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Emergency Contraception: Is Ella The Answer?

Choosing an Emergency Contraceptive: A Shopper’s Guide

With all the options available on the market, which emergency contraception should you take if you just had unprotected sex? Years ago, all we had for emergency birth control was off-label use of a high-dose oral contraceptive, such as two doses of Ovral, followed 12 hours later by another two doses. This regimen was available only by prescription, and the problem was that the high dose of estrogen made women want to hurl their guts out. This could result in throwing up the very medication you’re trying to ingest, landing you back at square one.

So Plan B and its knock-offs leaped us forward. By utilizing higher doses of progesterone, minus the estrogen, side effects were significantly reduced.

Plan B

Plan B consists of Levonorgestrel 0.75mg (a type of synthetic progesterone). According to the FDA, Plan B “acts primarily by stopping the release of an egg from the ovary (ovulation). It may prevent the union of sperm and egg (fertilization). If fertilization does occur, Plan B may prevent a fertilized egg from attaching to the womb (implantation). If a fertilized egg is implanted prior to taking Plan B, Plan B will not work.”

There you have it. The first dose must be taken within 72 hours of unprotected sex, with the second dose 12 hours after the first. Plan B is available over the counter without a prescription if you’re 17 or older, and with a prescription if you’re younger than 17. The sooner you take it, the better. It’s most effective within the first 24 hours. At a California CVS, the cost was $49.59.

Next Choice

Next Choice is the generic version of Plan B, so ditto on the above. Since Plan B is no longer under patent and Next Choice is available as a generic, the advantage of both is that they tend to be the budget choice. At a California CVS, the cost of Next Choice was $40.

Plan B One-Step

Plan B One-Step consists of Levonorgestrel 1.5mg taken as one dose. Like Plan B and Next Choice, it must be taken within 72 hours of unprotected sex and is available over the counter if you’re 17 or older. The advantage to Plan B One Step is that you don’t have to remember to take that pesky second dose exactly 12 hours later. Like Plan B and Next Choice, this pill works best if you take it right away. At a California CVS, the cost was $49.99.


Ella works by blocking the effects of progesterone and is a chemical cousin to the abortion pill RU-486 (mifepristone), but experts swear it’s not an abortion pill and does not work to terminate an existing pregnancy. The exact mechanism of how it works is still unclear. If approved by the FDA, the advantage Ella will offer is that it is effective up to five days after unprotected sex, and does not appear to be less effective if taken on day five than on day one. This means that if you make a boo-boo and it slips your mind to race to Walgreens right away, or if you don’t discover that emergency contraception exists until day four or five, you may still be covered. Also, early studies suggest that Ella might be more effective in reducing unwanted pregnancy than the other options.

The down side is that, chances are, Ella will cost more than the other options, so if you’re on a budget, you might still go for Plan B or Next Choice. And although manufacturers are shooting for over-the-counter status, it’s not looking likely that it will be over the counter, at least not at first. The other down side is that this drug is new. We don’t know much about it yet, and I’m rarely the first doctor to run out and prescribe something until I know my patients are safe.

What About You?

What do you think about Ella? If you knew there was a chance you were aborting a pregnancy you’d never know you had, would you use it if you had unprotected intercourse and didn’t want to have a child? Would you recommend it to your friends or daughters? Is this good news, or does it scare you?

Read more: College Life, Gynecology, Health, Obstetrics, Pregnancy, Sexual Health, Women's Health, , , , , , , , , , ,

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Lissa Rankin

Lissa Rankin, MD is a mind-body medicine physician, founder of the Whole Health Medicine Institute training program for physicians and other health care providers, and the New York Times bestselling author of Mind Over Medicine: Scientific Proof That You Can Heal Yourself.  She is on a grassroots mission to heal health care, while empowering you to heal yourself.  Lissa blogs at and also created two online communities - and She is also the author of two other books, a professional artist, an amateur ski bum, and an avid hiker. Lissa lives in the San Francisco Bay area with her husband and daughter.


+ add your own
9:53PM PDT on Jul 29, 2012


11:18AM PDT on May 19, 2011

ella is a great new alternative to Plan B, not only is it more effective but it works for a longer period of time (5 days instead of 3). Women can have it prescribed online which is great for those who do not want to go to an actual doctor's office when they can have a doctor collect the same information online.

5:58AM PST on Mar 7, 2011

Thanks for the information

12:31AM PST on Mar 5, 2011

Thanks for the article.

5:44AM PST on Jan 9, 2011

Thanks for the info.

10:17AM PDT on Aug 21, 2010

Of COURSE it's a good thing--and the nonsense about "what if it's an ABORTION? is just not relevant!

Well, on second thought, it probably IS relevant to the anti-choice mob. They want to control your body and mine, just in case an embryo MIGHT be stopped from implanting on a uterine wall.

As if that is THEIR business....

3:42PM PDT on Aug 20, 2010


2:41AM PDT on Jul 1, 2010

My daughter is named Ella and having a baby is probably the best contraceptive around! (lol)

6:04AM PDT on Jun 29, 2010

Lika, it's not as simple as wearing a condom. I got pregnant when I was 18 and the guy was wearing a condom. My mother got pregnant with me while on the pill and pregnant with my sister while using the sponge and spermicide. In these three cases, Ella wouldn't have been the answer since we thought we were protected but sometimes condoms do break or slide off at the worst time possible. I've personally never seen one break but the sliding off thing happens a lot.

2:04AM PDT on Jun 29, 2010

Why is this on the woman's responsibility? Obviously, date rape and other issues are still a great concern. Because hormone pills can have severe side effects, if a man (of any age) really loves his woman, he would wear a condom, or just plain not pressure her into it.

For the cases of rape, victims still are afraid to come forth, which is a travesty. It seems as if the rapist is innocent til proven guilty, which makes the victim a liar until redeemed. I have a problem with that.

For those who chose to have unprotected sex, it should be talked about, and the first time, fine, but more than that, it's irresponsible. We must make sure people are informed and are being responsible with these issues. Knowledge wields wisdom. With wisdom comes self discipline...

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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people are talking

I've got to start doing all five things, especially getting more sleep, and eating healthier foods! …

I do pretty much all of that. I do multitask while at work and I only eat lunch. Run in the am after…

I think the important number is whatever works for you and your partner


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