Plan B Alternatives: Other Emergency Contraception Methods, Explained

What to know about your options as the demand for morning-after pills increases.

Medicine for emergency contraception in a female hand
Photo: Adobe Stock

After news broke that the Supreme Court had overturned Roe v. Wade—the law that guaranteed a person's federal right to a safe and legal abortion—drug retailers saw a drastic increase in demand for emergency contraceptives like Plan B.

In response to the increase, CVS, Rite Aid, and Walmart all moved to limit purchases of Plan B and similar drugs. But shortly after that announcement, CVS walked back its purchasing limit of the drugs when sales "returned to normal."

While the availability of Plan B may change as demand fluctuates, it's important to know that the well-known drug isn't the only form of emergency contraception out there.

Here's what to know about the most common types of emergency contraception, including how they work and who may benefit most from each one.

Ella

What it is: Ella is the brand name for ulipristal acetate and it's available as a single 30-milligram tablet, intended for oral use.

How it works: Ella is "a progesterone modulator," Jamie Alan, PhD, associate professor of pharmacology and toxicology at Michigan State University, told Health. "It works by delaying or inhibiting ovulation and affecting the endometrium [the inner layer of the uterus] making the environment 'hostile' for sperm."

How to use it: Ella is taken orally and is only available by prescription. It can be effective at preventing pregnancy for up to five days after unprotected sex, but it's more effective the sooner you take it. Data show that Ella reduces the rate of pregnancy to 9 in 1,000 (or 0.9%) when it's taken within 24 hours of unprotected sex.

What it costs: It depends on your health insurance coverage (if you have it), but Ella typically runs between $42–$47, according to GoodRx. The pill should be free with health insurance coverage, though, according to Healthcare.gov.

Other factors to consider: According to Planned Parenthood, while Ella is the most effective type of morning-after pill you can get, and it has been shown to work more effectively than other options in people over 165 pounds, the drug's effectiveness may wane in people more than 195 pounds.

Ella can also interact with several medications, including some designed to treat epilepsy, tuberculosis, HIV, and fungal infections.

Levonorgestrel Pills

What they are: This is a large category of emergency contraception that includes Plan B One-Step, Aftera, Next Choice, Take Action, and AfterPill. Dosing varies by brand but the medications are available in oral tablet form.

How they work: These pills contain levonorgestrel, a type of progestin that works by preventing the release of an egg from the ovary or preventing fertilization of the egg by sperm, according to the U.S. National Library of Medicine. It may also thin the lining of the uterus to prevent pregnancy.

"Levonorgestrel pills do not end a pregnancy that is implanted, but work primarily by delaying or preventing ovulation," Lisa Masterson, MD, a board-certified ob/gyn in Santa Monica, California, told Health.

How to use them: These medications are usually OTC—meaning, you can typically find them on shelves at your local pharmacy or big box chain. "They don't require a prescription like Ella," Dr. Masterson said.

Instructions for each medication vary by brand, but in general, you'll take a tablet by mouth as soon as possible after having unprotected sex. These medications can lower your risk of getting pregnant by 75 to 89% if you take them within three days of having unprotected sex, according to Planned Parenthood. Levonorgestrel pills are "moderately effective" when taken within five days, ACOG said.

What they cost: Prices vary by brand, but GoodRx says the average retail price of Plan B One-Step and similar levonorgestrel tablets is around $23.

Other factors to consider: Like Ella, these medications are not the best option for women in bigger bodies—specifically those over 165 pounds. "It doesn't work as well in these women," Lauren Streicher, MD, a clinical professor of obstetrics and gynecology at Northwestern University Feinberg School of Medicine, told Health. "People need to be aware of that."

Paragard

What it is: Paragard is a copper IUD. It's hormone-free and prevents pregnancy for up to 10 years.

How it works: The copper IUD works mainly by making sperm less able to fertilize the egg and is typically used as a more regular form of contraception, according to the American College of Obstetricians and Gynecologists (ACOG) explains. It's the most effective form of emergency contraception, preventing pregnancy 99.9% of the time.

How to use it: When it's used for emergency contraception, the copper IUD needs to be inserted by a medical professional within five days of having unprotected sex. Afterward, you can use the IUD for long-term birth control and can have it removed any time you want to become pregnant.

What it costs: If you have health insurance and you're in-network, the IUD should be free, according to Healthcare.gov. However, GoodRx lists the average price as $1,043 without insurance.

Other factors to consider: Paragard doesn't have a weight limit, so it works the same in every body. But it's not the most comfortable method of emergency contraception. "Insertion can be painful, and it is more likely to be painful if you have not had a child," Alan said. It's also one of the hardest forms of emergency contraception to access. "Even if you want to get an IUD, getting in to see someone quickly can be tough," Dr. Streicher said.

Combined Hormonal Birth Control Pills

What it is: These are pills that contain both estrogen and progestin, and are often used for daily birth control. But when they're taken in higher amounts, they can be used for emergency contraception, ACOG said.

How it works: When combination birth control pills are taken in higher-than-usual amounts, they can delay ovulation in order to prevent pregnancy.

How to use it: To use combined hormonal birth control pills as a form of emergency contraception, you'll need to take them as soon as possible up to five days after having unprotected sex. "You take two doses, 12 hours apart," Dr. Streicher said.

The number of pills you'll need to take depends on the dosage of the actual pills you have (or will get), Dr. Masterson said. "You may need to consult your physician to know how many pills to take depending on the brand," she added.

What it costs: If you have health insurance coverage, it shouldn't cost you anything, according to Healthcare.gov. Without health insurance coverage, the cost really depends on the brand you use.

Other factors to consider: If you already have a pack of combined hormonal birth control pills at home, this can be an easy option to use, Dr. Streicher pointed out. But it's also the least effective form of emergency contraception, according to ACOG. And, if you're breastfeeding, it's not recommended you try this method, Alan said.

If you need emergency contraception and you're not sure what to do, call a healthcare provider; they should be able to offer up personalized guidance. Just don't wait too long. "The sooner you act," said Dr. Streicher, "the better with emergency contraception."

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