Birth Control & Family Planning

Emergency Contraception: Plan B vs. Ella vs. Copper IUD

By the Find Her Doctor editorial team · Updated November 1, 2026 · 5 min read

Emergency contraception (EC) can prevent pregnancy after unprotected sex or a birth control mishap, like a broken condom or missed pills. You have three main options: levonorgestrel pills such as Plan B (over the counter, best within 3 days), ella (prescription, works up to 5 days), and the copper IUD (the most effective, placed within 5 days). The sooner you act, the better the pills work.

If you're reading this at 1 a.m. after a condom broke, here's the short version, then the details.

The 60-second decision guide

• It's been less than 3 days, and you want the easiest option: buy a levonorgestrel pill (Plan B or a generic) at any pharmacy. No prescription, no ID, no age limit.
• It's been 3 to 5 days, or you weigh more: ask for ella, which needs a prescription. Telehealth can often get you one the same day.
• You want the most effective option, and ongoing birth control too: call an OB/GYN or family planning clinic and ask for a copper IUD for emergency contraception, within 5 days.

How the options compare

The CDC's 2024 practice recommendations also list the higher-dose levonorgestrel IUD as an emergency option for some patients. Ask your clinician whether it fits you.

How does it actually work?

EC pills work mainly by delaying or preventing ovulation. If no egg is released, sperm can't fertilize one. They don't end a pregnancy that has already implanted, and they don't harm an existing pregnancy. That's why the morning-after pill is not the abortion pill; they're different drugs that do different things.

The copper IUD works differently: copper is toxic to sperm and eggs and prevents fertilization.

Levonorgestrel pills (Plan B, Take Action, My Way and others)

• One pill, as soon as possible
• On the shelf at most pharmacies and big-box stores (some stores keep it behind a counter or in a locked case, but you still don't need a prescription or ID)
• Generics work the same as brand-name Plan B and usually cost less

Anyone can buy it, regardless of age or sex, so a partner or friend can pick it up for you.

Does Plan B work if I weigh more?

Research suggests levonorgestrel EC may be less effective at higher body weight or BMI. ACOG notes that the copper IUD is the most effective option regardless of weight, and that ella may be more effective than levonorgestrel for people with obesity. Don't let this stop you from taking levonorgestrel if it's the only thing you can get tonight. It's still better than nothing.

Ella (ulipristal acetate)

• One pill, as soon as possible within 5 days
• Needs a prescription, often available same-day through telehealth or a clinic
• Holds its effectiveness better across the 5-day window than levonorgestrel

Call the pharmacy before you go to confirm they have ella in stock. Not every location keeps it on hand.

Ella and hormonal birth control

Ella and progestin-containing birth control can interfere with each other. CDC guidance says to wait at least 5 days after taking ella before starting or restarting hormonal birth control, and to use condoms or skip sex until your new method is working. Ask your clinician for a plan.

The copper IUD as emergency contraception

A copper IUD placed within 5 days of unprotected sex prevents more than 99% of pregnancies, and it keeps working as birth control for up to 10 years. Read more in our guide to hormonal vs. copper IUDs.

The hard part is getting an appointment fast. When you call, say the words "I need an IUD for emergency contraception" so the front desk knows it's time-sensitive and doesn't book you three weeks out.

What the next few weeks look like after an EC pill

• Side effects: nausea, headache, tiredness, breast tenderness, belly pain or spotting. These usually pass in a day or two.
• Your next period: may come a few days early or late. A common worry is that spotting a few days later means it "didn't work." It's a typical side effect.
• If you vomit soon after the pill: ask a pharmacist or clinician whether you need another dose.
• Pregnancy test: take one if your period is more than a week late.

EC pills protect you only from sex that already happened. You can still get pregnant later in the same cycle, so use condoms or start a regular method.

Questions people are embarrassed to ask

Can I use it more than once? Yes. There's no safety limit on how many times you can use levonorgestrel EC. But EC pills are less effective than ongoing birth control, so if you need them often, consider a regular method like the pill, an IUD or an implant.

I'm already on birth control and missed pills. Can I still take it? Yes. Continue or restart your regular method as your clinician advises. If you take ella, follow the 5-day rule above first.

Is it safe? Yes. EC pills have been used for decades and serious side effects are rare. The CDC's Medical Eligibility Criteria list no medical conditions where the risks of EC pills clearly outweigh the benefits. They're safe for teens and for people who can't use estrogen.

Should I keep one at home? Many clinicians suggest buying levonorgestrel EC ahead of time, since it works best the sooner you take it. Check the expiration date and store it as the label says.

Getting emergency contraception in New York

• Pharmacies: levonorgestrel EC is sold over the counter with no age limit.
• Insurance: some health plans cover EC; rules vary by plan, so ask your pharmacist or insurer. New York Medicaid covers family planning services, including emergency contraception.
• NYC Sexual Health Clinics: the city Health Department's clinics offer emergency contraception at low or no cost for anyone 12 and older, regardless of immigration or insurance status, and without parental consent. Most services are walk-in on weekdays, and the city says EC patients get priority when the clinic is busy. Check current hours at nyc.gov or by calling 311.
• Clinics and OB/GYN offices can prescribe ella or place a copper IUD.

When to call your provider

Call your provider if you:

• Have severe belly pain within a few weeks of taking EC, which could be a sign of ectopic pregnancy
• Have a period more than 7 days late
• Have bleeding much heavier than usual
• Were sexually assaulted. You can get care, EC and STI prevention at a hospital emergency department.

Need a copper IUD or an ella prescription? Complex Family Planning specialists and OB/GYNs can help. Search the directory to find a provider near you.

Frequently asked questions

Sources

• ACOG — Emergency Contraception (Practice Bulletin 152)
• ACOG — Emergency Contraception (patient FAQ)
• CDC — U.S. Selected Practice Recommendations for Contraceptive Use, 2024
• FDA — Plan B One-Step and ella prescribing information
• NYC Department of Health and Mental Hygiene — Sexual Health Clinics

This article is for general education and is not medical advice. It does not replace an evaluation by a licensed clinician who knows your history. If you think you have a medical emergency, call 911.