How to use emergency contraception effectively - Alison Edelman

0:06 In a 2021 study, researchers asked over 500 participants a simple question:

0:12 how does the morning-after pill work?

0:15 Despite these pills widespread use, 60% answered incorrectly.

0:20 Emergency contraceptives are often misunderstood.

0:23 In fact, even the phrase “the morning-after pill” is a misnomer.

0:27 So, how do they work?

0:30 Each month, the brain and the ovaries prepare an egg to be released.

0:34 First, a group of immature eggs start to grow protective,

0:38 fluid-filled sacs called follicles.

0:41 Around the eighth day, one of these follicles becomes mature or dominant,

0:45 and the others are reabsorbed.

0:47 At this point, the brain signals

0:49 the pituitary gland to produce luteinizing hormone, often just called LH.

0:54 A big surge in LH tells the dominant follicle to rupture, releasing the egg.

1:00 This is ovulation.

1:02 The egg travels to the fallopian tube, where it stays for about 24 hours,

1:06 and it’s only in this very short window that it can be fertilized by sperm.

1:12 The rise of LH also stimulates the production of a hormone called progesterone.

1:17 When progesterone binds at specific receptors,

1:20 this also helps to signal ovulation.

1:22 And high levels of progesterone are vital for preparing the uterine

1:26 lining to support the possible implantation of a fertilized egg.

1:31 So, where do emergency contraceptive pills come into play?

1:35 Emergency contraceptives are not abortion pills.

1:38 Instead, they work much earlier in the process before pregnancy,

1:42 by disrupting or delaying ovulation.

1:45 There are two main types of pills.

1:47 The first type, sometimes called Plan B,

1:51 contains a molecule called levonorgestrel,

1:53 which is structurally very similar to the body’s hormone, progesterone.

1:57 When taken, levonorgestrel interferes with the production of LH.

2:02 Because LH doesn’t surge, there’s no ovulation.

2:06 That said, Plan B needs to be taken before an LH surge.

2:10 It can’t prevent ovulation once LH starts rising.

2:14 The second type of pill contains a molecule called ulipristal acetate.

2:19 It works by blocking progesterone from binding at receptors,

2:23 thereby delaying ovulation.

2:25 Ulipristal acetate works even if LH has already begun to rise,

2:30 which means it’s effective in a wider window of time than Plan B.

2:34 Since both pills work by blocking or delaying ovulation,

2:38 the name “the morning-after pill” can be misleading.

2:42 Emergency contraceptives are most effective when

2:44 taken as soon as possible after sex,

2:47 to better the chance of disrupting ovulation before it occurs.

2:51 There is no need to wait until morning.

2:53 For this reason, many healthcare providers suggest having them on hand.

2:58 Yet emergency contraceptives may still prevent pregnancy even

3:01 if they’re taken 3 to 5 days after sex, depending on the pill.

3:06 That’s because sperm can live in the reproductive tract for about five days.

3:10 So, for example, if a person ovulates three days after having unprotected sex,

3:16 there's still a chance of pregnancy.

3:18 Since it's difficult to know exactly where someone is in their cycle,

3:21 it’s best to take emergency contraceptives as soon as possible.

3:26 But perhaps the most widely held misconception about these pills

3:29 is that they can harm a person’s future fertility.

3:33 Decades of research have shown that this isn’t the case,

3:36 even if emergency contraceptives are taken multiple times.

3:40 In fact, the effects of both pills are short lived,

3:43 and they don't provide continued protection.

3:46 It's recommended that a person uses condoms for the remainder of their cycle,

3:50 and if they have unprotected sex again, then repeat use.

3:54 Of course, emergency contraceptive pills aren’t failproof.

3:57 As they neither prevent fertilization nor the implantation of a fertilized egg,

4:02 these pills are ineffective if someone has already ovulated,

4:06 or the LH surge has already peaked.

4:09 However, there is a third option that can protect against pregnancy,

4:12 even if a person has already ovulated.

4:15 Many people know copper intrauterine devices, or IUDs,

4:19 as a form of long-term birth control,

4:21 but they also work to prevent pregnancy if inserted soon after unprotected sex.

4:26 Unlike emergency contraceptive pills,

4:29 a copper IUD can prevent pregnancy before and after fertilization.

4:34 Copper is toxic to sperm and creates

4:36 a uterine environment that makes implantation unlikely.

4:39 Of course, copper IUDs might be less accessible in an emergency

4:44 situation— they must be inserted by a trained healthcare provider.

4:47 But on the upside, they continue to prevent

4:50 pregnancy for at least 10 years while in place.

4:53 Most healthcare providers agree that it's more effective,

4:56 as well as less expensive,

4:58 to use a regular form of birth control when trying to avoid pregnancy.

5:02 But if or when you need it, emergency contraceptives are a safe option to use.