How It Works
Ella works as an emergency contraceptive by delaying or preventing ovulation. It stops an egg from being released from the ovary so that fertilization doesn’t occur. It may also thin the lining of the uterus, which makes it more difficult for a fertilized egg to attach and implant.
| Quick Facts | |
|---|---|
| Common Brands | Ella |
| Drug Class | Emergency contraceptive, selective progesterone receptor modulator |
| Generic Status | No generic is available |
| Availability | Prescription only |
Dosing
Ella is an oral tablet that comes in a single dosage strength of 30 mg. The recommended dose is one tablet by mouth as soon as possible after unprotected sex or contraceptive failure, but it can be taken up to 5 days (120 hours) after intercourse.
If vomiting occurs within 3 hours of taking the tablet, a repeat dose may be considered to ensure the medication works.
Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. Always follow your healthcare provider’s instructions for exact dosing.
Uses
FDA-Approved Uses
Ella is FDA-approved as an emergency contraceptive to prevent pregnancy after unprotected sex or a known or suspected contraceptive failure (e.g., broken condom, missed pill).
Off-Label Uses
You may see Ella prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.
There are currently no common off-label uses for Ella.
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Side Effects
Like all medications, Ella can cause side effects. Some common side effects may improve over time as your body adjusts to the medication. Other side effects may be serious and require medical attention.
Common Side Effects
- Headache
- Nausea
- Stomach pain
- Menstrual cramps
- Tiredness or fatigue
- Dizziness
- Breast tenderness
- Irregular menstrual bleeding or spotting
Serious Side Effects
Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using Ella and call your doctor immediately if you experience:
- Severe allergic reactions: Symptoms include swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; racing heart; severe rash or itching; fever.
- Ectopic pregnancy: Ella may increase the risk of experiencing a pregnancy outside of the womb, which can be life-threatening. Symptoms include severe lower stomach or pelvic pain and unusual vaginal bleeding or stomach pain. These symptoms may arise 3 to 5 weeks after taking Ella.
Call your doctor immediately if you experience any concerning or prolonged symptoms.
Pharmacist Tips
Take Ella As Soon As Possible
The sooner the tablet is taken after unprotected sex or contraceptive failure, the more effective it is at preventing pregnancy.
Take Ella With Or Without Food
The medication may be taken with or without food at any point during your menstrual cycle.
Call Your Prescriber If You Vomit After Taking Ella
If vomiting occurs within 3 hours of swallowing the dose, contact a prescriber immediately. A repeat dose may be necessary for the medication to remain effective.
Pause Hormonal Birth Control Pills
Wait at least 5 days before starting or resuming regular hormonal birth control. Taking them at the same time as Ella may cause both medications to lose their effectiveness.
Use A Barrier Method During Sex
Medical professionals highly advise using a reliable barrier method, such as a condom with spermicide, every time you have sex until your next period arrives.
Your Period May Arrive Earlier Or Later Than Usual
Ella can affect the timing of your next menstrual cycle, causing it to arrive a few days earlier or later than anticipated. If your period is more than a week late, you should take a home pregnancy test.
Practice Safe Sex
Ella does not protect against sexually transmitted infections (STIs), including HIV.
Do Not Take Ella If You’re Pregnant
Ella doesn’t end a pregnancy. It only works to prevent it. If you wish to end your pregnancy, contact your OB-GYN for safe options.
Do Not Take Ella More Than Once Per Cycle
Ella should not be used as regular birth control. It’s unknown if it’s safe to use more than once in the same menstrual cycle.
Drug Interactions
Certain medications and substances can interact with Ella, potentially altering its effectiveness or increasing the risk of side effects. For example:
- Anticonvulsants: Ella may interact with medications used to control seizures, such as carbamazepine, phenytoin, oxcarbazepine, felbamate, and topiramate.
- Barbiturates: Ella can interact with drugs used to treat insomnia, migraine, or seizure, such as phenobarbital, amobarbital, butalbital, or primidone.
- Rifampin: You should not use Ella with this medication.
- Griseofulvin: This medication may interact with Ella.
- Bosentan: This medication may interact with Ella.
- St. John’s wort: This herbal supplement can interact with Ella.
- Hormonal birth control: Hormonal contraceptive pills, implants, patches, or intrauterine devices may interact if used within 5 days of Ella.
Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.
FAQs
Why do I need a prescription for Ella when I can just buy Plan B off the shelf?
As of now, the FDA has not approved Ella for over-the-counter use in the U.S. However, organizations such as the American College of Obstetricians and Gynecologists state that no clinical examination or pregnancy testing is required before prescribing either oral emergency contraceptive, and access should not be withheld from patients who request it.
Does Ella still work even if I wait until the 4th day after unprotected sex?
Yes, Ella can be used up to 5 days (120 hours) after unprotected sex. You should take it as soon as possible.
Will Ella still work if I weigh over 165 pounds?
Ella may be less effective in people with a larger body size. There isn’t a definitive weight cutoff where it stops working, though some studies suggest reduced efficacy at a BMI over 30 kg/m². If you weigh over 165 pounds, consider discussing your options with a provider.
Can I take this pill if my period tracker says I am ovulating today?
Ella functions best when taken before ovulation, as its primary mechanism is to delay or block the release of an egg. If ovulation has already taken place, the medication will not be effective. Since predicting exact ovulation timing is difficult, providers typically recommend taking the pill as soon as possible after unprotected sex.
Why did my pharmacist tell me not to take my regular daily birth control pill for 5 days after taking Ella?
Taking regular hormonal birth control within 5 days of using Ella can cause an interaction that makes both medications less effective.
Will taking this pill cause a miscarriage or an abortion if I am already pregnant?
Ella will not end a pregnancy that has already started. It is not an abortion pill and is not recommended for people who are already pregnant.
What exactly should I do if I feel nauseous and throw up after swallowing the pill?
If you vomit within 3 hours of taking Ella, contact a healthcare provider immediately. Your provider may consider a replacement dose to ensure the drug works effectively.
How long does it usually take for my normal period to start after taking Ella?
Your next period may arrive a few days earlier or later than you expect. Clinical studies show an average delay of about 2.5 days, with cycles generally returning to normal the following month.
Can I take Ella twice in the same month?
Do not take Ella more than once during the same menstrual cycle. The safety and efficacy of taking it more frequently are currently unknown.
If I take Ella today, does it also protect me if I have unprotected sex again tomorrow?
No, Ella does not provide ongoing protection. A reliable barrier method, like a condom, should be used for any future intercourse until your next menstrual period.
Is it normal to have heavy spotting or stomach cramps after taking this?
Yes. Common side effects of Ella include abdominal or stomach pain, menstrual cramps, and irregular bleeding or spotting.
Will taking this emergency pill make it harder for me to have a baby in the future?
Fertility typically returns shortly after the medication wears off, which takes a few days.
How do I actually know if the pill worked?
The most reliable indicator is the arrival of your next menstrual period. If your period is delayed by more than 7 days, taking a home pregnancy test is advised.
Is it safe to take Ella if I am currently breastfeeding my baby?
Ulipristal acetate does pass into breast milk. Tell your healthcare team if you are nursing, so they can provide specific guidance on whether it is safe for your situation.
Are there any antibiotics or natural supplements that will make Ella stop working?
Yes, certain supplements, such as St. John’s wort, and specific antibiotics, such as rifampin, can interact with Ella and reduce its effectiveness.
Does this emergency pill protect me against STIs?
No, Ella provides no protection against human immunodeficiency virus (HIV) or any other sexually transmitted infections (STIs). Barrier methods are still required to reduce STI risks.
Comparable Medications
Ella, levonorgestrel (Plan B), or Paragard (Copper IUD)?
There are several medications that your doctor can prescribe in place of Ella. Here are a few possible alternatives below.
Levonorgestrel
An emergency contraceptive pill used to prevent pregnancy within 3 days after unprotected sex.
ParaGard
An intrauterine device that is inserted in the uterus and used to prevent pregnancy for up to 10 years.
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Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions. Learn more about our editorial standards here.