Can I use birth control pills as EC? Can I get an Ella prescription early? and other things you always wanted to know about emergency contraception

It was 2004 and a Women’s March had just concluded. Yet there I remained, standing on a crowded corner in Washington, D.C., my prescription pad firmly in hand. My goal? To write as many scripts for emergency contraception as I could get out before my hand cramped – up to 12 refills for  some of the women and teens coming up to me on the street.32321209178_a3bf8c2012_z-1

It’s now 15 years later and most EC is available easily to people of all ages, without a person needing to access a doctors office (or worse, a doctor on the street corner) in order to get the medication. That’s a huge and essential development, too. With abortion bans passing in states throughout the U.S. and the President determined to cater to anti-abortion activists in order to win another term in the White House, there may be no act more important to a person’s future than to be sure they are able to prevent unintended pregnancies.

But with blatant misinformation being spread purposefully by opponents of reproductive rights and health, emergency contraception is still surrounded in a cloak of mystery that continues to make it difficult to access and use effectively. Here are a few lingering questions that people still ask about what is now a process that’s been around for more than two decades in a variety of forms.

Is emergency contraception an abortifacient? 

Obviously there are entire political campaigns, court cases and “religious liberty” virtue signaling around the obsession that emergency contraception could cause a fertilized egg not to implant. This belief has led a small (but extraordinarily noisy and disproportionately politically connected) minority of people to argue that any form of emergency contraception is in actuality a potential abortion. The fact is that almost all medical professionals believe pregnancy does not begin until an egg implants, making the argument pointless. But even if that were not the case and a fertilized egg was the beginning of a pregnancy, emergency contraceptives like Plan B or Ella do not alter the lining of the uterus – they only prevent ovulation for a few days in order to give live sperm enough time to die off before an egg is released. If Plan B did alter the lining fewer people would still get pregnant despite taking the medicine – currently Plan B and its generic counterparts have a success rate of only about 90 percent when taken within 72 hours of unprotected sex, and that rate drops quickly as you add days on (Ella is more effective, working for up to a week, but requires a prescription). Even IUDs, which antis claim prevent implantation, aren’t actually abortifacient and are more likely to make a womb hostile to sperm than irritate a lining. They can be the most effective EC out there, but be sure you were interested in long acting birth control if you do get one – don’t just do it because you had unprotected sex once.

Can you use birth control pills as EC?

There are a lot of questions going around about whether or not a person can make their own EC out of an existing pack of hormonal birth control pills. The answer is yes – but with caveats. People often used pill packs to prevent pregnancy after unprotected sex prior to EC being available over the counter, especially in the 1990’s and early 2000s when access to a health clinic for birth control pills could be the only way a person has a shot at preventing pregnancy once sex already occurred. Today EC is so much easier to access and the types available for purchase are more fine tuned especially for preventing ovulation, making them much preferable to the old method of navigating multiple pills from a pill pack. Unlike full birth control pills, Plan B and other emergency contraceptives are less likely to cause nausea since they don’t contain estrogen. It’s also just one pill, one dose, rather than needing to navigate the correct number of pills at the correct intervals in order to be protected after sex (usually doses need to be taken 12 hours apart to be effective). In other words, true emergency contraception is always going to be easier and gentler on your body. But there may be circumstances where you just can’t get to a place that has EC in time – maybe your store doesn’t stock it, or the clinic you’d go to is closed for the weekend, or you don’t have the $40 it might cost to buy OTC without going through a doctor. In those cases, yes, if you have pills available that is far better than putting yourself at risk for an unwanted pregnancy. If you find yourself in that situation consider reaching out to friends that you know are on the pill who may have extra packs in their possession (many prescription programs send them months or even a year at a time now), and use this resource to figure out how to do the right dosage. Also, be aware that like Plan B, birth control pills are less likely to be effective as EC if a person has a higher BMI (Body Mass Index).

Speaking of higher BMI, should I take twice as much Plan B if I’m overweight?

NO! Don’t do it! Plan B does lose its efficacy if a person has a BMI of 26 or more, but taking more of the medicine is not going to make it more effective. If a person has unprotected sex and wants to try to prevent pregnancy, then just one dose of Plan B should be taken – not multiple – and you should try to take it as quickly as possible in order to have a better chance at preventing ovulation. There is at this time no indication that a double dose will do anything more than just give you more hormones that you don’t really need, and won’t change the likelihood of getting pregnant at all. If at all possible, to be truly safe try to use Ella instead, or look at getting an IUD placed as quickly as possible if long acting reversible contraception was already a path you wanted to pursue.

Can you “stock up” on EC if you want Ella?

Everyone recommends that a person capable of getting pregnant should have at least one dose of EC on hand for emergencies. Unfortunately Ella, considered the most effective due to its longer window of usability and success with physically larger patients, is sadly prescription only. But just because you need a prescription doesn’t mean you can’t still get a dose (or more!) to have on hand. Ask your doctor to write you a prescription now so you can get it filled on your own timeline and have it ready in case you (or a friend, or a family member, or a partner) need it down the road. In fact, ask for multiple doses – some doctors can write refills for anywhere from six to even 12 doses.

Also, if you are currently getting your birth control pills via mail order, check in to see if your clinic or doctor can add an EC dose into the delivery. While obviously it is less likely you’ll need EC when you are already on birth control, accidents do happen and pills do get lost or forgotten. Plus, it’s always good to have one on hand to share.