Providers, including pharmacists, often get questions about what to do if someone needs EC again within the same menstrual cycle. Check out the most frequently asked questions about the need for repeat EC dosing and how to answer them.
Can I use over-the-counter EC pills if I have already taken it this cycle?
Short answer:
Yes! Over-the-counter (OTC), levonorgestrel emergency contraception (LNG-EC), such as Plan B One-Step, can be used as many times as you need it, even in the same cycle.
Behind the answer:
While LNG-EC is not designed for repeat use in the same menstrual cycle, as it may not be the most cost effective or effective method of preventing pregnancy, this doesn’t mean it can’t be used this way. Since EC only works to delay ovulation, it needs to be taken again for repeated sex. The American College of Obstetricians and Gynecologists endorses that LNG-EC may be used repeatedly per menstrual cycle, if needed.
Can I use prescription EC pills if I have already taken it this cycle?
Short answer:
Probably, but we don’t know for sure. Less is known about using prescription EC pills, ulipristal acetate (UPA-EC), brand name ella, multiple times per cycle.
Behind the answer:
The science is less clear about repeated use of UPA-EC in the same menstrual cycle. However, there is evidence that daily doses of ulipristal 5 mg and 10 mg for the management of uterine fibroids appears to be both safe and well tolerated. While this dose is less than the 30 mg dose that is used for emergency contraception, EC is not often taken daily. This is an opportunity to engage patients in an informed decision-making process to determine if additional doses of UPA-EC are their best option for pregnancy prevention.
Is it safe to take EC pills multiple times this cycle?
Short answer
Yes, for LNG-EC. For UPA-EC, we don’t know for sure.
Behind the answer:
Studies have found that repeated administration of LNG-EC in the same menstrual cycle is not associated with an increased risk of adverse events. While repeated use of LNG-EC in the same cycle may result in menstrual irregularities, these changes are usually mild. However, data on the safety of this practice over the long-term are limited. The World Health Organization suggests that frequent, repeated use of EC might be considered harmful for patients with certain health conditions classified as medical eligibility criteria 3 or 4 for progestin-only pill contraceptives, like breast cancer.
Can I use OTC EC pills if I have already used prescription EC pills this cycle?
Short answer:
Yes, but it might be less effective.
Behind the answer:
Data for this is less clear, but OTC EC pills may be less effective in preventing ovulation due to how prescription EC pills work on hormone receptors. If you have already used UPA-EC this menstrual cycle, the most effective option is a copper IUD (Paragard) or a hormonal IUD with 52mg of LNG (Mirena or Liletta). Check out this article with what providers need to know about placing an IUD after sex.
How to talk to patients about other birth control after repeat EC dosing
Short answer:
it’s reasonable to ask people about their ongoing contraceptive needs and preferred method of contraception, however using EC as a primary method of birth control might be the method that works best for them.
Behind the answer:
People who use EC more than once in a cycle do so for a variety of reasons. Providers can ask questions to understand an individual’s ongoing needs and desires for contraception, how important it is to prevent pregnancy right now (and in the near future), and to identify what their preferred method of contraception is. While some people may be interested in using another method of contraception that is more effective at preventing pregnancy than EC, others might be satisfied with using EC.
For people who want to start using another method of contraception after taking any type of EC pill, they can start using a barrier method or any IUD that has been shown to be effective as EC on the same day they take EC pills. For people who want to start hormonal methods of birth control, they can start them on the same day as they take LNG-EC. If they are taking UPA-EC, people may want to wait up to five days after the last time they had sex to start their hormonal method to avoid decreasing the effectiveness of UPA-EC.
Bottom line
Since EC works to prevents pregnancy by delaying ovulation, it needs to be taken again for repeated sex to be effective. Repeat doses on EC pills may cause menstrual changes, but EC can safely be used multiple times, even within the same cycle. It’s reasonable for providers to ask about an individual’s desire for alternative methods of birth control, but ultimately, your patient gets to decide what birth control method is the best fit for them.
