The Difference Between the Morning After Pill and the Abortion Pill

He was my first love, a flame that took years to finally flicker out. We would meet in secret, long after we’d split. My friends wouldn’t stand for me making the same mistake over and over. His parents wouldn’t allow for our relationship.

This time he’d ejaculated quickly, without care for contraception. He’d assumed I was taking the Pill, and I’d failed to tell him otherwise. The next day we drove to the pharmacy where I took the morning after pill, well within the recommended window of time. Yet, weeks later, I found out I was pregnant.

What is the Morniing After Pill?

The morning-after pill (also known as Emergency Contraception, EC, Preven, or Plan B) prevents pregnancy and does not cause an abortion. It prevents fertilization of an egg or attachment of a fertilized egg to the uterine wall. The morning-after pill is sold over-the-counter and consists of one pill that contains the progestin, levonorgestrel.

How Effective is the Morniing After Pill?

Emergency contraception is only 95 percent effective, even when taken as directed. It is available without a prescription, and comes in two doses. The first is taken within 72 hours of unprotected sex (including failed contraception or a forgotten Pill). The second dose is taken 12 hours later.

I’d taken both doses as instructed, but swallowed the second pill without water. The evening after my tryst I was at the theater with friends who knew nothing of my situation. Imagining their disapproval, I’d kept it secret, and forced the pill down my dry throat (where it stuck) as the show began.  

How Does the Morning After Pill Work?

It uses levonorgestrel, a form of progesterone that prevents the release of the luteinizing hormone necessary for ovulation. It also thickens the vaginal fluid, providing a barrier between the sperm and any previously released eggs. If fertilization does take place, the levonorgestrel encourages the endometrium to shed so the egg can’t implant in the womb.

Once the 72-hour window has passed, emergency contraception is no longer effective, but you do have the option to take Ella up to five days after unprotected sex. When five days have passed, the abortion pill provides a next step.  

The Morning After Pill vs. the Abortion Pill

One is a hormonal contraceptive, and the other is a form of early medical abortion. One prevents a potential pregnancy from happening, and the other terminates an existing pregnancy.

If you think you might have conceived, and are still within the five-day window outlined above, you can take emergency contraception. If you have tested positive for pregnancy, you would take the abortion pill.  

The Abortion Pill

The abortion pill (also known as RU-486, medical abortion, Mifeprex®, or mifepristone) terminates an already established pregnancy when used in combination with another medication.

How Does the Abortion Pill Work?

You can take the abortion pill up to 10 weeks after the first day of your last period. You can also take the medicine at home, making the experience less invasive.

The abortion pill is comprised of two different medicines. The first is mifepristone, which blocks the production of progesterone, and causes the endometrium to break down. The second is misoprostol. This is placed in the vagina where it triggers the womb to contract and release its contents.  

How Effective is the Abortion Pill?

The abortion pill is said to be 98 percent effective for women who are less than eight weeks pregnant. This falls to 96 percent at nine weeks, and 93 percent at 10 weeks. If it’s been longer since your last period, you can choose to have an in-clinic abortion.

Neither the morning after pill nor the abortion pill provides an everyday birth control method. They simply provide options when faced with an unexpected or complicated pregnancy. If you want to avoid conception altogether, the Pill is one of many hormonal contraceptives available, and is 99 percent effective.  

The Birth Control Pill

There are two types of Pill: the combined and the progesterone-only (or mini pill). The combined contains synthetic estrogen and progesterone, while the mini pill only contains the latter.

The estrogen substitute blocks ovulation, while the progesterone substitute works in a similar way to the morning after pill. It thickens the mucus at the entrance to your womb, making it harder for sperm to get through. It also thins the uterine lining, reducing your chances of supporting a fertilized egg.

Why is There So Much Confusion Surrounding These Different Medications?

While these pills do very different things—one prevents pregnancy, one ends pregnancy—there is still much confusion surrounding the two. The morning after pill lowers your chances of becoming pregnant by preventing or delaying ovulation—but the FDA labeling also says it “may inhibit implantation” whereas research shows that it does not interfere with implantation. This FDA labeling and lack of research, along with misunderstandings around implantation, all contribute to the confusion between the two pills.

Which pill should I take to prevent pregnancy?

Explore your options. You may prefer an intrauterine device to an oral contraceptive, depending on what feels best for you. I’d stopped taking the Pill a few weeks before I had unprotected sex because I felt my body needed a break.

I’d then failed to explore my options because the information I needed wasn’t available to me. This was 17 years ago, and I knew nothing of the abortion pill. Instead my ex and I panicked. He paid for me to have a clinical procedure, but I went alone, and it was carried out without pain prevention.

I wish I’d known then what I know now. We may all, at some point in our lives, be faced with an unplanned or complicated pregnancy. What matters is that we get to choose how to proceed, and that the choices we make are informed.

Featured image by Qi Bin

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