Ella (Ulipristal) - Oral

What Is Ella?

Ella (ulipristal) is used as an emergency contraceptive to prevent pregnancy within five days of unprotected sex (also referred to as condomless sex) or suspected failure of another birth control—like a condom breaking. This medication mainly works by blocking or delaying ovulation—the release of an egg from the ovary.

If an egg is already released, however, then a sperm can still fertilize—meet and join as one cell or unit—with the egg. In this case, Ella might still be able to prevent pregnancy by blocking this fertilized egg from trying to bind with the endometrium, the lining of the uterus.

Unlike other emergency contraceptive pills, Ella is only available as a prescription tablet and not over-the-counter (OTC). You will need a healthcare provider to prescribe it for you.

What Is Ella Used For?

As previously mentioned, Ella is an emergency contraceptive used to prevent pregnancy.

However, like all Food and Drug Administration (FDA) approved contraceptive methods, Ella doesn’t interfere with an established pregnancy when a fertilized egg is already attached to the uterus.

Compared with other developed countries, the United States (U.S.) has many unintended pregnancies—especially among people with low incomes or within the age group of 15 to 19. About half of all pregnancies aren’t planned.

Additionally, many barriers prevent people from easily accessing birth control to consistently and appropriately use them. One example obstacle is a number of pharmacies refusing to stock or dispense emergency contraceptives—like Ella. Therefore, experts recommend and support better access to these emergency contraceptives.

How to Take Ella

Take Ella by mouth with or without food. Take within five days of unsafe sex (also referred to as condomless sex) or suspected birth control failure. If you threw up within three hours of taking Ella, consider taking another dose.

Storage

Since Ella is a non-controlled prescription, your healthcare provider may give you enough refills for up to one year from the original written date on the prescription. Since Ella shouldn’t be used as a regular form of birth control, your healthcare provider might authorize fewer refills at a time.

After picking up Ella from the pharmacy, keep the medication in its original packaging until you’re ready to take it. Store Ella at room temperature between 68 degrees and 77 degrees Fahrenheit (F). Also, protect Ella from light.

If you’re going to travel with Ella, know the regulations of your final destination. In general, however, make a copy of your Ella prescription. Also, keep the medication in its original packaging—with your name on it—from the pharmacy.

What Are the Side Effects of Ella?

Like other contraceptive medications, Ella has potential side effects.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects with Ella include:

• Dizziness
• Headache
• Menstrual cycle changes
• Nausea
• Pain with menstrual period
• Stomach upset
• Tiredness or low energy

Severe Side Effects

Although stomach upset is a common side effect with Ella, it can be excessive and serious. If you experience severe lower stomach pain within three to five weeks of taking Ella, immediately let your healthcare provider know. Your serious stomach pain might be a symptom of an ectopic pregnancy. In an ectopic pregnancy, the fertilized egg doesn’t attach to the uterus—but in another place, such as the fallopian tube or ovary.

Other possible severe side effects with Ella may include:

• Itchiness
• Rash
• Swollen eyes, face, tongue, or throat

If you experience any of these serious side effects, seek immediate medical attention.

Long-Term Side Effects

After taking Ella, you might experience menstrual cycle changes. Your menstrual period might start earlier or later than expected. This side effect is usually temporary and will go away.

However, immediately let your healthcare provider know if your period is more than one week late. You may receive a pregnancy test. If you have severe lower stomach pain after three to five weeks of taking Ella, you might have an ectopic pregnancy. Get medical help right away.

Dosage: How Much Ella Should I Take?

Modifications

In some instances, you may need to change your dosing of Ella or choose a different contraceptive method.

For example, if you vomit within three hours of taking Ella, you may need to take another dose in order for the medication to be effective.

Ella might not be as effective in people with a body mass index (BMI) over 30. BMI is a type of measurement that takes into account your height and weight. Talk to your healthcare provider about how to proceed.

Additionally, based on the available data, Ella use during pregnancy isn't linked to a higher risk of negative effects in the fetus. However, you likely wouldn't be using Ella if you are already pregnant. Still, if you do not know you are pregnant and take Ella, it is unlikely that it will harm the fetus.

As for breastfeeding, there is little safety data on Ella in nursing babies. Therefore, the manufacturer recommends against taking Ella while nursing. With low amounts of Ella in breast milk, however, some experts just recommend not nursing the baby for 24 hours after taking Ella.

Missed Dose

Ella is typically taken as a one-time dose within five days of unprotected sex (also referred to as condomless sex) or suspected birth control failure. If you missed the chance to take Ella within five days, you would have a higher likelihood of pregnancy.

If you threw up within three hours of taking Ella, this would count as a missed dose. So, if you did not make up for this missed dose within five days of condomless sex or suspected birth control failure, you’ll be at a higher risk of pregnancy.

Overdose: What Happens If I Take Too Much Ella?

Ella is typically not taken more than once within the same menstrual cycle unless you threw up within three hours of taking it.

While overdose data on Ella is limited, clinical study participants have tried a high one-time dose of 120 milligrams of Ella without any side effects.

Precautions

What Are Reasons I Shouldn’t Take Ella?

Don't take Ella if you suspect or know that you’re pregnant.

What Other Medications Interact With Ella?

Ella is broken down in the body by a type of protein in the liver. This protein is called CYP3A4. Therefore, any medications that affect how CYP3A4 works might also affect the amount of Ella in the body.

CYP3A4-inducing medications—like St. John’s Wort for mood and Topamax (topiramate) for seizures or migraines—encourage CYP3A4 to quickly break down Ella. With lower amounts of Ella in the body, the medication is also potentially less effective.

As for CYP3A4-inhibitors, like a ketoconazole antifungal, these medications prevent CYP3A4 from working as well. As a result, higher amounts of Ella will be in the body, which can cause more side effects.

As previously mentioned, taking Ella with other hormonal contraceptives might lessen the effectiveness of both medications. Wait for five days after taking Ella before using a regular hormonal contraceptive. As a reminder, make sure to use a barrier birth control method—like a condom—at least until your next menstrual period.

If you have any questions about these drug interactions, talk with your pharmacist or healthcare provider.

What Medications Are Similar?

There are many different available methods of birth control. Including Ella, however, there are only three other options used as emergency contraceptives.

Since these choices are used as emergency contraceptives, they aren’t typically used together. Discuss any questions you have with your healthcare provider.

Copper Intrauterine Device

The most effective emergency contraceptive is the copper intrauterine device (IUD) known as Paragard. It’s a nonhormonal device that, over time, releases small amounts of copper—a naturally-occurring essential element in the body.

Copper affects how the sperm moves and prevents the sperm from joining with the egg. A healthcare provider can help place the IUD in your uterus within five days of condomless sex or birth control failure. The IUD can be used as an emergency contraceptive and can continue working as a regular form of birth control for 10 years.

Levonorgestrel

The second option is levonorgestrel. Like Ella, it can be taken within five days of condomless sex or birth control failure. Levonorgestrel is as effective as Ella when taken within three days. However, Ella is more effective than levonorgestrel at the three to the five-day mark.

Levonorgestrel is available as a single dose of 1.5 milligrams. It’s also known as two tablets of 0.75 milligrams for you to take 12 hours apart.

Yuzpe Regimen

In the Yuzpe regimen, you will take one dose of ethinyl estradiol 0.1 milligrams with 0.5 milligrams of levonorgestrel. Then, 12 hours later, you will take another dose of this hormonal combination. Although the Yuzpe regimen is an option, it’s not as effective as Paragard, Ella, or levonorgestrel. Additionally, the Yuzpe regimen is linked to more side effects—like nausea and vomiting.

How Can I Stay Healthy While Taking Ella?

When taken within five days of condomless sex or birth control failure, Ella can lower your risk of pregnancy. If possible, try to take the medication sooner within this time frame for better effectiveness. If you threw up within three hours of taking Ella, consider taking another dose.

After taking Ella, you’re still at risk of becoming pregnant. Therefore, it’s still important to use a barrier birth control method—like a condom—at least until your next menstrual period. In general, using a condom is also beneficial at preventing sexually transmitted infections (STIs)—primarily since Ella itself cannot protect you from STIs. In addition to using condoms, you can get certain vaccines to prevent STIs. Also, consider getting STI testing.

Ella isn’t meant to be used as routine birth control. Since there are so many available birth control choices, speak with your healthcare provider to help decide on the best option for you—based on costs, convenience, and other preferences. If you plan to use a regular hormonal contraceptive soon, wait five days after taking Ella before starting on your hormonal birth control—like an oral birth control pill or patch.

After taking Ella, your period can run a little late. This is normal. However, if you notice that your period is more than one week late, pregnancy is possible. Talk with your healthcare provider to receive a pregnancy test. Also, get medical help right away if you experience severe lower stomach pain after three to five weeks of taking Ella.

While on birth control, you may continue to maintain healthy habits to feel your best, including incorporating exercise and staying hydrated as much as possible. Speak with your healthcare provider about a personal best approach for a healthy lifestyle.