Common Physical Side Effects
Emergency contraceptive pills (ECPs) contain a high dose of hormones that can lead to various physical side effects, most of which are mild and resolve within a few days. While not everyone experiences them, they are a significant consideration when using the medication.
- Nausea and Vomiting: This is one of the most common side effects. For EC with levonorgestrel (e.g., Plan B), up to a quarter of users may feel nauseous. If vomiting occurs within two hours of taking the pill, a replacement dose may be necessary as the medication may not have been fully absorbed.
- Headaches and Dizziness: Many users report experiencing a headache or feeling lightheaded shortly after taking the pill. These symptoms are typically temporary.
- Fatigue: A feeling of tiredness or low energy is another reported side effect, a result of the hormonal fluctuations caused by the pill.
- Breast Tenderness: Hormonal changes can lead to sensitive or tender breasts, similar to what some people experience before a regular menstrual period.
- Abdominal Pain: Mild cramping or lower abdominal pain is also possible. Severe, unbearable pain could be a sign of a more serious issue, such as an ectopic pregnancy, and requires immediate medical attention.
Menstrual Cycle Disruptions
One of the most noticeable cons of the emergency pill is its potential to temporarily disrupt your menstrual cycle. The high dose of hormones can cause a variety of changes to your next period, which can be unsettling.
- Timing: Your next period might arrive earlier or later than you expect. While most women get their period within a week of the expected date, a delay of more than seven days warrants taking a pregnancy test.
- Flow Changes: The flow of your next period may be lighter or heavier than usual. While this is generally temporary, excessive bleeding—like soaking through multiple pads in a short period—should be evaluated by a healthcare provider.
- Spotting: Light vaginal bleeding or spotting between periods is a common side effect of the hormonal surge. This can occur in the days or weeks following EC use and is different from your actual period.
Limitations and Reduced Effectiveness
Emergency contraception is not 100% effective and its efficacy can be impacted by several factors. Understanding these limitations is key to using the pill responsibly.
- Decreased Efficacy Over Time: Both levonorgestrel (Plan B) and ulipristal acetate (ella) are most effective the sooner they are taken after unprotected sex. The effectiveness of levonorgestrel declines significantly if taken more than 72 hours (3 days) after intercourse, though it can be used for up to 120 hours (5 days). Ulipristal acetate is generally more effective than levonorgestrel and can be used for up to 120 hours.
- Impact of Body Weight: For levonorgestrel-based pills (like Plan B), effectiveness may be reduced in individuals with a higher body mass index (BMI). Ulipristal acetate's effectiveness is not affected by weight in the same way, but higher weight can still be a factor.
- No STI Protection: The emergency pill provides no protection against sexually transmitted infections (STIs), a significant drawback for anyone who has had unprotected sex.
- No Protection for Future Encounters: Taking the emergency pill only protects against pregnancy from the most recent episode of unprotected sex. It does not provide ongoing protection, meaning another dose would be needed for any subsequent unprotected encounters within the same cycle.
Emergency Contraception vs. Regular Contraception
One of the most crucial disadvantages is that the emergency pill is not a substitute for regular birth control. Its intended use is for true emergencies, such as a broken condom or missed birth control pills.
- Lower Effectiveness: While a vital backup, the emergency pill is considerably less effective at preventing pregnancy over time than long-term contraceptive methods like the implant, IUD, or birth control pills.
- Financial Cost: Relying on emergency contraception repeatedly is more expensive and less convenient than maintaining a regular birth control method.
- Increased Side Effects with Frequent Use: The hormonal disruption is temporary but can be more pronounced and lead to greater menstrual irregularities if the pill is used frequently.
Comparison of Common Emergency Contraception Pills
| Feature | Levonorgestrel (e.g., Plan B One-Step) | Ulipristal Acetate (ella) |
|---|---|---|
| Availability | Over-the-counter | Prescription only |
| Time Window | Up to 72 hours, but can be used for up to 120 hours | Up to 120 hours |
| Weight Effectiveness | Potentially less effective in individuals with a BMI of 25 or higher | Works similarly across a broader weight range |
| Mechanism | Primarily delays or prevents ovulation | Delays or inhibits ovulation |
| Drug Interactions | Some drugs (e.g., St. John's Wort) may reduce effectiveness | Cannot be taken with progestin-containing birth control or some other medications |
The Reassurance of No Long-Term Fertility Impact
A common concern among users is the long-term impact on their fertility. Fortunately, there is no evidence to support that emergency contraception has any negative effect on future fertility, and it does not cause infertility. The hormones leave the body within days, and once a person's cycle returns to normal, their fertility is not affected.
Conclusion
While emergency contraception provides a crucial safety net for preventing unintended pregnancy, it is important to be aware of the cons of the emergency pill. These drawbacks include temporary, and sometimes unpleasant, side effects like nausea and headaches, the potential for a disrupted menstrual cycle, and limitations on its effectiveness based on time and body weight. It is not designed for routine use and offers no protection against STIs. For reliable, long-term contraception, safer and more effective options are available through a healthcare provider. Ultimately, the emergency pill is a valuable tool when used as intended: as a backup plan, not a primary one.
