Emergency Contraception: Morning-After Pill & Copper IUD Guide

What Is Emergency Contraception?

Emergency contraception is a safe, effective way to prevent pregnancy after unprotected sex, contraceptive failure (like a broken condom), or sexual assault. It works primarily by preventing or delaying ovulation and must be used within a specific time window after intercourse.

Emergency contraception, often called the "morning-after pill," refers to methods that can prevent pregnancy after unprotected sexual intercourse. Despite its common name, emergency contraception can be used for several days after sex, not just the morning after. The term "emergency" emphasizes that these methods are intended for backup use, not as a primary form of contraception.

There are two main categories of emergency contraception: emergency contraceptive pills (ECPs) and the copper intrauterine device (IUD). Each method works differently, has different effectiveness rates, and is appropriate for different situations. Understanding these options empowers you to make informed decisions about your reproductive health.

Emergency contraception is most commonly used after unprotected sex, but it's also appropriate when regular contraception fails. This includes situations where a condom breaks or slips off, missed birth control pills, a diaphragm that shifts out of place, or failed withdrawal. Sexual assault survivors should also have access to emergency contraception as part of their medical care.

How emergency contraception works

Emergency contraception primarily works by preventing or delaying ovulation, the release of an egg from the ovary. If ovulation has not yet occurred, emergency contraception can prevent the egg from being released, meaning there will be no egg for sperm to fertilize. Sperm can survive in the female reproductive tract for up to 5 days, so preventing ovulation during this time is crucial.

It's important to understand what emergency contraception does NOT do: it does not cause an abortion. Emergency contraception cannot terminate an established pregnancy. If a fertilized egg has already implanted in the uterus, emergency contraception will not affect it. This is a key distinction that differentiates emergency contraception from abortion-inducing medications.

What Are the Types of Emergency Contraception?

There are three main types of emergency contraception: levonorgestrel pills (Plan B), ulipristal acetate (ella), and the copper IUD. The copper IUD is the most effective option (over 99%), while pills are more accessible. Ella maintains effectiveness for 5 days, while Plan B works best within 72 hours.

Emergency contraception comes in several forms, each with its own advantages and limitations. The right choice depends on factors including how much time has passed since unprotected sex, your body weight, whether you need a prescription, and your plans for ongoing contraception.

Levonorgestrel (Plan B One-Step)

Levonorgestrel emergency contraceptive pills contain a synthetic hormone similar to progesterone. Available under brand names like Plan B One-Step, Take Action, My Way, and AfterPill, these pills contain 1.5 mg of levonorgestrel in a single dose. This is the most widely available form of emergency contraception and is sold without prescription in many countries.

When taken within 72 hours (3 days) of unprotected sex, levonorgestrel prevents approximately 85% of expected pregnancies. However, effectiveness decreases significantly over time. Studies show that efficacy drops from about 95% within the first 24 hours to about 58% between 49-72 hours. While it can still be used up to 120 hours (5 days) after intercourse, it becomes progressively less effective.

Research indicates that levonorgestrel may be less effective in women with higher body weight. Studies suggest reduced effectiveness in women weighing over 70 kg (154 lbs) and minimal effectiveness above 80 kg (176 lbs). For women in this weight range, ulipristal acetate or the copper IUD may be better options.

Ulipristal acetate (ella)

Ulipristal acetate, sold under the brand name ella, is a selective progesterone receptor modulator. It requires a prescription in most countries and is typically more expensive than levonorgestrel products. However, it offers significant advantages in terms of effectiveness and timing.

Ella maintains consistent effectiveness throughout the full 120-hour (5-day) window, unlike levonorgestrel which decreases over time. Clinical trials show approximately 85% reduction in expected pregnancies when taken at any point within this window. This makes ella a better choice if you're taking emergency contraception closer to the 5-day limit.

Studies suggest ella maintains effectiveness in women with higher body weight better than levonorgestrel. It appears to remain effective in women up to approximately 85 kg (187 lbs), though effectiveness may decrease at higher weights. For women above this weight, the copper IUD remains the most effective option.

Copper IUD (Intrauterine Device)

The copper IUD is the most effective form of emergency contraception available, preventing over 99% of expected pregnancies when inserted within 5 days of unprotected sex. Unlike emergency contraceptive pills, the copper IUD's effectiveness does not decrease during this time window and is not affected by body weight.

The copper IUD works differently from hormonal methods. The copper creates an environment that is toxic to sperm and eggs, preventing fertilization. If fertilization has already occurred, the copper IUD may also prevent implantation, though this is not its primary mechanism.

A major advantage of the copper IUD is that it can remain in place as ongoing contraception for up to 10 years. This makes it an excellent choice for women who want highly effective, long-term, hormone-free contraception. It requires insertion by a trained healthcare provider and is typically covered by insurance or available at reduced cost through family planning clinics.

When Should You Use Emergency Contraception?

Use emergency contraception as soon as possible after unprotected sex, contraceptive failure (broken condom, missed pills), or sexual assault. The copper IUD and ella are effective for up to 5 days, while Plan B works best within 72 hours. Time is critical—sooner is always more effective.

Emergency contraception should be considered whenever there's a risk of unintended pregnancy. The most common situations include having sex without any contraception, condom breakage or slippage during intercourse, missed birth control pills, late contraceptive injection, dislodged diaphragm or cervical cap, and failed withdrawal method.

Sexual assault survivors should be offered emergency contraception as part of their medical care. Healthcare providers should ensure survivors are aware of their options and can make informed decisions about pregnancy prevention. Access to emergency contraception is considered an essential component of sexual assault response.

Timing is critical

The effectiveness of emergency contraception depends heavily on how quickly it's used after unprotected sex. For all methods, sooner is better. Don't wait to see if you might be pregnant; by the time you could test positive, emergency contraception would no longer be effective.

For levonorgestrel (Plan B), effectiveness is highest within the first 24 hours (up to 95%) and decreases to about 85% within 72 hours. After 72 hours, it can still be used but with reduced effectiveness. For ulipristal acetate (ella), effectiveness remains consistent at about 85% throughout the full 5-day window. The copper IUD maintains over 99% effectiveness for the entire 5-day period.

After taking emergency contraception

After using emergency contraceptive pills, you can continue or start using regular contraception immediately. If you're using the copper IUD, it serves as both emergency contraception and ongoing birth control. For those taking ella, hormonal contraception can be started 5 days afterward since ella can interact with hormonal methods.

Your menstrual period may come earlier or later than expected after using emergency contraception. This is normal and doesn't indicate whether the method worked. If your period is more than 7 days late, take a pregnancy test. If you vomit within 2 hours of taking an emergency contraceptive pill, contact a healthcare provider as you may need another dose.

How Effective Is Emergency Contraception?

The copper IUD is the most effective emergency contraception (over 99% effective). Ella prevents about 85% of expected pregnancies throughout its 5-day window. Plan B is about 85% effective within 72 hours but decreases over time. No method is 100% effective.

Understanding effectiveness rates for emergency contraception can be confusing because different studies report results differently. The most meaningful measure is the percentage of expected pregnancies prevented. If 8 women out of 100 would be expected to become pregnant without any intervention, and only 1 does after emergency contraception, that method prevented 87.5% of expected pregnancies.

The copper IUD prevents over 99% of expected pregnancies when inserted within 5 days of unprotected sex. This makes it by far the most effective option. A systematic review of studies involving over 7,000 women found only 10 pregnancies among copper IUD users, representing a failure rate of less than 0.1%.

Ulipristal acetate (ella) prevents approximately 85% of expected pregnancies when taken within 120 hours. Importantly, its effectiveness remains consistent throughout this period, unlike levonorgestrel which decreases over time. This makes ella the preferred pill option when more than 72 hours have passed.

Levonorgestrel (Plan B) is most effective when taken as soon as possible. Within the first 24 hours, it prevents approximately 95% of expected pregnancies. This decreases to about 85% between 24-72 hours and continues to decrease through day 5. The overall effectiveness rate of about 85% reflects use across the entire time window.

Factors affecting effectiveness

Body weight significantly impacts the effectiveness of emergency contraceptive pills. Research shows levonorgestrel may be less effective in women weighing over 70 kg (154 lbs) and may not work well above 80 kg (176 lbs). Ulipristal acetate appears to maintain effectiveness better at higher weights, though it may be reduced above 85 kg (187 lbs). The copper IUD's effectiveness is not affected by body weight.

The timing of your menstrual cycle also matters. Emergency contraception is most effective before ovulation has occurred. If you've already ovulated, the methods work less well because their primary mechanism (preventing ovulation) can't take effect. Unfortunately, there's no reliable way to know exactly when ovulation will occur.

What Are the Side Effects of Emergency Contraception?

Common side effects of emergency contraceptive pills include nausea, headache, fatigue, and irregular bleeding. Your next period may be early, late, or heavier than usual. The copper IUD may cause cramping during insertion and heavier periods initially. These effects are temporary and resolve on their own.

Emergency contraceptive pills are generally well-tolerated, but some women experience side effects. The most common is nausea, which occurs in about 15-25% of women taking levonorgestrel and may be more common with ulipristal acetate. Vomiting is less common (5-10%) but if it occurs within 2 hours of taking the pill, another dose may be needed.

Other reported side effects include headache, fatigue, dizziness, breast tenderness, and abdominal pain. These symptoms are typically mild and resolve within a few days. There are no known long-term health risks from using emergency contraceptive pills, and they don't affect future fertility.

Changes in your menstrual cycle are common after using emergency contraception. Your next period may come earlier or later than expected, sometimes by a week or more. The bleeding may be lighter or heavier than usual. These changes are temporary and your cycle should return to normal within one or two months.

Copper IUD side effects

The copper IUD insertion process may cause cramping and discomfort, though this varies widely among women. Taking ibuprofen before the procedure can help. Some women experience cramping for a few days after insertion. Spotting or irregular bleeding is common in the first few months.

If the copper IUD is kept as ongoing contraception, periods often become heavier and may be more painful, especially in the first few months. These effects typically improve over time. The copper IUD doesn't contain hormones, so it doesn't cause hormonal side effects like those sometimes associated with hormonal contraception.

Is Emergency Contraception Safe?

Emergency contraception is very safe for most people. There are few contraindications, and serious complications are rare. It can be used multiple times without health risks. Emergency contraceptive pills are safe during breastfeeding. The main concern is that pills may be less effective at higher body weights.

Emergency contraceptive pills have an excellent safety profile. Unlike some hormonal contraceptives, they don't carry significant risks for blood clots, heart attack, or stroke. This means they can be used safely by women who cannot use estrogen-containing contraceptives. There are no known health risks from using emergency contraception multiple times.

The only significant contraindication for ulipristal acetate (ella) is pregnancy, as its effects on an existing pregnancy are not fully known. Levonorgestrel is safe during pregnancy and will not cause harm, though it won't be effective. The copper IUD should not be inserted if there's an active pelvic infection or known uterine abnormalities.

Breastfeeding and emergency contraception

Levonorgestrel is considered safe during breastfeeding. Small amounts pass into breast milk, but this is not considered harmful to the infant. You can continue breastfeeding without interruption after taking levonorgestrel.

For ulipristal acetate, the manufacturer recommends expressing and discarding breast milk for 24 hours after taking the pill, though some experts consider this precaution unnecessary. The copper IUD is fully compatible with breastfeeding since it contains no hormones.

Repeated use

Emergency contraception can be used more than once, even within the same menstrual cycle. There are no known health risks from repeated use. However, it's not recommended as a primary contraceptive method because regular contraception is more effective, cost-effective, and convenient. If you find yourself needing emergency contraception frequently, consider discussing ongoing contraceptive options with a healthcare provider.

How Can You Access Emergency Contraception?

Levonorgestrel (Plan B) is available without prescription in many countries at pharmacies, clinics, and some supermarkets. Ella typically requires a prescription. The copper IUD requires a healthcare visit for insertion. Many family planning clinics offer emergency contraception at reduced cost or free.

Access to emergency contraception varies by country and by method. In many countries, levonorgestrel emergency contraception is available "over the counter" (OTC) without a prescription and without age restrictions. This includes the United States, United Kingdom, Canada, Australia, and many European countries. It's sold at pharmacies, some supermarkets, and health clinics.

Ulipristal acetate (ella) typically requires a prescription in most countries. In some places, pharmacists can provide it under certain protocols. Because it requires a prescription, there may be delays in accessing it, which is significant given the time-sensitive nature of emergency contraception.

The copper IUD requires insertion by a trained healthcare provider, typically a doctor, nurse practitioner, or midwife. This can be done at family planning clinics, women's health centers, hospital emergency departments, or private healthcare providers. Some clinics offer same-day appointments for emergency IUD insertion.

Cost and insurance

The cost of emergency contraception varies widely. Levonorgestrel products range from about $10-50 USD for generic versions to $40-60 for brand names like Plan B. Ulipristal acetate (ella) typically costs $40-90. The copper IUD is more expensive upfront ($500-1000) but may be cost-effective long-term as ongoing contraception.

In many countries, emergency contraception is covered by health insurance or available free or at reduced cost through family planning programs. Some jurisdictions require insurance to cover emergency contraception without cost-sharing. Planned Parenthood and similar organizations often offer sliding-scale pricing based on income.

What Are Common Misconceptions About Emergency Contraception?

Emergency contraception does NOT cause abortion, does NOT affect future fertility, and is NOT dangerous with repeated use. It is NOT the same as the abortion pill. It does NOT provide protection against STIs. These misconceptions can prevent people from accessing effective pregnancy prevention.

Misinformation about emergency contraception is widespread and can prevent people from using it when they need it. Understanding the facts is essential for making informed reproductive health decisions.

Myth: Emergency contraception causes abortion

This is false. Emergency contraception prevents pregnancy from occurring; it does not terminate an existing pregnancy. The primary mechanism of action is preventing or delaying ovulation. If a fertilized egg has already implanted in the uterus, emergency contraception will have no effect. Major medical organizations including the American College of Obstetricians and Gynecologists and the World Health Organization confirm that emergency contraception is not an abortifacient.

Myth: Emergency contraception damages fertility

There is no evidence that emergency contraception affects future fertility. Studies have followed women who used emergency contraception and found no impact on their ability to become pregnant later. Emergency contraceptive pills work by temporarily delaying ovulation; they don't permanently affect the ovaries or reproductive system.

Myth: Emergency contraception is dangerous if used multiple times

Emergency contraception can be safely used multiple times without health risks. While it's not intended as a primary contraceptive method (because regular contraception is more effective), repeated use is not harmful. The hormones in emergency contraceptive pills are similar to those in regular birth control pills, just in a different dose and timing.

Myth: You can only take it "the morning after"

Despite being called the "morning-after pill," emergency contraception can be effective for up to 5 days (120 hours) after unprotected sex. The copper IUD and ella maintain effectiveness throughout this period. While sooner is always better, you shouldn't assume it's too late if more than a day has passed.

What Should You Do After Taking Emergency Contraception?

After taking emergency contraception, you can resume or start regular contraception immediately (except wait 5 days after ella for hormonal methods). Take a pregnancy test if your period is more than 7 days late. Contact a healthcare provider if you have severe pain, heavy bleeding, or signs of infection.

Taking emergency contraception doesn't provide ongoing protection. You could become pregnant if you have unprotected sex again, even the next day. If you don't want to become pregnant, it's important to use reliable contraception going forward.

For those using levonorgestrel (Plan B), you can start or continue hormonal contraception immediately. Condoms, diaphragms, and other barrier methods can also be used right away. For those using ulipristal acetate (ella), wait 5 days before starting hormonal contraception, as the medications can interact. Use barrier methods during this time.

When to take a pregnancy test

If your period doesn't arrive within 3 weeks of taking emergency contraception, take a pregnancy test. It's also wise to test if your period is significantly lighter than usual or if you have pregnancy symptoms like breast tenderness, nausea, or fatigue. Home pregnancy tests are accurate from the first day of a missed period.

Remember that emergency contraception is not 100% effective. If it doesn't work and you become pregnant, the pregnancy will not be affected by having taken emergency contraception. There's no increased risk of birth defects or complications.