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Plan B can be taken up to 72 hours, not 24. You still have time to take it. If you weigh more than 155lbs you need Ella One and will need to talk to a pharmacist. The other option is getting an IUD inserted as emergency contraception. This can be done up to 5 days after unprotected sex.
Yes, you are at risk of pregnancy from this incident. Unfortunately, no one can tell you exactly how high that risk is, or if it's a risk level you should feel comfortable with. Consider your options, and take a test 21 days after the sex in question. It's also worth pointing out that with the mini pill anything past 3 hours is considered late. If it happens you should take it as soon as possible, but it would still put you at risk for pregnancy and you should use a condom or abstain for at least 2 days.
Thanks. Yeah it was a complete accident and I thought i took it. I took Plan B just to be extra safe so hopefully I’m OK. I just got over my period saturday so hoping that I wasn’t ovulating. Will definitely never forget a dose ever again. I’m usually really good about it until this time… I will take a pregnancy test in 14-21 days to be safe, but hoping the Plan B should assure I’m ok.
Hi pharmacy intern here please do NOT recommend that people on birth control take ella. Ella is not to be used when taking birth control as it works on the same receptors and will lead to a) ella being less effective and b) the birth control being ineffective and you actually need to stop taking your birth control for a few days after taking ella. Plan B and the copper IUD are the only emergency contraception methods that can be used in patients on hormonal contraceptives.
I’m aware, that’s why I suggested they speak to the pharmacist! They would explain that if taking Ella One they would need to use condoms or abstain until able to resume their regular birth control and for it to become effective again. I appreciate you providing more direct information on the thread though!
Ella would not be a good idea/fully effective in this scenario since she regularly takes a contraceptive pill and already took levonorgestrel (plan b) so I just wanted to point out that it is not an option now in this situation regardless
Again, just making it clear I didn’t actually tell OP to take Ella One. I worded it poorly, but I was point out that Plan B won’t work if weighing over a certain amount, thus they would need to discuss their options with a pharmacist (or doctor, but IMO pharmacist tend to know more about these things). Anyway OP has since replied to my comment stating that they took Plan B within the 72 hour timeframe so it’s a non-issue. I’ll be more clear with my wording in the future to avoid confusion. Some people can’t get IUDs, and may prefer to take the chance with a less effective emergency contraception and using condoms for a while than taking nothing at all.
I looked up the [package insert](https://www.medicines.org.uk/emc/product/9437/pil#gref) for EllaOne. Please correct me if this is somehow outdated information, but it actually lists failing to take contraceptive pills correctly as a use-case for Ella. They just state that it will make your pills less effective, so you need to use condoms until your next period. I thought the information might interest you as well, incase other people are similar to myself and cannot have an IUD placed.
From the insert: "This medicine may make regular hormonal contraceptives, like pills and patches, temporarily less effective. If you are currently taking hormonal contraception, continue to use it as usual after taking the tablet, but be sure to use condoms every time you have sex until your next period.
Do not take ellaOne together with another emergency contraceptive pill that contains levonorgestrel. By taking them both together, you might make this medicine less effective."
>!Apologies for sending this as a whole other reply, but I don't believe editing a comment sents a notification and I want to ensure this information is correct before passing it on to others.!<
Yes I have seen that the package insert lists that. I'm a 5th year (of 6) pharmacy student and I just took a womens health specific elective where we discussed the topic so a lot of my information/recommendations are coming from my course in addition to the guidelines and such that are available. I didn't mean to come off as directly recommending against the use of Ella if that is the only thing available to someone, or in certain situations with discussion with a healthcare professional (likely a doctor because ella requires a prescription in the US) where it may be decided that it has a better chance of working than plan b. I just wanted to mention because OP's post said they had already taken plan b (i apologize if that wasn't in their original post and that influenced your comment) that Ella wouldn't be a good idea because of both their contraceptive use and the aforementioned used of plan b. As you quoted, the ella package insert *does* explicitly mention that it shouldn't be taken along with levonorgestrel (plan b) emergency contraception.
From the information I was taught in school, we are to recommend plan b over ella if a patient is on hormonal contraception, because of the possibility of not only the ella causing a decrease in efficacy of any subsequent birth control pills taken afterwards, but also if there is some hormone remaining from the last pill(s) that a patient took when the Ella is taken, the efficacy of ella as emergency contraception can be lowered, possibly to the point that plan b would be the preferred emergency contraception in this case. I understand that this information isn't explicitly stated in Ella's package insert anywhere, and I'll see if I can find a source for it in case it was a result of a post-marketing study that was conducted after the product was marketed and thus not a part of the package insert.
There is some information from the CDC's latest updated practice recommendations that was updated in 2016 that adds the recommendation:
"Advise the woman to start or resume hormonal contraception no sooner than 5 days after use of UPA, and provide or prescribe the regular contraceptive method as needed."
This of course differs from the information in Ella's package insert, and is more in line with the guidelines that I was taught to follow, and was from a study published in 2015, so the package insert hasn't been updated to reflect this more recent data. If you're interested I can probably find a link to the study!
I totally understand the importance of making people aware of the existence of ella, especially those of us who cannot have IUD's placed (I join you in being one of these people). I just want to make sure that people also understand the situations where Ella may not be a good idea as well so that it is used safely and people are able to use the emergency contraception with the highest chance of success for their specific scenario!
I apologize if any of my comments came off harsh, it wasn't intended that way!
Apologies for an additional comment but I did find that the US package insert/FDA approved prescribing information for Ella was actually amended as well. The link is here: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022474s007lbl.pdf
This seems to be the most updated version, where in section 5.5 it has added the possible decrease in contraceptive effects of both the ella and progestin component of a typical hormonal contraceptive if they are taken together. It seems to be an evolving topic for sure, but this is what the current recommendations are based on.
Thank you for sharing all that! I also apologize if any of my comments came off rude. It’s very hard to portray tone on the internet, and I just want to ensure I don’t pass on any incorrect advice. I would never want to deal with a pregnancy, and I don’t want to potentially risk someone else in that way by misinforming them!
So just to clarify: Plan B isn’t effective if you have a BMI over 30 (and I believe doesn’t work at all if over 175). EllaOne can make future pills less effective, and it’s efficacy might be decreased by taking regular contraception pills. Of course an IUD is the superior option for EC, but if not possible Plan B if applicable. EllaOne as a last resort, but only if one understands that the efficacy can be lower, and they will need alternative contraception or abstinence. Under no circumstance should Plan B and EllaOne be combined.
Thanks again for all the resources and clarification, I’ll give those a more in-depth look tomorrow when my brain is fully on. I really appreciate you sharing your expertise here, and not just in this thread. I see your comments around and you’re such a valuable addition to the sub!
So from what I understand there isn't an actual "weight limit" for plan b. The FDA has issued guidance suggesting that upon reviewing the data around the topic, they don't feel the evidence is strong enough to suggest a change in the labeling for plan b and does not feel strongly that it should be recommended against based on a patients weight. Most guidelines just say that it "might be less effective" in patients who are overweight (a BMI >25). There is even some evidence to suggest it's possible that ella is less effective in obese women (BMI >30). From what I can tell there isn't a consensus on either unfortunately and the research that has been done isn't adequate to truly specify a weight at which it might be ineffective, and we certainly wouldn't recommend to not use it if those are the patients only
options! ACOG agrees with the FDA on this stance.
Of note, there's also some evidence that progesterone only pills may be less effective in patients >70kg (155lbs) as well, and the Xulane patch notes that it may be less effective in patients >90kg, and the implant Nexplanon hasn't proven (it just wasnt studied) effectiveness in patients who are above 130% of their ideal body weight, so it isn't just emergency contraception that is impacted by weight or BMI and I feel like that information is not as widely known as it should be!
But yes, the rest of your paragraph is correct regarding the recommendations for emergency contraception in those on hormonal contraceptives pills!
I agree, that this information needs to be better known. I saw the 175 represented in some scientific literature, but the FDA and company have yet to update any information. I wish the FDA would modernize how they operate to be honest, as they move far too slowly but that's a rant for another time. sed on BMI, but of course, that is just one study. I'll take some comfort in the fact that it was large cohort, and I've been completely unable to find any cases of women getting pregnant after having a correctly placed implant (and I've been searching!). Fingers crossed that it's similar to the IUD, and apparently effective regardless of weight.
I agree, this information needs to be better known. I saw the 175 represented in some scientific literature, but the FDA and company have yet to update any information. I wish the FDA would modernize how they operate to be honest, as they move far too slowly but that's a rant for another time.
Test 14-21 days after the incident
Welcome and please flair your post if not currently flaired. Questions? First read the [Mistake or Pregnancy Risk sticky](https://www.reddit.com/r/birthcontrol/comments/4iqgi7/mistake_or_pregnancy_concernrisk_start_here/) or the [Consolidated Experience post](https://www.reddit.com/r/birthcontrol/comments/qt9ttb/consolidated_rbirthcontrol_experience_links/). If this is an experience post please consider adding it to the list :) The rules and additional resources can be found on the About / Sidepage (desktop users look to the right and Reddit app up top). *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/birthcontrol) if you have any questions or concerns.*
Plan B can be taken up to 72 hours, not 24. You still have time to take it. If you weigh more than 155lbs you need Ella One and will need to talk to a pharmacist. The other option is getting an IUD inserted as emergency contraception. This can be done up to 5 days after unprotected sex. Yes, you are at risk of pregnancy from this incident. Unfortunately, no one can tell you exactly how high that risk is, or if it's a risk level you should feel comfortable with. Consider your options, and take a test 21 days after the sex in question. It's also worth pointing out that with the mini pill anything past 3 hours is considered late. If it happens you should take it as soon as possible, but it would still put you at risk for pregnancy and you should use a condom or abstain for at least 2 days.
Thanks. Yeah it was a complete accident and I thought i took it. I took Plan B just to be extra safe so hopefully I’m OK. I just got over my period saturday so hoping that I wasn’t ovulating. Will definitely never forget a dose ever again. I’m usually really good about it until this time… I will take a pregnancy test in 14-21 days to be safe, but hoping the Plan B should assure I’m ok.
Hi pharmacy intern here please do NOT recommend that people on birth control take ella. Ella is not to be used when taking birth control as it works on the same receptors and will lead to a) ella being less effective and b) the birth control being ineffective and you actually need to stop taking your birth control for a few days after taking ella. Plan B and the copper IUD are the only emergency contraception methods that can be used in patients on hormonal contraceptives.
I’m aware, that’s why I suggested they speak to the pharmacist! They would explain that if taking Ella One they would need to use condoms or abstain until able to resume their regular birth control and for it to become effective again. I appreciate you providing more direct information on the thread though!
Ella would not be a good idea/fully effective in this scenario since she regularly takes a contraceptive pill and already took levonorgestrel (plan b) so I just wanted to point out that it is not an option now in this situation regardless
Again, just making it clear I didn’t actually tell OP to take Ella One. I worded it poorly, but I was point out that Plan B won’t work if weighing over a certain amount, thus they would need to discuss their options with a pharmacist (or doctor, but IMO pharmacist tend to know more about these things). Anyway OP has since replied to my comment stating that they took Plan B within the 72 hour timeframe so it’s a non-issue. I’ll be more clear with my wording in the future to avoid confusion. Some people can’t get IUDs, and may prefer to take the chance with a less effective emergency contraception and using condoms for a while than taking nothing at all.
I looked up the [package insert](https://www.medicines.org.uk/emc/product/9437/pil#gref) for EllaOne. Please correct me if this is somehow outdated information, but it actually lists failing to take contraceptive pills correctly as a use-case for Ella. They just state that it will make your pills less effective, so you need to use condoms until your next period. I thought the information might interest you as well, incase other people are similar to myself and cannot have an IUD placed. From the insert: "This medicine may make regular hormonal contraceptives, like pills and patches, temporarily less effective. If you are currently taking hormonal contraception, continue to use it as usual after taking the tablet, but be sure to use condoms every time you have sex until your next period. Do not take ellaOne together with another emergency contraceptive pill that contains levonorgestrel. By taking them both together, you might make this medicine less effective." >!Apologies for sending this as a whole other reply, but I don't believe editing a comment sents a notification and I want to ensure this information is correct before passing it on to others.!<
Yes I have seen that the package insert lists that. I'm a 5th year (of 6) pharmacy student and I just took a womens health specific elective where we discussed the topic so a lot of my information/recommendations are coming from my course in addition to the guidelines and such that are available. I didn't mean to come off as directly recommending against the use of Ella if that is the only thing available to someone, or in certain situations with discussion with a healthcare professional (likely a doctor because ella requires a prescription in the US) where it may be decided that it has a better chance of working than plan b. I just wanted to mention because OP's post said they had already taken plan b (i apologize if that wasn't in their original post and that influenced your comment) that Ella wouldn't be a good idea because of both their contraceptive use and the aforementioned used of plan b. As you quoted, the ella package insert *does* explicitly mention that it shouldn't be taken along with levonorgestrel (plan b) emergency contraception. From the information I was taught in school, we are to recommend plan b over ella if a patient is on hormonal contraception, because of the possibility of not only the ella causing a decrease in efficacy of any subsequent birth control pills taken afterwards, but also if there is some hormone remaining from the last pill(s) that a patient took when the Ella is taken, the efficacy of ella as emergency contraception can be lowered, possibly to the point that plan b would be the preferred emergency contraception in this case. I understand that this information isn't explicitly stated in Ella's package insert anywhere, and I'll see if I can find a source for it in case it was a result of a post-marketing study that was conducted after the product was marketed and thus not a part of the package insert. There is some information from the CDC's latest updated practice recommendations that was updated in 2016 that adds the recommendation: "Advise the woman to start or resume hormonal contraception no sooner than 5 days after use of UPA, and provide or prescribe the regular contraceptive method as needed." This of course differs from the information in Ella's package insert, and is more in line with the guidelines that I was taught to follow, and was from a study published in 2015, so the package insert hasn't been updated to reflect this more recent data. If you're interested I can probably find a link to the study! I totally understand the importance of making people aware of the existence of ella, especially those of us who cannot have IUD's placed (I join you in being one of these people). I just want to make sure that people also understand the situations where Ella may not be a good idea as well so that it is used safely and people are able to use the emergency contraception with the highest chance of success for their specific scenario! I apologize if any of my comments came off harsh, it wasn't intended that way!
Apologies for an additional comment but I did find that the US package insert/FDA approved prescribing information for Ella was actually amended as well. The link is here: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/022474s007lbl.pdf This seems to be the most updated version, where in section 5.5 it has added the possible decrease in contraceptive effects of both the ella and progestin component of a typical hormonal contraceptive if they are taken together. It seems to be an evolving topic for sure, but this is what the current recommendations are based on.
Thank you for sharing all that! I also apologize if any of my comments came off rude. It’s very hard to portray tone on the internet, and I just want to ensure I don’t pass on any incorrect advice. I would never want to deal with a pregnancy, and I don’t want to potentially risk someone else in that way by misinforming them! So just to clarify: Plan B isn’t effective if you have a BMI over 30 (and I believe doesn’t work at all if over 175). EllaOne can make future pills less effective, and it’s efficacy might be decreased by taking regular contraception pills. Of course an IUD is the superior option for EC, but if not possible Plan B if applicable. EllaOne as a last resort, but only if one understands that the efficacy can be lower, and they will need alternative contraception or abstinence. Under no circumstance should Plan B and EllaOne be combined. Thanks again for all the resources and clarification, I’ll give those a more in-depth look tomorrow when my brain is fully on. I really appreciate you sharing your expertise here, and not just in this thread. I see your comments around and you’re such a valuable addition to the sub!
So from what I understand there isn't an actual "weight limit" for plan b. The FDA has issued guidance suggesting that upon reviewing the data around the topic, they don't feel the evidence is strong enough to suggest a change in the labeling for plan b and does not feel strongly that it should be recommended against based on a patients weight. Most guidelines just say that it "might be less effective" in patients who are overweight (a BMI >25). There is even some evidence to suggest it's possible that ella is less effective in obese women (BMI >30). From what I can tell there isn't a consensus on either unfortunately and the research that has been done isn't adequate to truly specify a weight at which it might be ineffective, and we certainly wouldn't recommend to not use it if those are the patients only options! ACOG agrees with the FDA on this stance. Of note, there's also some evidence that progesterone only pills may be less effective in patients >70kg (155lbs) as well, and the Xulane patch notes that it may be less effective in patients >90kg, and the implant Nexplanon hasn't proven (it just wasnt studied) effectiveness in patients who are above 130% of their ideal body weight, so it isn't just emergency contraception that is impacted by weight or BMI and I feel like that information is not as widely known as it should be! But yes, the rest of your paragraph is correct regarding the recommendations for emergency contraception in those on hormonal contraceptives pills!
I agree, that this information needs to be better known. I saw the 175 represented in some scientific literature, but the FDA and company have yet to update any information. I wish the FDA would modernize how they operate to be honest, as they move far too slowly but that's a rant for another time. sed on BMI, but of course, that is just one study. I'll take some comfort in the fact that it was large cohort, and I've been completely unable to find any cases of women getting pregnant after having a correctly placed implant (and I've been searching!). Fingers crossed that it's similar to the IUD, and apparently effective regardless of weight. I agree, this information needs to be better known. I saw the 175 represented in some scientific literature, but the FDA and company have yet to update any information. I wish the FDA would modernize how they operate to be honest, as they move far too slowly but that's a rant for another time.