North Dakota Health Dept. - Division of Family Health

Family Planning Program ● Division of Family Health ● Community Health Section

Emergency Birth Control Methods
(Emergency Contraceptive Pills, Plan B and Copper T IUD)

Emergency Contraceptives

Have you ever in your life:

* Made love unexpectedly?	* Awakened to realize you were having sex?
* Been forced to have sex?	* Expected your partner to pull out, but he didn't?
* Had a condom break, slip or come off?	* Found out after sex that your diaphragm had slipped?
* Forgotten to take several birth control pills?	* Unintentionally let "outercourse" lead to intercourse without proper protection?

If you answered "yes" to any of the above questions, you should know about emergency contraceptive pills. Emergency contraception is pregnancy prevention after unprotected sex, suspected contraceptive failure or rape. Emergency contraceptive pills (ECPs) are two large doses of ordinary birth pills that may be taken within 72 hours after unprotected intercourse to avoid becoming pregnant. Making emergency contraception widely available could cut the number of unintended pregnancies in half and reduce the need for abortion. However, while emergency contraceptive pills prevent most of the pregnancies that follow a single act of intercourse, they are nowhere near as effective as ongoing contraceptives. Complete information about emergency contraceptive pills is available through your clinician.

How do you use emergency contraceptive pills?
Progestin-only pills (POPs):
PLAN B: Take one pill as soon as possible within 72 hours of unprotected intercourse and one pill 12 hours later.
Ovrette: Take 20 pills as soon as possible within 72 hours of unprotected intercourse and 20 more pills 12 hours later.

Combined oral contraceptive pills (COCs):
Preven: Take two pills as soon as possible within 72 hours of unprotected intercourse and two more pills 12 hours later.
Ovral: Take two pills as soon as possible within 72 hours of unprotected intercourse and two more pills 12 hours later.
Levlen, Lo-Ovral, Nordette, or Tri Phasil: Take four pills as soon as possible within 72 hours of unprotected intercourse and four more pills 12 hours later.
Alesse: Take five pills as soon as possible within 72 hours of unprotected intercourse and five more pills 12 hours later.

What are the advantages?

ECPs prevent unwanted pregnancies after forced intercourse, a mistake or a condom breakage.
Some women who can't take birth control pills on a regular basis can still use ECPs.
ECPs prevent abortions and cost less than an abortion. They can be obtained and left in your medicine cabinet in case of an emergency such as a condom breakage or forced sex.
It is not dangerous to use emergency contraceptive pills more than once, but it is necessary to find an ongoing method of contraception that you will use consistently and correctly.

What are the disadvantages?

ECPs cause nausea (in about 50 percent of women) or vomiting (in about 20 percent of women). Nausea may be prevented by taking a Dramamine pill one hour before each dose of emergency contraceptive pills.
ECPs are not as effective as other contraceptives.
ECPs are not as effective as inserting a Copper T IUD after unprotected sex.
ECPs should not be used as your regular contraceptive. However, if you must use ECPs several times, they are not dangerous. Except in the state of Washington, you must get a prescription for ECPs from your clinician. They are not available over the counter.
There's no protection against sexually transmitted infections; you may need to be treated for infection.

Where can I get emergency contraceptive pills (ECPs)?
You can go to your clinician or family planning clinic to obtain ECPs. Some clinicians are not familiar with emergency contraception. In this case, call the toll-free hotline at 800.584.9911 or 888.NOT2.LATE for phone numbers of clinicians near you who prescribe emergency contraceptive pills.

What distinguishes Plan B from other ECPs?
Plan B is a form of emergency contraception that can prevent pregnancy if taken within 72 hours after unprotected sex (if a contraceptive fails or if no contraception is used). It is the first progestin-only emergency contraceptive to be approved by the FDA. As with other emergency contraception, it may be taken if a mistake is made using another method, if a couple forgets to use a contraceptive or if a woman is forced to have intercourse. Each Plan B packet includes a single course of treatment and consists of two progestin-only, postcoital tablets, each containing 0.75 mg levonorgestrel. The first tablet should be taken as soon as possible within 72 hours (three days) of unprotected intercourse. The second tablet must be taken 12 hours later.

What are the advantages?

Plan B provides an important safety net for women whose regular contraceptive method may have failed, or for women who may have had intercourse without contraception.
The Plan B regimen is highly effective, reducing the average risk of pregnancy among users from about 1 percent to about 8 percent. In the first 24 hours after intercourse, Plan B can prevent 95 percent of expected pregnancies.
Plan B's levonorgestrel-only regimen is much better tolerated than emergency contraception regimen which combines ethinyl estradiol plus norgestrel or levonorgestrel. In one comparative study of the two regimens, the incidence of nausea in women who took Plan B was greatly reduced.
There are no biomedical or scientific data to suggest that there would be an increased risk of birth defects if Plan B fails or if a woman who is already pregnant takes Plan B.

What are the disadvantages?

Plan B is not a substitute for correct use of regular contraceptives. It is not dangerous to use emergency contraceptive pills more than once, but it is necessary to find an ongoing method of contraception that you will use consistently and correctly.
Plan B should not be used in cases of suspected pregnancy, undiagnosed abnormal genital bleeding or hypersensitivity to any component of the product.
Common side effects of Plan B may include nausea, lower abdominal pain, fatigue, headache, dizziness, breast tenderness and menstrual changes.
Plan B provides no protection from HIV or sexually transmitted diseases.
If you are opposed to emergency contraceptive methods that prevent implantation of a fertilized egg, it is important to know that taking emergency contraceptive pills before ovulation can prevent fertilization by preventing or delaying ovulation.
After taking Plan B, your next period may be early, on time, or late, especially if pills are taken before ovulation.

What is the emergency postcoital insertion of an IUD?
For up to five to eight days after unprotected intercourse, you can have an intrauterine device (IUD) inserted to keep you from getting pregnant. This is currently the most effective postcoital contraceptive available in the United States. When used after unprotected intercourse, the Copper T 380A IUD is inserted into the uterus. It prevents implantation of a fertilized egg (if an egg was fertilized by the unprotected sex). Women wanting the most effective emergency contraceptive should consider IUD insertion. It has about one-tenth the failure rate of pills. Complete information about this emergency contraceptive is available from your clinician.

What are the advantages?

Fifty percent of the 3.5 million unintended pregnancies each year in the U.S. could be prevented by the widespread use of emergency contraception. It is much better to use a contraceptive at the time of intercourse (condoms, pills or even withdrawal), but if you have unprotected sex, emergency insertion of an IUD will reduce your chance of getting pregnant.
The emergency IUD can be inserted for five to eight days after unprotected sex.
If 1,000 women have unprotected intercourse in the middle two weeks of their cycle, 80 would become pregnant without emergency contraception, but only one will become pregnant if a Copper T 380A is inserted as emergency contraception.
Once in place, this IUD can be used for at least 10 years as an effective contraceptive.
The emergency IUD may be used by some women who cannot take emergency contraceptive pills.
Fertility returns immediately after the IUD is removed.

What are the disadvantages?

You may have some cramping or pain at the time of, or just after insertion of, the IUD.
If you leave the IUD in place, it may cause irregular periods or more cramping with periods.
IUDs offer no protection against sexually transmitted infections. Use a condom if infection is a possibility.
There is a high initial cost of insertion of the Copper T IUD. However, over time it becomes an extremely cost-effective contraceptive.
The emergency IUD is not available without a prescription. Not all clinicians will insert IUDs.

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