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 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 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?