Emergency Contraception#

The copper IUD prevents pregnancy mainly by releasing copper that's toxic to sperm, so sperm cannot reach and fertilize an egg. It also has secondary effects on the egg and the lining of the uterus that make pregnancy unlikely. It works regardless of where you are in your cycle, and its effectiveness does not depend on body weight, drug interactions, or vomiting. A pill works by delaying ovulation - so if ovulation has already happened, the pill cannot help. The copper IUD still works in that situation.

The two pills work in similar ways (both delay ovulation), but the prescription pill works closer to the moment of ovulation than the over-the-counter pill. The over-the-counter pill essentially stops working once your body's hormone surge has begun; the prescription pill can still delay ovulation even partway through that surge. The practical result: the prescription pill has a higher success rate, especially when taken in days 3-5 after unprotected sex.

Yes. Emergency contraception pills may be less effective at higher body weight or BMI.

• Over-the-counter morning-after pill - may be less effective at higher BMI, especially BMI 30 or above.
• Prescription morning-after pill - generally performs better than the over-the-counter pill, but may also be less effective at BMI 30 or above.
• Copper IUD - effectiveness is not affected by body weight or BMI.

If your BMI is 30 or higher and you want the most reliable option, the copper IUD is usually preferred. If an IUD is not accessible quickly, the prescription pill is usually the more effective oral option.

This depends on local clinic availability. Sexual-health clinics, family-doctor offices, and some walk-in clinics offer IUD insertions. If you call ahead and explain it's for emergency contraception, many clinics will fit you in within 1-2 days. TeleTest can fax a referral to a clinic that handles same-day or rapid EC insertions.

The clinician will confirm there is no current pregnancy or active infection, then insert the IUD during a brief pelvic exam. Insertion itself takes a few minutes. Most patients describe a strong cramp or brief sharp pain during placement that eases off within minutes. Taking ibuprofen 30-60 minutes before the appointment helps. Some clinics offer additional pain management - ask in advance.

Yes. The copper IUD is effective for both emergency contraception (preventing this pregnancy) and ongoing contraception (preventing future pregnancies) immediately after insertion.

Many guidelines use a 5-day window, but some Canadian patient guidance allows copper IUD insertion up to 7 days after unprotected sex. Timing can depend on where you are in your cycle, local clinic policy, and clinician assessment.

If you are past 5 days but still within 7 days, contact a clinic promptly rather than assuming it is too late.

The clinician will check for an existing pregnancy before insertion (usually with a quick urine pregnancy test). If a pregnancy is already established, the copper IUD is not inserted. The IUD does not cause abortion.

Yes - this is one of the biggest advantages. Once inserted for EC, the copper IUD continues to provide highly effective contraception for 5-10 years with no further action needed. You can have it removed any time if you want to try to conceive.

The IUD can be removed by a clinician any time, including a few days or weeks after insertion. Most patients who get the IUD for EC choose to keep it because it's so effective and low-maintenance, but you are not committed to keeping it long-term.

Most patients have heavier and crampier periods on the copper IUD. For most, this stabilizes within 3-6 months. If your periods are already heavy or painful, the copper IUD may not be the best long-term option - mention this so your clinician can help you weigh whether to keep it after the EC use.

No. EC does not protect against STIs. If you had unprotected sex, consider STI testing - TeleTest can help with this in the same consultation or a follow-up. See STI Testing Overview.

Take one tablet by mouth as soon as possible after unprotected sex, up to 120 hours (5 days) later. Swallow whole with water. Take with or without food. The sooner you take it, the more effective it is.

The prescription morning-after pill is more effective than the over-the-counter pill, especially later in the 5-day window. In clinical trials, about 1-2 pregnancies per 100 users occurred after treatment. It works best before ovulation; once ovulation has already happened, no emergency contraception pill is reliable.

• Effectiveness: the prescription pill is more effective overall, with the biggest advantage in days 3-5 after unprotected sex.
• Window: the prescription pill works up to 5 days; the over-the-counter pill is most effective in the first 3 days.
• Body weight: both pills may be less effective at higher BMI. Available evidence suggests the over-the-counter pill loses effectiveness earlier (at a lower BMI) than the prescription pill, but exact cutoffs vary across studies.
• Access: the over-the-counter pill is at any pharmacy with no prescription; the prescription pill needs a clinician consultation first.
• Interaction with regular birth control: the prescription pill may be less effective if you've recently used progestin-containing hormonal birth control, and resuming hormonal contraception too soon after taking it can reduce both. Ask a clinician or pharmacist which EC option fits your situation - in many cases the over-the-counter pill or the copper IUD is preferred. See below for details.

For most patients who can wait a short time for a prescription (TeleTest can fax to your pharmacy quickly), the prescription pill is the better oral choice.

Most patients have no significant side effects. Possible side effects include mild nausea, headache, fatigue, breast tenderness, and a slightly earlier, later, heavier, or lighter next period. Side effects are usually short-lived.

If you vomit within 3 hours of taking the pill, take another dose as soon as possible. If vomiting continues, talk to a pharmacist or clinician about alternatives.

The prescription pill passes into breast milk. The current Canadian product information recommends not breastfeeding for one week after taking the prescription pill. During that week, pump and discard breast milk to maintain supply.

If you want to avoid interrupting breastfeeding, the over-the-counter morning-after pill or the copper IUD may be better options.

Yes - this is an important detail. The prescription morning-after pill works at the progesterone receptor. Progestin-containing birth control can reduce its ability to delay ovulation, and it may temporarily reduce the effectiveness of hormonal contraception.

• If you are not currently using hormonal birth control: take the prescription pill as soon as possible, then wait at least 5 days before starting any hormonal birth control method. Use condoms or avoid sex until your next period.
• If you took the prescription pill because of missed pills, a late patch/ring, or another hormonal contraception problem: follow the missed-dose instructions for your specific birth control method and use condoms until your next period. A clinician or pharmacist can help choose between the prescription pill, the over-the-counter pill, or the copper IUD.
• Do not take the prescription morning-after pill and the over-the-counter morning-after pill together, because they may interfere with each other.

If ongoing hormonal contraception was already used recently, the copper IUD is the most reliable emergency contraception option. If an IUD is not accessible, a clinician or pharmacist can help decide which pill option is most appropriate.

Yes. Certain enzyme-inducing medications can reduce effectiveness, including rifamycin-class antibiotics, certain antifungals, certain anti-seizure medications, some HIV medications, and St. John's wort. If you take any of these, the copper IUD is the more reliable EC option.

Available evidence suggests the prescription pill may be less effective at higher BMI, but it generally performs better than the over-the-counter pill in this group. If you have a higher BMI and want the most reliable EC option, the copper IUD is preferred because its effectiveness is not affected by body weight. A pharmacist or clinician can help you decide.

The Canadian product information says not to use it twice in the same menstrual cycle, because safety and effectiveness of repeated use in the same cycle have not been established.

If you have unprotected sex again after taking the prescription pill, use condoms and contact a clinician or pharmacist promptly to discuss the safest next step.

The prescription morning-after pill is safe for most patients. Severe liver disease is a relative reason to choose a different option. Mention any medical conditions and medications in your TeleTest consultation - the clinician will confirm the pill is appropriate for you.

Take one tablet by mouth as soon as possible after unprotected sex, ideally within 72 hours. Swallow whole with water. Take with or without food. The sooner you take it, the more effective it is.

The over-the-counter pill reduces the chance of pregnancy when taken as soon as possible after unprotected sex - best within 72 hours, and the sooner the better. It is less effective than the prescription pill or the copper IUD, and its effectiveness drops the longer you wait. If it has been more than 3 days, the prescription pill or the copper IUD is a better choice.

Most patients have no significant side effects. Possible side effects include mild nausea, fatigue, headache, breast tenderness, abdominal cramps, and a next period that is earlier, later, heavier, or lighter than usual. Side effects are usually short-lived.

If you vomit within 2 hours of taking the pill, take another dose as soon as possible. If vomiting continues, talk to a pharmacist or clinician about alternatives.

Yes - the over-the-counter morning-after pill is safe with breastfeeding and does not require any milk-discarding period. This is often the preferred EC pill for breastfeeding patients.

No significant interaction. Unlike the prescription pill, the over-the-counter morning-after pill does not interfere with restarting or continuing hormonal birth control. If you are already on the pill, patch, or ring and missed doses, you can take the over-the-counter morning-after pill and continue your usual method without delay (still use backup contraception for 7 days).

Yes. The same enzyme-inducing medications that affect the prescription pill also reduce the over-the-counter one: rifamycin-class antibiotics, certain antifungals, certain anti-seizure medications, some HIV medications, and St. John's wort. The copper IUD is more reliable for patients on these medications.

The over-the-counter pill may be less effective at higher BMI, and available evidence suggests it loses effectiveness earlier than the prescription pill does. If you have a higher BMI, the prescription pill or the copper IUD is generally preferred. A pharmacist or clinician can help you decide.

Yes - it can be taken more than once in a cycle if needed, but it is not designed for regular use. Frequent use can cause irregular bleeding. If you find yourself needing EC repeatedly, talk to a clinician about an ongoing birth control method.

Yes - take it anyway. It is very difficult to know reliably whether ovulation has already happened, even with cycle tracking, ovulation-predictor kits, or symptom tracking. People often:

• Miscount cycle day.
• Have an unusually early or late ovulation that month (stress, illness, travel, or sometimes for no clear reason).
• Misread ovulation-predictor kits.
• Confuse mid-cycle symptoms (mittelschmerz, cervical-mucus changes) with the actual moment of ovulation.

Because the pills work best before ovulation but the cost of being wrong about your cycle day is much higher than the cost of taking an EC pill that turns out not to be needed, the safer choice is to take EC as soon as possible rather than skip it because you think you've already ovulated.

If you're particularly concerned that ovulation may have already happened, the copper IUD is the most reliable option - it works regardless of where you are in your cycle, including after ovulation. If an IUD is not accessible quickly, take the prescription morning-after pill (more effective than the over-the-counter pill in the later part of the 5-day window). When in doubt, contact a clinician or pharmacist.

No. EC works mainly by delaying or preventing ovulation - the release of an egg from the ovary. If ovulation has not yet happened, no egg is available to be fertilized. EC does not affect an existing pregnancy and is not an abortion medication.

The main sign that EC worked is your next period arriving roughly on time. Your next period may be a few days earlier or later than expected, lighter or heavier, or more painful - all of this is normal.

Take a home pregnancy test if:

• Your period is more than 7 days late.
• Your next period is much lighter or shorter than usual.
• You have any pregnancy symptoms (breast tenderness, nausea, fatigue) that linger.

Your next period may come a few days earlier or later than expected, and may be lighter, heavier, or crampier than usual. These changes are temporary and do not mean anything is wrong. If your period is more than 7 days late, take a pregnancy test.

No. EC prevents pregnancy but does not protect against sexually transmitted infections. If you had unprotected sex, consider STI testing - TeleTest can help with this. See STI Testing Overview.

EC will not work if you are already pregnant and will not harm an existing pregnancy. It is not an abortion medication. If you're unsure whether you might already be pregnant, take a home pregnancy test before EC if you have time, but don't delay EC if the test result is unclear and you've had recent unprotected sex.

No known long-term effects on health or fertility. EC is safe when used as directed.

There is no minimum age. EC is safe at any age once a person is able to become pregnant. Anyone can buy the over-the-counter morning-after pill at a pharmacy in Canada.

EC pills are safe for the vast majority of patients. The main exceptions:

• Certain enzyme-inducing medications (rifamycin antibiotics, some anti-seizure drugs, some HIV antiretrovirals, St. John's wort) reduce effectiveness - the copper IUD is more reliable.
• Severe liver disease is a relative reason to choose a different option (especially for the prescription pill).
• Recent use of the prescription morning-after pill within 5 days reduces the effectiveness of starting hormonal contraception.

A pharmacist or clinician can quickly screen for these.

EC pills are not subsidized the same way as ongoing prescription contraception in most provinces. Out-of-pocket cost ranges roughly $15-$50 depending on the pharmacy and which pill. Some provincial drug-benefit programs cover EC for eligible patients - check your program. The copper IUD itself often has a one-time cost but the procedure and follow-up are typically covered under your provincial health plan.

EC is not a long-term birth control method. If you do not want to rely on EC repeatedly, plan ongoing contraception:

• After the over-the-counter morning-after pill - you can start or continue hormonal birth control right away. Use backup contraception as directed for your method, often for 7 days.
• After the prescription morning-after pill - wait at least 5 days before starting or resuming hormonal birth control. Use condoms or avoid sex until your next period.
• After a copper IUD for EC - the IUD is already providing ongoing contraception. Nothing else is needed unless you choose to have it removed.

See Birth Control for a full overview of options.

If your next period is more than 7 days late, take a home pregnancy test. A test taken too early (in the first 2 weeks after unprotected sex) can give a false negative.

Unprotected sex carries STI risk separate from pregnancy. If your partner's status is unknown, consider testing. Typical timing:

• Chlamydia and gonorrhea - testing is reliable from about 2 weeks after exposure.
• Syphilis, HIV, hepatitis - testing windows vary but generally 1-3 months from exposure for full clearance, with earlier testing useful in many cases.

See STI Testing Overview.

If you have questions, want to discuss ongoing birth control, or had a difficult experience (unwanted contact, partner conflict, contraception sabotage), a TeleTest consultation can help connect you with the right resources. For sexual assault, local sexual-assault treatment centres offer free, confidential support and forensic care - calling your local police non-emergency line or a sexual-assault crisis line can help you find the nearest one.