Emergency contraception (EC) is birth control that can be used after unprotected sex. The most effective EC option is the copper IUD, but the easiest and most accessible options for most people are EC pills, which can be purchased at pharmacies or online. There are currently two types of EC pills available in the U.S.:
1. Levonorgestrel (LNG) based pills: brand names include Plan B One-Step, Next Choice One Dose, and My Way
FDA approved for 3 days after sex, but may have some benefit for up to 5 days.
Efficacy decreases with each passing day.
Newer research suggests they’re not as effective for patients who are overweight or obese.
Available in the aisles of drug stores for women and men of all ages, no prescription needed.
2. Ulipristal acetate based pill: brand name ella
Available by prescription only.
FDA approved for up to 5 days after sex.
Just as effective as levonorgestrel when used in the first 3 days after sex; works better than levonorgestrel when used on days 4 and 5.
Remains effective for women who are overweight; may be less effective for obese women.
Many patients head straight to the pharmacy when they need EC. So what do we know about what happens when they do?
Getting EC at a local pharmacy
The laws about pharmacy access for levonorgestrel-based EC (LNG) changed in 2013 and we are still learning how available it truly is. For example, a study in western Massachusetts looked at the availability of EC in pharmacies and how well pharmacy staff counseled patients on using EC. A researcher posed as a patient calling to get information about EC use 4 days after unprotected sex. The “patient” asked about the availability of LNG and ella, and which was better. Here’s what the study found:
Of 110 pharmacies, 89% had LNG in stock;
Only 7% of pharmacies had ella in stock;
11% of pharmacies didn’t have any EC in stock;
Only 29% of pharmacy staff correctly identified ella as the superior medication for use four days after unprotected intercourse;
Only 21% of pharmacy staff provided information that was completely accurate.
Unfortunately, the “patients” received a lot of misinformation from the pharmacy staff. (Note that this study included only Massachusetts pharmacies, so it may not represent the experiences your patients will have at their local pharmacies.) The “patients” who called pharmacies in Massachusetts were wrongly told that all EC is the same. They were told that all EC only works for two days. Wrong again. They were also told that ella isn’t even available in the U.S. Totally wrong; it has been available since 2011.
If you practice in Alaska, California, Hawaii, Massachusetts, New Hampshire, Vermont, or Washington, your patients may be able to get a prescription for ella directly from a pharmacist. These states all have laws allowing pharmacists to prescribe emergency supplies such as EC. Not all pharmacists participate, so you may want to advise patients to call ahead and check.
The bottom line
The most effective EC pill, ella, has been hard to get at the pharmacy for a while, but should be reappearing now. We also can’t count on other health care professionals to educate our patients about EC. We need to talk to our patients about EC, especially ella, before they need it.
Not sure what to tell your patients about EC? Here are some suggestions:
Take EC as quickly as possible, up to five days after sex.
ella is better than LNG, especially for women with BMI ≥26 or when it has been > 3 days since sex. (Even more effective? The copper IUD.)
If ella is the best option for them, they will need a prescription. Give them a prescription with refills before they need it. Annual visits are a good opportunity for this.
Common side effects of both LNG and ella include headache, nausea, and abdominal pain. The side effects are usually mild, but you can prescribe an anti-emetic to take with EC.
We also need to encourage our pharmacies to keep EC in stock. The best way to find out if your pharmacy has EC in stock is to call it and ask to speak with the pharmacist. After this study was conducted, there was an interruption in the supply of ella as a new distributor took over this product. Some pharmacies might not know how to get their supply refilled. You can direct your pharmacist to www.ellanow.com, where they can order ella.