Emergency Contraceptives Available in the U.S.

Medically reviewed by Carmen Pope, BPharm. Last updated on April 11, 2023.

What is Emergency Contraception?

Emergency contraception is a safe and effective way to prevent pregnancy that may occur because of:

• Forgotten contraception or a missed oral contraceptive
• Failed contraception (for example, a condom broke, a diaphragm was dislodged, or the expulsion of an IUD or implant)
• Failed withdrawal
• Starting an oral contraceptive too late in your cycle
• A sexual assault or sex against your will.

Oral forms of emergency contraception may be referred to as “The Morning After Pill”; however, women do not need to wait till the morning after to take the ECP. The ECP should be taken as soon as possible after unprotected sex, but can be taken within 3 to 5 days, depending on the type of ECP.

What can be used for Emergency Contraception?

In the United States, two types of oral emergency contraceptive pills (ECP) are available: levonorgestrel-containing ECPs and ulipristal-containing ECPs.

• Progestin-only ECPs can be purchased over-the-counter (OTC) by anybody (men or women) with no restrictions and without ID. Branded ECPs, such as Plan B One-Step, cost about $40 to $50 and generics, such as My Way, about $35 to $45 (see the table below for a full list of brands and generics). Progestin-only ECPs are most reliable if used within 72 hours (3 days) of unprotected sex.

• Ulipristal-containing ECPs (eg, ella) are only available on a prescription, regardless of age. Through an online prescription service, ella costs around $67. Ulipristal ECPs should be taken within 5 days of having unprotected sex.

• A copper IUD (intrauterine device) may also be used for emergency contraception if it is inserted by a trained health professional within 5 days of having unprotected sex. In the U.S. the device is called ParaGard T 380A and consists of copper wound around a small T-shaped device. It takes 5 to 10 minutes to insert and it can be left in place for up to 10 years. The effectiveness of a copper IUD is up to 99%.

Important facts about Emergency Contraception.

• Emergency contraception should be taken as soon as you can. However, emergency contraception is still effective if there is a few days delay between unprotected sex and accessing contraception.
  • Progestin-ECPs: Most effective within 72 hours (3 days); moderate effectiveness within 5 days
  • Ulipristal ECPs: Most effective within 5 days
  • Copper IUDs: Most effective within 5 days.
• Don’t take more than one ECP. This means do not take Progestin-ECPs and Ulipristal ECPs at the same time because these may counteract each other.
• Do not take more pills than recommended (this will not make the ECP more effective and may increase the risk of side effects such as feeling sick or vomiting).
• If you throw up (vomit) within three hours of an oral ECP, you will need to take another dose.
• Your next period should start when you are expecting it, although it may be a few days early or late. If it doesn’t come, you should consider getting a pregnancy test.
• See your doctor if you develop any worrying symptoms, such as:
  
  • Severe abdominal, calf, or leg pain
  • Chest pain, cough or feeling short of breath
  • Severe headache, dizziness, or numbness
  • Blurred vision or trouble speaking
  • A yellowish tint to your skin or the whites of your eyes (called jaundice).
• Although oral progestin ECPs are considered safe to take multiple times, you should start using a regular birth control method if you are having regular sex because this is a much more effective way of preventing pregnancy rather than relying on emergency contraception.

What are the differences between Emergency Contraceptives?

Progestin and ulipristal ECPs are taken orally, and the copper IUD is inserted into the uterus.

• Progestin ECPs
  • Should be taken as soon as possible but can be taken within 72 hours (3 days) of having sex (98% effective). Some studies have shown moderate efficacy still exists if taken up to 120 hours (5 days) after unprotected sex; however, this is less than ulipristal.
  • Usually taken as one tablet containing 1.5 mg levonorgestrel. Some generic forms may contain two tablets of 750 mcg which can both be taken at the same time or separated by 12 hours.
  • Work by stopping or delaying the release of the egg from the ovary (ovulation). Progestin ECPs work before the egg is released from the ovary, and their effect happens before implantation of the egg in the uterus occurs.
  • May not work as well in women who weigh more than 165 lbs (75 kg) or have a body mass index (BMI) of more than 25 kg/m2; however, this has not been totally confirmed.
  • Can be obtained over-the-counter (OTC) without a prescription, identification, or age restriction. Cost: $35-$55. Generic versions may be less expensive.
  • Progestin ECPs will not affect an existing pregnancy. They are not an abortifacient, and will not terminate a pregnancy.
• Ulipristal ECPs
  
  • Should be taken as soon as possible but can be taken within 120 hours (5 days) of having sex (98% effective).
  • Taken as one tablet (30mg) of ulipristal.
  • Prevent pregnancy by blocking the natural hormone progesterone from occupying its receptor site in the body. Inhibits or delays ovulation. 
  • After taking ulipristal, a woman should wait at least five days before starting any other hormonal birth control (such as birth control pills [oral contraceptives], injections, implants, skin patches, or vaginal rings). Condoms or diaphragms should be used instead.
  • Ulipristal could potentially harm an unborn baby or cause birth defects and should not be used if a woman is already pregnant or thinks she might be pregnant.
  • Should not be used by girls who have not yet started their periods or by postmenopausal women.
  • Should not be given twice in the same menstrual cycle.
  • Requires a prescription from a doctor unless a woman lives in one of the following states, then she can obtain a prescription from a pharmacist: Alaska, California, Hawaii, Maine, Massachusetts, New Hampshire, New Mexico, Vermont, Washington.
  • Cost: Approximately $50 plus a prescription fee.
• Copper IUDs
  
  • The copper produces an inflammatory reaction that interferes with sperm motility, egg fertilization, and possibly implantation.
  • Copper IUDs protect against pregnancy for up to 10 years once inserted.
  • 99% effective at preventing pregnancy
  • Very convenient – no need to remember a daily pill
  • No lasting effect on fertility.

Is Emergency Contraception Safe?

ECPs are generally safe because they are usually just taken as a single dose. The risk of side effects increases if more than one course of levonorgestrel is taken during the same menstrual cycle. Ulipristal should NOT be used more than once during a menstrual cycle. If a menstrual period is delayed by more than one week after taking an ECP, a woman should see her doctor.

ECPs will not end an already established pregnancy and should not be used by women who think they might be pregnant. Studies have shown that levonorgestrel-containing ECPs do not increase the risk of birth defects in a fetus; however, there have been isolated reports of birth defects in women who had unknowingly been pregnant and taken ulipristal.

Taking an ECP has not been shown to decrease a woman’s future fertility.

ECPs do not protect against HIV and other sexually transmitted infections (STIs). See your doctor if you think you may have been exposed to an STI.

Some drugs or herbal products may decrease the effectiveness of ECPs.

Copper IUDs have been associated with more painful and heavier periods in some women. Once removed, fertility returns to normal almost immediately. They may not be suitable for some women (such as those with endometriosis); however, they may be used during breastfeeding since they contain no hormones. Occasionally the IUD may dislodge from your uterus and 1 in 1000 may experience a perforation, although this is extremely rare.

What are the side effects of Emergency Contraception?

Oral ECPs are very safe to use. Side effects, if they occur at all, are usually short-term and mild and may include:

• Nausea
• Vomiting
• Irregular bleeding, spotting, heavier bleeding, delayed or early menstruation
• A headache
• Dizziness
• Breast tenderness
• Fatigue or tiredness
• Stomach pain or cramps.

You can ask your healthcare provider for anti-nausea medication if you feel sick or vomit. If vomiting occurs within 3 hours of taking an ECP contact your healthcare provider as a repeat dose may be needed.

Side effects of copper IUDs may include:

• Pain when the IUD is inserted
• Cramping or backaches for a few days after insertion
• Heavier and more painful periods, spotting between periods
• Dislodgement
• Partner may complain of feeling the strings of the IUD during sex.

See also

• Birth Control Pills (Oral Contraceptives)
• Birth Control Pills and Your Period
• Birth Control Pills: Benefits, Risks & Side Effects
• Birth Control Pills: Why do I get breakthrough bleeding?
• Emergency Contraception: What You Need to Know
• Grapefruit and Birth Control Pills: Your Questions Answered
• Hormonal Birth Control (Non-Pill Options)
• Missed your birth control pill? Here's what to do
• Non-hormonal Methods of Birth Control
• Permanent Birth Control

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer