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While abortion is banned or severely restricted in many states, reproductive health experts say it is important to know the options available to both the patient and the provider in case of emergency contraception. For many people, this is an ultimate safety net against unintended pregnancies.
Many lawyers advise that women and those who may become pregnant have an emergency contraceptive in hand before they need it. “This is going to be really important for people living in states where this is their last chance and they really need to prevent pregnancy,” said Cynthia Harper, a contraceptive researcher and professor at the University of Obstetrics, Gynecology and Reproductive Sciences. California, San Francisco.
But some emergency contraceptive options work well for some people and some options are more readily available than others. Here’s what you need to know.
What is emergency contraception and how is it different from the abortion pill?
The term refers to contraceptive options that are used after intercourse to prevent an unwanted pregnancy from happening. You may need it if you have unprotected sex, or if the condom breaks or you forget to take a few birth control pills.
It’s not the same thing as a drug abortion or abortion pills, although it’s a common misconception, says Dr. Suzanne Goodman, director of training at the University of California’s Bixby Center’s Beyond the Pill program, which aims to promote access and equity in contraceptive healthcare. .
Emergency contraception prevents a pregnancy from happening in the first place, he explains, when a drug abortion is used to end a pregnancy that has already occurred.
Emergency contraception is “not harmful for a developing pregnancy,” Goodman says. “Language that mixes emergency contraception with abortion is often used to limit access,” she says. “But abortion pills work in very different ways, disrupting and expelling an implanted pregnancy.“
What are the four types of emergency contraception?
Most people who have heard of emergency contraception probably think of the post-morning pill. But there are actually four different types of emergency contraceptives available – two pills and two pregnancy devices or IUDs.
Plan B or other levonorgestrel pills: The most readily available form of emergency contraception is an over-the-counter pill containing levonorgestrel, The brand name is probably best known under Plan B, although it is also sold under other brand names, including After, My Way, Tech Action and others. It is a single dose pill, has no age limit and does not require a prescription. It works best within 72 hours of unprotected intercourse.
Ella: The second type of emergency contraceptive pill is Ulipristal Acetate, sold in the United States under the brand name Ella. It is a single-dose pill that requires a prescription. Studies show that Ella remains effective throughout the five-day window after intercourse, in contrast to levonorgestrel, which shows a decrease in efficacy after three days, Goodman said. It is more effective for patients weighing more than 165 pounds.
Copper and hormonal IUD: The most effective form of emergency contraception as a whole is the IUD, which must be inserted by a physician within five days of intercourse to prevent pregnancy. (These are also the most effective forms of early contraception.) Both copper and hormonal IUDs can be used.
Copper IUD is “almost 100% effective as an emergency contraceptive,” said Harper of UCSF. He says more recent evidence shows that hormonal IUDs – sold under the name Mirena or Lileta – are also effective.
Dr. Alison Edelman, a professor of obstetrics and gynecology at the University of Oregon Health and Science, says there is a huge additional benefit to taking an IUD for emergency contraception. Once you have it in place, you have an effective contraceptive running. IUDs are effective for three to 12 years, depending on which one you get.
Where Can You Buy Emergency Contraceptives?
Although Levonorgestrel pills, such as Plan B, are supposed to be on the counter and stored on store shelves, research has shown that in reality they are often stored in a locked display box or behind the counter, so you may need to ask a pharmacist to order them online. You can, however, wait for them to be delivered, which means it can be a good option if you want to stock up on it.
For Ella, you need a prescription to get it. Studies have shown that Ella rarely has stock in pharmacies – they usually have to order it. This is why many reproductive health experts recommend that doctors give patients a script for it ahead of time. Companies like Nurx, SimpleHealth and PRJKT RUBY offer telemedicine appointments for women who need a prescription for eel.
Kelly Cleland, executive director of the American Society for Emergency Contraception, said, “We really want to encourage patients and healthcare providers to always have this conversation so that people have an emergency contraceptive in hand when they need it.”
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How does an emergency contraceptive work?
Both Plan B and Ella pill alternatives work late in ovulation so that the sperm does not come out until the ovum is effective. IUDs work primarily to prevent fertilization, so even if the egg is secreted, it never mixes with the sperm.
When used as an emergency contraceptive, Edelman said, copper IUDs emit copper ions that are toxic to sperm, creating a kind of “hostile environment” that prevents them from reaching or fertilizing eggs. He says there is little evidence about the proper mechanism of action with hormonal IUDs, but they probably interfere with how eggs and sperm are transported through the body, so that they do not mate.
Edelman noted that since there is still some uncertainty about how a hormonal IUD works as an emergency contraceptive, you may want to take one of the pill forms if you are at the highest risk of getting pregnant due to being in the middle of your cycle. Contraception At the same time you get your hormonal IUD.
How soon after sex should these methods be used?
If you are using pills, the sooner the better. “Most people don’t really know where they are in the cycle. They don’t know whether ovulation will happen tomorrow or the day after tomorrow,” said Cleland of the American Society for Emergency Contraception. This means that if you delay taking the pill, you may miss the ovulation prevention window and get pregnant anyway.
For the IUD, it is also important to place it within five days of unprotected sex.
Are some forms of emergency contraception more effective for overweight people?
Yes. Evidence shows that levonorgestrel pills, such as Plan B, do not work in patients weighing more than 165 pounds. For them, Ella is a good choice – it works well in people up to 195 pounds. Of course, Ella needs a prescription, which can be a barrier to access, as these drugs are ticking the clock to work. The IUD is the most effective choice for those who weigh more than 195 pounds.
If you can’t get enough ELA or IUD fast enough, another option might be to take a double dose of Plan B. Edelman, who studied the relationship between weight gain and emergency contraception, said there was no clear evidence. Double dose works, but it is not dangerous. “If I were and I had an urgent need [emergency contraception]I will take single or double dose as opposed to doing nothing, ”he says.
Edelman says there are also places like family planning clinics, planned parenting or university health centers where women may be able to get the same day IUD placement as an emergency contraceptive.
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How much does emergency contraception cost and does insurance cover it?
Federal law requires that most insurance plans cover prescription contraceptives, including IUDs, without cost sharing for the patient, although there are some exceptions.
Plan B and its generics are generally not covered by insurance because they are over-the-counter drugs. They usually retail for about $ 40- $ 50. You may also be able to get it discounted or free from the planned guardianship. You can often find levonorgestrel pills much cheaper online if you pre-order them to keep on hand. Another idea: If your doctor writes you a prescription for Plan B, insurance will cover it.
Ella costs about $ 50 or more at the pharmacy, but can be covered if you have health insurance or Medicaid. You will need to get a prescription from a healthcare provider.
IUDs must be inserted by a trained technician and the procedure and device must be covered by insurance. If you have to pay for an IUD out of pocket, that’s about $ 1000 or more.
Is emergency contraception legal where abortion is prohibited?
Yes, although reproductive health advocates are concerned that conservative state lawmakers banning abortions would later become some kind of urgent contraceptive target. Because the language of the label says levonorgestrel can interfere with the implantation of an already fertilized egg. It was based on old science, Cleland says; Part of the evidence now shows that the drug works by stopping ovulation, and reproductive health experts are urging the Food and Drug Administration to change this label. “We need to make sure these product labels are consistent with scientific evidence,” Cleland said.
Can emergency contraception fail?
Yes. Emergency contraceptive pills work late in ovulation, but if you have already started ovulation before taking them, it may be too late to prevent pregnancy. If you continue to have unprotected sex the same month, it can also fail – you can ovulate again if you are not in effective form of early birth control after the effects of the emergency pill have stopped, Edelman warns. This is why it may be a good idea to take an IUD immediately after unprotected sex, even if you are taking the pill, he said: “We know that having birth control on board helps prevent pregnancy immediately in that cycle.”
Is there an age limit for getting an emergency contraceptive?
No. Once there was an age limit on the pills but they have all been removed, Cleland said. There may be state laws for IUDs that require parental consent for minors.