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Emergency contraception 101: What is Ella?

You've probably heard of Plan B, but did you know there's another "morning-after" pill called Ella? Learn more about why Ella might be right for you in an emergency.

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When it comes to emergency contraception pills, most people know about Plan B. But there’s another option called Ella that might be better for more people. Ella is effective for up to five days after unprotected sex (including broken condoms or missed pills) compared to Plan B’s three-day window, works better than Plan B for people who weigh between 165 to 196 pounds, and is usually covered by insurance. At Hey Jane, we offer Ella via delivery or local pharmacy pickup so you can keep a backup option at home for future use. 

Keep reading to learn how Ella works, who can use it, potential side effects, and more.

What is Ella?

Ella (ulipristal acetate) is a type of emergency contraception pill approved by the FDA to prevent pregnancy after unprotected sex or a birth control mishap (like a broken condom). Unlike Plan B, which you can get over-the-counter or with a prescription if using insurance, Ella is only available by prescription. However, both Ella and Plan B are typically covered by most insurance plans with a prescription.

Ella works by delaying ovulation, which stops an egg from being available for fertilization. It’s most effective when taken as soon as possible after unprotected sex, but it works for up to 5 days (120 hours) of sex.

When should I take Ella?

Ella works best when taken as soon as possible. Unlike Plan B, which is most effective within 3 days (72 hours), Ella is effective for up to 5 days (120 hours). 

If you’ve had unprotected sex multiple times within a short period, it’s a good idea to discuss your options with a health care provider. There is no maximum number of times you can take Plan B or Ella, but if you find you’re using it frequently, you might want to explore a regular form of birth control.

Do I need to take a pregnancy test after taking Ella?

It’s normal for your period to come a little earlier or later than usual after taking Ella. However, if your period is more than a week late, it’s a good idea to take a pregnancy test.

Can I take Ella if I’m on birth control?

You can take Ella if you’re on birth control, but you will need to use a back up method. Ella works by blocking the hormone progesterone to delay your ovaries from releasing an egg. Most birth control options have a type of progesterone as a main ingredient, which means Ella can make your birth control pill, patch, or ring less effective.

If you missed a pill or made a mistake with a patch or ring less than seven days before taking Ella, you can continue taking your birth control as normal right after taking Ella.

If you’re taking hormonal birth control and were more than seven days late to take your pill, insert your ring, or apply your patch when you took Ella, wait six days before resuming your regular birth control method.

During this time—and until your birth control becomes effective again—be sure to use a backup method like condoms to prevent pregnancy.

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Who should take Ella?

Certain medications and supplements might make Ella less effective. They include: 

Medications/Supplements Contraindication with Ella
Hormonal birth control Ella can mess with progesterone-based birth control pills, patches, and rings so it's recommended to use a backup method for a week to be extra safe.
Rifampin An antibiotic that can reduce Ella’s effectiveness.
Griseofulvin Antifungal medication that may interfere with how Ella works.
Certain anti-seizure medicines Used for seizures, bipolar disorder, and psychiatric conditions; may reduce Ella’s effectiveness.
Certain HIV medications Certain medications for HIV treatment can lower Ella’s effectiveness.
St. John’s wort Herbal supplement for anxiety and depression; can make Ella less effective.

If you’re breast/chestfeeding, talk to your provider about whether Ella is right for you, as it does pass into breast milk.

While there’s no official weight limit for taking Ella, it may be less effective for people who weigh over 195 pounds.

Is there a weight limit for Ella?

Neither Ella nor Plan B have an official weight limit. However, Ella is more effective for people who weigh less than 195 pounds. Plan B is more effective for people who weigh less than 155 pounds, making Ella a more accessible option to a wider number of people. 

However, if you only have access to one option and fall outside its recommended weight range, you can still take the medication. Just know that it’ll be more effective the sooner you take it, and you may want to take a pregnancy test after one week just to be sure it worked.

If you’re looking for birth control options without a weight limit, the IUD might be right for you!

Advance provision and Ella

Emergencies are unpredictable, and it’s always better to be prepared if you can. You can ask a provider like Hey Jane about advance provision—getting emergency contraceptive pills like Ella ahead of time, so you have the medication on hand right when you need it most. 

Research shows that having emergency contraception ready in advance more than doubles the odds of using emergency contraception and can reduce the time between unprotected sex and taking the pill by about 15 hours. This means it can lower your risk of an unplanned pregnancy.

Side effects of Ella 

Like any medication, Ella can cause side effects. The most common side effects of Ella include:

Side Effect Description
Nausea Ella affects hormones and the digestive system, which can lead to nausea. Try small, bland meals or ginger tea to soothe your stomach.
Fatigue Hormonal changes from Ella can affect your energy levels, requiring extra rest and self-care.
Headache Hormonal fluctuations caused by Ella can trigger headaches, but ibuprofen or Tylenol can help.
Dizziness Hormonal shifts may affect blood pressure and circulation, causing dizziness. Try to rest and hydrate, and if your dizziness feels severe, seek medical attention immediately.
Breast/Chest Tenderness Hormones in Ella can lead to temporary breast tenderness. Wearing loose, comfy clothing and taking ibuprofen or Tylenol can help.
Abdominal pain Hormonal changes can cause slight cramping or bloating in the abdomen. Try using a heating pad or taking ibuprofen or Tylenol to reduce pain.
Menstrual cycle changes After taking Ella, you may notice temporary changes to your menstrual cycle. You may experience more spotting before and after your period than usual, and your period may be early or late. This is normal, and not a cause for concern.

Severe side effects are rare, but if you experience symptoms like severe abdominal pain three to five weeks after taking Ella (which could indicate an ectopic pregnancy), seek medical attention immediately.

Ella offers a highly effective and more accessible alternative to Plan B for emergency contraception. Understanding how and when to use Ella can help ensure that the medication is effective. To get either Plan B or Ella, sign up for care with Hey Jane today.

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Written by

Taneia Surles, MPH

Taneia Surles, MPH, is a freelance writer, editor, and public health professional specializing in sexual health and wellness. She has bylines in Health, Healthline, mindbodygreen, and Well + Good.

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