Plan B or IUD? Here’s what to know about emergency contraception, from an SIU doctor
Emergency contraceptive sales spiked in late June after the U.S. Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization overturned the constitutional right to an abortion.
Some large companies put temporary limits on the quantity of emergency contraceptive pills after the escalated demand, but Amazon and CVS have since removed the restrictions.
As more people purchase emergency contraceptive pills in case they need them in the future, questions circulate about the pills’ effectiveness and alternative methods.
The News-Democrat spoke with an obstetrics and gynecology doctor and a health policy professional about how to access and use emergency contraceptives. Here’s what to know.
What forms of emergency contraceptives are available?
The two primary avenues of emergency contraceptives are levonorgestrel pills and copper intrauterine devices (IUDs). Popular brands of levonorgestrel pills include Plan B and Ella, but there are generic options on the market as well.
Levonorgestrel pills prevent pregnancy by delaying or preventing ovulation. They are not an abortifacient and will not end or harm an existing pregnancy.
The IUD releases copper ions into the uterus, which make an inhospitable environment for sperm. The copper IUD is the only form of intrauterine device that’s currently prescribed as emergency contraception, but Dr. Erica Nelson, division chief of obstetrics and gynecology at Southern Illinois University, said hormonal IUDs may soon become an option, too.
Research the National Institute of Child Health and Human Development released in 2021 found the hormonal IUD, which releases levonorgestrel, appears to be as effective at preventing pregnancy as the copper IUD.
How effective is emergency contraception?
Plan B is about 75% to 89% effective when taken within three days of unprotected sex, according to Planned Parenthood.
The levonorgestrel pill should be taken as soon as possible after unprotected sex for the best chance at preventing pregnancy.
“The longer you wait, the more likely you are to have ovulated, and the sperm are already there,” Nelson said. “So if you take it in a short period of time, then you are preventing ovulation for that period of time. If you delay too long, you might already be pregnant, just because you’ve delayed.”
Nelson said levonorgestrel pills in general are about 90% effective, and IUDs are typically more effective. Nausea is one of the most common side effects of high doses of levonorgestrel, and people who vomit shortly after taking the pill may consider taking another.
While IUDs work for people regardless of their weight, Plan B’s effectiveness wanes somewhat for people who weigh more than around 165 to 170 pounds, Nelson said.
This doesn’t mean Plan B won’t work for those above the weight range, but effectiveness may drop below 85%, Nelson added.
Those who weigh more than 165 pounds might be better off taking Ella, which should be taken within five days of unprotected sex.
Planned Parenthood cautions Ella may not be effective for people who weigh more than 195 pounds, but an IUD may be a good option for people in that weight range.
The copper IUD lasts up to 12 years, and it’s one of the most effective emergency contraceptives currently on the market for people regardless of weight.
How can you access emergency contraception?
Walgreens, CVS, Walmart and many other retailers carry Plan B, which can be purchased over the counter. A Plan B pill typically costs around $50, but off-brand options can be cheaper.
Take Action is currently listed at Walgreens for about $40, and if you’re able to order generic pills online you may be able to save more.
Some insurance plans will cover emergency contraceptive pills, but you’ll have to get a prescription.
“The Affordable Care Act only pays for emergency contraception if it’s been prescribed. So we still see a lot of people who ask for a prescription for it,” Nelson said.
Nelson said it’s generally straightforward to get an emergency contraception prescription if you are an established patient with a particular doctor, but any delays caused by trying to get in contact with a doctor increase the likelihood of ovulation as time passes.
Along with the requirement by the ACA that emergency contraception must be prescribed for insurance coverage, the ability of pharmacists to choose not to provide Plan B can also be problematic.
Pharmacists in Illinois and in Missouri are allowed to refuse to provide patients with emergency contraceptive pills.
“And a lot of these barriers end up being more so for lower socioeconomic class people, because they maybe can’t afford it over the counter, so now they’re relying on the pharmacist to give it to them,” Nelson said.
Ella requires a prescription regardless of insurance coverage, and IUDs must be inserted by a medical professional.
Are emergency contraceptives still available in Illinois and Missouri?
Emergency contraception is legal and available in Illinois and Missouri.
One Kansas City-based health system stopped providing Plan B pills shortly after Missouri’s abortion ban came into effect, but it resumed offering them when the Missouri attorney general’s office said the abortion ban does not affect the legality of emergency contraceptives.
Usha Ranji, associate director for women’s health policy at Kaiser Family Foundation, said there has been some backlash against emergency contraceptives historically.
“On the policy side, there has been a conflating of abortion and emergency contraception in some places and in some policies, and there have been policy attempts to limit access to EC, referring to it as an abortifacient,” Ranji said.
One example Ranji gave of people fighting against access to emergency contraception was the 2014 U.S. Supreme Court Case Burwell v. Hobby Lobby, where the majority of the court held the craft supply company had a right to deny employees contraceptives coverage based on a religious objection.
Information about emergency contraception insurance coverage across the country is available online.
