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How to answer the most frequently asked questions about the difference between emergency contraception and the abortion pill

What providers need to know about how these pills work and when to use them

by Robin Watkins, CNM, WHNP-BC

published 05/18/22

With everything in the news these days, you may be asked more frequently about the difference between emergency contraception (EC) pills, a.k.a. the morning after pill, and medication abortion, a.k.a. the abortion pill. We’ve got everything you need to know to answer the most frequently asked questions, no matter if it’s a family member, your neighbor, or a patient who is asking.

Are morning after pills and abortion pills the same thing?

Not at all! Quick answer: These are different medications—they work in different ways in the body, and they are not used in the same way. There are two types of EC or morning after pills (which can be taken at any time of day up to five days after sex), over-the-counter (OTC) levonorgestrel-based EC pills (LNG-EC) and prescription-only EC pills that contain ulipristal acetate (UPA). They both work by delaying ovulation. So that means that eggs and sperm never meet, and pregnancy is prevented from starting in the first place.

If people want to understand more about how EC works to delay ovulation you can explain that a spike of luteinizing hormone (LH) is what triggers ovulation and both LNG and UPA EC pills work by slowing down LH production. UPA can delay ovulation even after the LH levels have started to rise while LNG doesn’t work once LH levels start rising—that’s why UPA is more effective than LNG as EC and taking LNG EC as soon as possible is so important. If EC is taken after ovulation has occurred, research supports that it does not affect implantation. Unfortunately, this newer research is not currently included in the package insert for LNG EC pills.

This handy chart has a side-by-side comparison of EC and medication abortion pills and can be shared with patients and others asking about the difference between these medications.

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Will EC cause an abortion?

No. Both types of EC pills work to prevent a pregnancy by delaying ovulation and they don’t affect an ongoing pregnancy.

What happens if you take EC while you are pregnant?

If someone takes EC pills (or birth control pills) while they are pregnant, research shows that they do not affect ongoing pregnancies—meaning they won’t cause a miscarriage or an abortion, and they don’t affect fetal development.

Does taking EC pills or having an abortion now affect someone’s chances of getting pregnant in the future?

Neither impact future fertility. Taking EC pills in the past does not change someone’s chances of getting pregnant the next time they ovulate. And since taking EC pills only delays ovulation, it’s possible that someone could get pregnant right after taking EC. That means that if someone has unprotected sex after taking EC, you should counsel them to take EC again, even if it’s in the same cycle.

Having an abortion only ends the current pregnancy, it does not affect future fertility or pregnancies.

How do I get EC pills?

While LNG EC pills are available OTC without a prescription or ID check for people of all ages and genders, that doesn’t mean that everyone has equal access. People can search Bedsider’s EC finder to learn where to get EC pills in person and online. Some college campuses even have EC vending machines installed to ensure 24/7 access at a lower cost than the drug store. Since a prescription is needed for UPA, it requires people to have a visit with a health care provider before getting it. If that’s you, consider offering an advanced prescription to help people get timely access to UPA EC pills since they have higher efficacy.

How do I get abortion pills?

Getting abortion pills (or having an abortion procedure) can both be arranged with a provider. You can refer to AbortionFinder.org for help finding an abortion provider.

Robin Watkins is the Sr. Director, Health Care at Power to Decide. Robin is a midwife and women’s health nurse practitioner focused on expanding provider capacity to offer equitable, resonant, and high-quality sexual and reproductive health care. Robin provides clinical care in Washington, DC. When she is not talking sex, placing IUDs, or asking One Key Question, you can find her riding her bike on the streets of DC or eating ice cream for dinner.
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