unwanted pregnancy, but it’s not generally something we devote much thought to unless a situation arises in which we consider using it. When you consider taking any drug, it’s important to learn as much as possible about the drug and its effects on the body in order to make a fully informed decision. Emergency contraception (EC) is no exception here, however it does present some unique challenges.
Making informed decisions about our healthcare generally requires time: time for research, time for second opinions, time for careful consideration of all your options. When you’re considering using EC, however, time is not on your side — if you’re going to use it you need to do so within a narrow window of time in order for it to be as effective as possible. Most of the time when we hear about EC the advice is that if you think you might need it, think no more and just take it. This can be useful advice at the time if you are truly scared of becoming pregnant, but it also perpetuates the idea that there are no real options to weigh, and no real decision to make.
So what’s the solution?
As much as some women might feel that they don’t need to think about EC, my suggestion is to learn everything you can about EC now before you ever find yourself in a situation where you’re considering using it.
If you’re a woman who is currently having sex through which you could get pregnant, and you do not at all want to become pregnant at this time, then learning about EC is relevant to you (yes, even if you are using a form of birth control). So let’s learn!
Let’s talk first about the different options available for EC. We typically think of there being one “morning-after-pill,” but there are actually two types of pills that can be used for emergency contraception. The type of EC pill that can be purchased over the counter contains levonorgestrel (a kind of progestin that is also found in some types of contraception pills as well as the Mirena IUD). There are several different brands of this kind of EC pill, including Plan B (yes, Plan B is actually a brand name not just another euphuism for emergency contraception). These types of pills can be taken up to 5 days after unprotected sex, but they are thought to be most effective if taken within the first 72 hours.
The other type of EC pill contains ulipristal acetate, a selective progesterone receptor modulator (so it works by acting on the receptors in a woman’s body designed for progesterone). Ella is the only brand of this type of pill available, and it requires a prescription. Ella can be taken up to 5 days after unprotected sex, and unlike the levonorgestrel-containing pills, it is considered to be equally effective whether you take it on day 1 or day 5. Both types of EC pills are thought to prevent pregnancy by preventing or delaying ovulation. So basically if you have already started to ovulate, then the EC pill will not be effective.
There is a third option for EC in the copper IUD, ParaGard. This kind of IUD can be used as emergency contraception if inserted within 5 days of unprotected sex. The copper in the device affects the ability of sperm to swim and therefore their ability to successfully fertilize an egg.
Okay, so that’s how the various methods work to prevent pregnancy, but what other effects do they have on the body?
Both kinds of EC pills can affect your menstrual cycle: you may find your next period comes earlier or later than you’d normally expect, and/or that you have lighter or heavier bleeding than normal. Both types of pills can cause nausea or upset stomach, breast tenderness, dizziness as well as other side effects. ParaGard has its own set of side effects to consider, with the most commonly reported being heavier periods, spotting between periods, and cramps and back pain. Rarer but serious possible side effects include uterine perforation, the device falling out of the uterus, and infection. Unlike the EC pills, once inserted ParaGard is meant to serve as your birth control method for several years, and can only be removed by a health care provider. Since the ParaGard will continue to affect your body long after the initial reason for its insertion is resolved, you’ll want to be very certain that you have considered both the risks and the benefits of the device before choosing it as your EC method.
A commonly asked question about emergency contraception is whether you can take it too often. In an article for Rewire, author Erica Sackin notes that, “From a medical perspective, no. There are no medical consequences to taking emergency contraception more than once.” However she goes on to say that, “The hormone contained in the pill is the same as ones found in the birth control pill — and that naturally occur in your body.”
As noted earlier, the levonorgestrel found in EC pills that are available over the counter is a progestin. It is important to understand that progestins are NOT the same thing as the progesterone that is naturally produced by a woman’s body. Dr. Lara Briden’s article “The Crucial Difference Between Progesterone and Progestins” notes that progesterone and progestins have “vastly different physiologic effects!” In many cases they have the directly opposite effects such as how progesterone “calms mood and promotes sleep” and “prevents breast cancer” while progestin “may cause anxiety and depression” and “increases the risk of breast cancer.” It is important to consider the known ways in which progestins affect the body when considering using EC pills, especially if you find yourself taking them frequently.
The American Congress of Obstetricians and Gynecologists’ (ACOG) information regarding emergency contraception includes a statement about frequent use of EC that I find particularly interesting. They note that, “EC pills can be used more than once during a single menstrual cycle…” (emphasis, ACOG). A thorough understanding of fertility and the menstrual cycle gives us the knowledge that women are only fertile for a few days each cycle. When we see women taking EC pills multiple times a year, and particularly multiple times in one menstrual cycle, it indicates a pervasive lack of understanding of the length of time in which women are actually fertile. Practicing fertility awareness could certainly help women to know when it would be useful to take EC, when it would be unnecessary because you’re not fertile, and when it would be unnecessary because you have already ovulated and so EC would be ineffective.
For women not on hormonal birth control, practicing fertility awareness could help them to avoid the stress associated with, “I had unprotected sex, now what?”
It could also allow women to avoid unpleasant side effects from EC if they were able to know that taking EC at this time in their cycle would not be necessary or effective.
Planned Parenthood notes that, “Most people don’t know exactly when they ovulate, so it’s best to use emergency contraception as soon as possible — no matter where you are in your menstrual cycle or whether or not you think you’re about to ovulate.” I feel that this statement is damaging to women because it perpetuates the myth that we cannot know our own bodies. It upholds the idea that whatever a woman “thinks” she knows about her body, she’ll never know more than doctors with drugs, and wouldn’t she rather just trust them than risk pregnancy? This fits nicely into the narrative that unplanned pregnancy is one of the worst things that can happen to a woman, truly akin to a life-threatening disease.
We need to trust that when faced with the possibility or actuality of an unplanned pregnancy, a woman will make the choice that is right for her.
One of the best ways to support her is to make sure that she has access to unbiased and complete information about all of her options. In the case of emergency contraception, she should have access to this knowledge well ahead of when it might be needed. It is essential that fertility awareness be included in this knowledge because only when we understand our bodies can we fully understand the drugs and devices designed to affect them.
Brigid Taylor is a women’s health and rights advocate, a Lamaze Certified Childbirth Educator, and an avid-reader. Read her full bio here.