Contraceptive Failure? Your Emergency Contraception Options

| Posted On Jul 12, 2021 | By:

Dr. Lilja Stefansson, OBGYN at Atrius Health, answers sensitive questions with straightforward answers.

Q: Dear Dr. Stefansson – I am freaking out. The condom ripped the other night during sex. Right now is not a good time for a pregnancy. Help! – “NotReady”

A: Dear “NotReady,” oh goodness! You experienced what is called a “contraceptive failure.” This happens when the birth control you are using literally fails you in your efforts not to procreate. People may also need to use emergency contraception, which I will now refer to as “EC,” if sex occurred without any contraception at all (consensually or forced).

You can take a breath because there are several options available for you.

First, let’s make sure your partner was using the condom correctly. Condoms, when used correctly, are very durable. Did you know that 93% of sexually active women in the US aged 15-44 report that they have had a partner that used a condom? It’s great to hear so many people are practicing safe sex! For the condom to do its job, however, it’s critically important that the condom is not expired, is not being kept in a wallet, has been placed correctly (read the instructions), and is only used with water or silicone-based lubricants.

Now that we’ve reviewed the important facts about condoms, let’s discuss your EC options.

Intrauterine Devices (IUDs)

IUDs work by preventing fertilization of the egg and possibly implantation.

Two types of IUDs have been studied for EC. (You getting all these abbreviations?!) The copper IUD (the nonhormonal IUD, Paragard®) has long been known as an option for EC up to 5 days (120 hours) after the first episode of unprotected intercourse. It has a failure rate of 0.0 to 0.1% (that is really good!). The 52 mg levonorgestrel IUD (hormonal IUD, Mirena®, Liletta®) was recently studied as EC and had a failure rate of 0.3%, which is also very good!

The great thing about IUDs is that they offer very effective, long-acting contraception (6-10 years depending on the device), and you won’t have to worry about being in a situation where you need EC again. The catch is that you need to call your reproductive health clinician (typically your gynecologist or primary care clinician) and schedule an appointment within five days of unprotected intercourse to have the IUD inserted in the office. An IUD is not used to cause an abortion. Your provider will order a pregnancy test before insertion to ensure you are not already pregnant.

Please keep in mind that while an IUD will prevent pregnancy, it will not prevent sexually transmitted infections (STIs).

Emergency Contraception Pills

EC pills primarily work by preventing ovulation. So, if you do not release an egg, it cannot get fertilized.

There are two types of pills specifically made for EC. The first and more commonly known is the “morning-after pill” (old lingo assuming intercourse was happening at night). This is a medication that contains a progesterone called levonorgestrel. It does not contain estrogen. The most well-known brand is the Plan B One-Step® pill, but other brand names include Next Choice One Dose® and Take Action®. Did you know that these are available over the counter at your local pharmacy? Did you know you can even order them online? Did you know any person of any gender and/or sex can buy it? Go ahead and Google it.

You take this single pill once, generally within three days (72 hours) of the first episode of unprotected intercourse. This pill can reduce your chances of pregnancy by 95% if taken in the first 24 hours, but as each day passes, so does the likelihood of it working. When taken between 48-72 hours after sex, it reduces the chance of pregnancy by only 61%. Additionally, if you weigh more than 155 lbs or your BMI is >25, the efficacy is decreased. The cost ranges from $20-$50, depending on which type of pill you get and where you get it. There are even some coupons on the medication’s website to help reduce the price. Additionally, sometimes you can get a prescription to cover the cost of this option.

The second option for a pill form of EC is ulipristal acetate (brand name Ella®). Similar to the progesterone-only option above, you can take this single pill once up to 5 days (120 hours) after unprotected sex. However, unlike the progesterone-only pill, which decreases in efficacy for pregnancy prevention with each passing day, the ulipristal acetate pill reduces your chances of getting pregnant by 85% for all five days. The catch with this medication (why is there always a catch?) is that it is only available by prescription, so you need to call your clinician. In addition, it is sometimes harder to find because some pharmacies do not regularly stock it and therefore need to order it (and this takes time, and time is of the essence here).

Myths and Facts about Emergency Contraception Pills

Myth: I can take EC whenever I want, so I do not need to think about using condoms or other birth control methods.

Fact: EC pills are not meant to be used as regular birth control. The pills are less effective than most contraceptives, and the emotional stress and costs related to using EC (physically and financially) can add up. We have so many effective contraceptive options available, and I recommend making an appointment with your OBGYN, PCP, or pediatrician to discuss your options. And if you are a male reading this (I know you are out there!) and are done with child-bearing, you can call your urologist for a little snip-snip!

Myth: EC can cause an abortion.

Fact: EC pills will NOT cause an abortion of an already existing pregnancy. If you are already pregnant and do not know it (please take a pregnancy test!), or you don’t want to end an established pregnancy, you do not need to worry about these medications causing the pregnancy to end. Having said that, you should not take an EC pill if you are already pregnant, so as stated, I recommend taking a pregnancy test first if you have any chance of being pregnant.

“NotReady,” I hope this helps you. For others, if you run into a situation where you need EC, I recommend calling your trusted Atrius Health reproductive OBGYN, your PCP, or your pediatrician for advice on which option is right for you.

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About Dr. Lilja Stefansson

Dr. Lilja Stefansson (she/her/hers) is a board-certified obstetrician-gynecologist. She did her residency at Virginia Commonwealth University, where she was known as the “Queen of Contraception,” and she loves nothing more than being able to help provide her patients with the knowledge and ability to control their reproductive lives. She loves this so much she completed a fellowship in Complex Family Planning from the University of Chicago. Her other clinical interests include adolescent gynecology, management of abnormal bleeding, and the general care of patients throughout their reproductive lifetime and beyond. In her spare time, you can find her in the garden with her husband, three human babies, and two fur babies.

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