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Learn the difference between Ella and Plan B emergency contraception pills, including how they work, how much they cost, and where to get them.

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Photography by Fahroni/Getty Images; Design by Erica Singleton

According to the Centers for Disease Control and Prevention (CDC), about 45 percent of all pregnancies in the United States are unplanned.

Emergency contraception is a safe and effective method for reducing the risk of unintended pregnancies. It’s recommended to be taken after people who don’t want to get pregnant engage in penis-in-vagina (P-in-V) sex without birth control or with a method that fails.

The most popular form of emergency contraception is the emergency contraceptive pill, also called “the morning-after pill.”

When emergency contraception is taken within 3 to 5 days of unprotected P-in-V sex, it has an up to 95 percent efficacy rate at preventing pregnancy.

Here’s what you need to know about the only two contraceptive pills approved by the Food and Drug Administration (FDA) — ella and Plan B — and how to choose the right one for you.

Emergency contraception prevents unwanted pregnancies when P-in-V sex occurs without participants using any birth control or using a method that failed.

Generally, for most emergency contraception to work, a person has to take it within 3 to 5 days of unprotected or inadequately protected P-in-V sex. But many experts suggest the sooner a person takes it, the higher its effectiveness.

Methods of emergency contraception are the copper intrauterine device (IUD), which is the most effective method, and the emergency contraceptive pill.

The FDA has approved two emergency contraceptive pills:

  • ella (ulipristal acetate)
  • Plan B One-Step (levonorgestrel)

Emergency contraception doesn’t cause an abortion, nor does it protect a person against sexually transmitted infections (STIs) or HIV.

Emergency contraceptive pills work against unintended pregnancy by delaying or stopping ovulation (the release of an egg from the ovary), so it can’t meet the sperm alive.

On the flip side, the copper IUD works by disrupting sperm function before it meets the egg or by triggering inflammation that prevents a fertilized egg from attaching to the uterine wall, which results in pregnancy.

According to the World Health Organization (WHO), anyone with a womb may take emergency contraception at any point that they need it. However, people under 17 may need a prescription to access emergency contraception.

Emergency contraceptive pills have a slightly lower efficacy rate in people in bigger bodies with a body mass index (BMI) of 30 or higher. In contrast, the copper IUD maintains its efficacy rate in people in bigger bodies.

CostAvailabilitySuccess rateTimingEfficacyHormones
ella$40–$68 for one tabletNeeds a prescription. You can get a prescription from a doctor, pharmacy, or telehealth birth control service, like Nurx, Lemonaid, Pandia Health, Pill Club, and Simple Health.99.1% to 97.9%It should be taken soon after unprotected P-in-V sex or within 5 days (120 hours). Ella is highly effective, but people with a BMI of 30 or higher have a slightly lower efficacy rate of 96.9%. The WHO warns that people in this category shouldn’t be denied emergency contraception when they need it. Ella contains 30 mg of ulipristal acetate, a synthetic progesterone agonist/antagonist.
Plan BAround $43 for one 1.5mg tablet. Plan B is the most widely available emergency contraceptive pill in the United States, and you can get it without a prescription in retail stores, pharmacies, clinics, or via telehealth birth control services.
It has no age or point-of-sale limit.
99.4% to 96.9%It should be taken soon after unprotected P-in-V sex or within 3 days (72 hours). Like ella, Plan B is very effective. But people with a BMI of 30 or higher have a slightly lower efficacy rate of 92.6%.The WHO warns that people in this category shouldn’t be denied emergency contraception if they need it. There’s 1.5 mg of levonorgestrel, a progestin-only (synthetic progesterone hormone) medication.

ella

Ella contains 30 mg of ulipristal acetate, the active ingredient. Its inactive ingredients include:

  • lactose monohydrate
  • croscarmellose sodium
  • povidone K-30
  • magnesium stearate

Ulipristal acetate is a synthetic progesterone antagonist that works as an antiprogestin, a substance that suppresses progesterone production, the female reproductive hormone. When taken before ovulation, it postpones follicular rupture, which inhibits or delays ovulation.

Some studies suggest ulipristal acetate may prevent pregnancy even shortly before ovulation begins (a period when levonorgestrel may no longer work) because of its direct effect on follicular rupture.

Research from 2015 suggested this effect may explain why ella is 65 percent more effective at preventing pregnancy than levonorgestrel at 24 hours and 42 percent more at 72 hours.

However, a 2014 study suggested that, although ulipristal acetate is more effective or has a longer effectiveness window than levonorgestrel, neither of these drugs have any adverse effect on embryo implantation, a fertilized egg attaching to the uterine lining that starts pregnancy.

The ella website also says that no emergency contraceptive pill can be effective when ovulation occurs.

Plan B

Plan B, the most popular hormonal emergency contraception, is a progestin-only emergency contraceptive pill that contains 1.5 mg of levonorgestrel.

It also prevents pregnancy by delaying ovulation so that the egg is not released early enough to get fertilized by the sperm.

When taken before ovulation, levonorgestrel postpones follicular development, so the ovaries don’t release eggs that meet with sperm.

ella

A tablet of ella may cost around $40 to $68.

The Affordable Care Act states that insurance plans should cover the cost of FDA-approved emergency contraception. So, if you have health insurance or Medicaid, you may get ella at no additional cost to you.

You can contact your health insurance provider to find out if your plan covers ella.

If you don’t have health insurance, you may be able to get it for free or at a lower cost at a family planning clinic. Some college health centers may also provide free emergency contraception for students.

Plan B

A tablet of Plan B may be around $40 to $50.

You may also get generic versions, like My Way, Option 2, Take Action, Aftera, My Choice, and EContra at a lower price.

Under the Affordable Care Act, many health insurance plans should cover the cost of FDA-approved emergency contraceptive pills. So, if you have health insurance or Medicaid, they may cover the cost.

Some family planning clinics or college health centers may also make it available for free or at a subsidized price.

ella

The WHO and other experts recommend taking emergency contraceptive pills soon after unprotected P-in-V sex.

However, ella has a window of action of 5 days (120 hours), meaning you can take it within that timeframe, and it’ll effectively prevent pregnancy.

Ella is the most effective contraceptive pill in the United States. It works better than Plan B when taken on days 1, 3, and 5.

Clinical trials show an efficacy rate of 97.9 to 99.1 percent.

Plan B

Plan B should be taken within 3 days (72 hours) after unprotected P-in-V sex. But just like ella, the sooner the pill is taken, the higher its efficacy.

Clinical trials suggest Plan B is 96.9 to 99.4 percent effective at preventing pregnancy.

ella

According to the CDC’s 2010 U.S. Medical Eligibility Criteria for Contraceptive Use, there are no conditions where the risks of using emergency contraception outweigh the benefits.

According to the American College of Obstetricians and Gynecologists, this means vagina owners with the following conditions still have access to emergency contraception:

  • heart disease
  • previous ectopic pregnancy
  • liver disease
  • migraines

People who are breastfeeding can also receive and take emergency contraception.

However, the FDA doesn’t recommend ella for people who:

  • are pregnant
  • are breastfeeding
  • are postmenopausal
  • haven’t had their first period

The ella website suggests that, if you take ella while breastfeeding, you shouldn’t breastfeed for a week after taking it.

The company also mentions that ella may not be suitable for those who:

  • are allergic to ulipristal acetate or any ingredients in ella
  • have certain medical conditions
  • are taking certain medications

The FDA also warns that some ​​medications or herbal products may make ella less effective. Some examples include:

  • barbiturates
  • bosentan
  • carbamazepine
  • felbamate
  • griseofulvin
  • oxcarbazepine
  • phenytoin
  • rifampin
  • St. John’s Wort
  • topiramate

Consider speaking with a doctor if you’re on any medications before using emergency contraceptive pills.

Some common side effects are headache, nausea, and stomach pain.

Other side effects include:

  • menstrual pain (dysmenorrhea)
  • tiredness
  • dizziness
  • spotting
  • change in menstrual cycle

Plan B

According to the FDA, there are no established adverse effects of using Plan B or other progestin-only pills during pregnancy and breastfeeding.

Vagina owners below age 17 can safely use Plan B without a prescription, but postmenopausal people may not use it.

Some common side effects of Plan B include:

  • heavier menstrual bleeding
  • nausea
  • dizziness
  • stomach pain
  • headache
  • fatigue
  • breast tenderness
  • delayed period

The FDA, however, recommends that you see a doctor if, after 3 to 5 weeks of taking Plan B, you experience severe lower stomach pain. Also, if your period is later than 7 days, consider taking a pregnancy test.

Like ella, certain medications and herbs may reduce Plan B’s effectiveness. These include:

  • barbiturates
  • bosentan
  • carbamazepine
  • felbamate
  • griseofulvin
  • oxcarbazepine
  • phenytoin
  • rifampin
  • St. John’s wort
  • topiramate

Consult a doctor if you’re on any regular medications before taking emergency contraception.

Plan B is the most widely available and recommended emergency contraceptive pill. You can get it without a prescription from retailers like Target, Walmart, and Walgreens.

You can also buy both ella (with a prescription) and Plan B (without prescription) at pharmacies, family planning clinics, and telehealth birth control services.

ella

Most people who have taken ella report that it worked to prevent pregnancy after unprotected P-in-V sex.

However, they also reported side effects, like delayed period, nausea, cramps, back pain, sore breasts, and bloating.

Ella has a 7.1 out of 10 average rating from over 600 reviews on Drugs.com

Plan B

Reviews on Drugs.com generally tell other users they shouldn’t worry about getting pregnant if they take Plan B, because it’s very effective.

However, they also mention that they experienced side effects, like painful periods, mood swings, swollen breasts, and late periods.

It has an 8.5 out of 10 average rating from over 800 reviews on the site.

The copper IUD is another safe emergency contraceptive option for preventing unintended pregnancy after unprotected P-in-V sex.

The copper IUD is a device that’s inserted into the uterus and releases copper ions that impair sperm function, so the sperm can’t fertilize an egg.

Additionally, even when the egg is already fertilized, the IUD may also prevent implantation in the uterus that marks the beginning of pregnancy.

The copper IUD is described as the most effective emergency contraception, with a more than 99.9 percent efficacy rate. What’s more, it maintains its effectiveness in people with a BMI of 30 or higher.

The copper IUD is a long lasting reversible contraceptive option, and it can stay in a person and be effective for at least 12 years.

You can insert it within 5 days of unprotected P-in-V sex.

You need a prescription to get this device, and a doctor has to insert it for you. You can make an appointment with a doctor or a family planning clinic for the procedure.

A copper IUD may cost around $1,300 or less, but you can get it for free or at a subsidized cost with a health insurance plan or Medicaid.

How long do you have to use emergency contraception?

Emergency contraceptive pills are a single tablet you take only once after having unprotected P-in-V sex. You can take it any time of the day or night, with or without food.

It should only be used as an emergency birth control option and is not effective as a regular contraceptive method.

How many times can you use a morning-after pill?

You can only take the morning after pill once after unprotected P-in-V sex.

Though not recommended, the morning-after pill may be taken more than once during the same menstrual cycle, according to the American College of Obstetricians and Gynecologists.

It’s best to speak with a doctor for advice on the best birth control method for you.

The office on women’s health says that there’s no “best” birth control method for vagina owners.

The best emergency contraception or birth control varies according to each person’s:

  • health status
  • lifestyle
  • cost
  • availability
  • accessibility

Availability and accessibility: Plan B is more readily available, more cost-effective, doesn’t need a prescription, and can be found in many retail stores compared with ella. You may opt for this pill if you’re in an emergency situation and don’t have time to wait for an ella prescription.

Cost: Plan B is cheaper than ella, making it a more pocket-friendly emergency contraceptive option. However, health insurance or Medicaid may cover the cost. You can also get it for free or at a subsidized cost at a family planning clinic.

Health status: The copper IUD is the most effective option for a person with a BMI of 30 or more. According to the FDA, a pregnant or breastfeeding person may use Plan B without it having any unusual side effects on them.

Lifestyle: A person who has had unprotected P-in-V sex and doesn’t take emergency contraception within the first 2 to 3 days may opt for ella or a copper IUD, which have longer efficacy windows.

Numerous studies suggest ella and Plan B are safe for all vagina owners, regardless of their medical condition or any other circumstances.

The CDC’s 2010 U.S. Medical Eligibility Criteria for Contraceptive Use also mentions that the benefits of using emergency contraception always outweigh the risks.

In terms of effectiveness, copper IUD is more effective and lasts longer than ella and Plan B, with a more than 99.9 percent efficacy rate.

However, the best contraceptive option for a person depends on factors, like lifestyle, health status, cost, availability, and accessibility.

Ella is only available with a prescription. You can get the prescription from a doctor, pharmacy, clinic, and telehealth birth control service. While Plan B is an over-the-counter medication, you can still get it in retail stores.

For increased effectiveness, consider taking ella and Plan B as soon as you have unprotected or inadequately protected P-in-V sex.

You can take ella at any time of the day, with or without food, within 5 days (120 hours) of unprotected P-in-V sex. You can use Plan B at any time of the day, with or without food, within 3 days (72 hours).

Yes, emergency contraception may affect your next period. A delayed or early period, spotting, heavy period, and irregular bleeding are side effects of using emergency contraceptives.

If your period is 7 days late or longer, consider taking a pregnancy test to confirm if you’re pregnant or not.

You don’t need to take Plan B or ella if you’re on birth control, and it doesn’t fail you, or you don’t miss it when you have P-in-V sex.

However, if you’re on birth control, and it fails, or you forget to take it when you have P-in-V sex, you should use an emergency contraception.

People with vaginas may benefit from having unrestricted access to emergency contraception to reduce their risk of unintended pregnancy. Both ella and Plan B are effective emergency contraceptive pills for preventing pregnancy after unprotected or inadequately protected sex.

Consider using an emergency contraceptive pill only when you need to, as opposed to making it your regular choice of birth control.

If you have doubts about which emergency contraception is best for you, you can speak with a doctor who may help you determine the right method for you.


Frances Gatta is a freelance healthcare writer with experience writing on general health, women’s health, healthcare technology, mental health, and personalized nutrition. You can connect with her on Twitter and LinkedIn.