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What's the difference between the pill and the morning-after pill?

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freakoutxx asks:

I'm 16 and thinking about having sex with my boyfriend for the first time. If I do choose to have sex with him I want to be as safe as possible. Of course we'll use a condom, but as I said I want to be as safe as possible so I was wondering about birth control pills. I've heard of the "morning after pill" and of "the pill." What's the difference? I found this info. on 'the pill' but I'm not sure it's accurate:

Combination Pill
This pill contains estrogen and progestin. The combination pill works in two important ways. First, it prevents the ovaries from releasing an egg each month. Second, it causes the cervical mucus near the opening of the uterus to thicken, making it close to impossible for sperm to enter.

Progestin Pill
Unlike the Combination pill, the Progestin pill contains no estrogen. This absence of estrogen means that the ovaries will still release an egg each month. But because the progestin causes a thickening of the cervical mucus (liquid near the opening of the uterus), it's close to impossible for sperm to enter and fertilize the egg

Also I was wondering is if I do choose to have sex with my boy friend, I would not be confiding in my parents, so I would need to get birth control pills on my own or with my boy friend. Would a prescription from my doctor be absolutely neccesary?

It's pretty obvious I don't know much about protecting myself when it comes to sex. But from your site I've gotten so many answers it's awesome! I've learned things about my body I never knew were SO important, and the great consequences of unsafe sex. But I haven't found much about these pills, I was hoping I could get some answers from you. I'd really like to learn more about this even if i don't have sex with my boy friend now I know I'll need to know later if I do. Thank you!!

Heather Corinna replies:

Hey there, freakout. I'm so glad you've found so much help here, and kudos to you for thinking about all of this in advance of sexual activity! Really, that's an ideal we're always all hoping for. If everyone had all of this information in advance, we'd all be a lot healthier, and probably have much better sex lives from day one. You rock!

The information you have above is accurate in terms of oral contraceptives: birth control pills. That first paragraph is about the combination (as, in, a combination of hormones) pill, and the second about the mini-pill. When you hear people talk about "the pill," they're talking about those kinds of pills, the types of BCPs are types you'd take every day, around the same time, in an ongoing fashion to prevent pregnancy. The combination pill is a bit more effective than the mini-pill, but both are highly effective, and which you'd be prescribed, if you decided you wanted to use the pill, would be up to your doctor or other healthcare professional. There are also other hormonal options besides the pill, too, like the vaginal ring or patch. If say, you wanted a hormonal method, but didn't think you could remember to take a pill every day, other options would give you the same level of protection and allow you to only have to tend to them once a week or less often.

The pill and other hormonal contraceptives aren't for everyone, though. For instance, if you're a smoker, have certain cardiovascular conditions or risk factors, if you deal with depression or migraines, all or some hormonal contraceptives may not be a good idea for you. As well, some women experience sexual side effects from some or all hormonal methods they aren't so keen on.

Birth control pills do require a prescription: they aren't available over the counter. If you wanted to stick with your usual doctor, your doctor could write you a prescription for them, and that doctor is obliged to keep that information confidential. However, your visit to that doctor may show up on your insurance bill if you've insurance. And if you elect to use your insurance to cover or co-pay the cost of your birth control pills, that, too, may show up on statements.

You also have the option, if you want the pill or another ongoing hormonal method of birth control -- and as someone to see yearly for your sexual health exams, which you'll also need once you become sexually active -- of seeing a private or public sexual health clinic for your prescription, and through some, you may be able to get your pills dispensed, as well. Clinics like Planned Parenthood do their fees on a sliding scale, based on your income. What that visit will cost depends on what you have in terms of funds, but you can call your local branch and get an idea of what you'd need. Too, BCPs do cost money, and they can be anything from cheap to costly, depending on how you pay for them. If you're paying right out of pocket, expect to pay between $20 and $50 a month or so for them: if some other service or insurance is covering them, they may cost less.

The morning-after pill, or Plan B, is different than the pills we're talking about above. Plan B is only intended for use when another method of birth control has failed -- like if a condom breaks or slips off -- or wasn't used at all. It is two progestin-based (the hormone in it is levonorgestrel) pills which can be used up to 120 hours after a pregnancy risk to prevent pregnancy. It is anywhere from 75& to 89% effective on average, and the sooner it is taken after a risk, the more likely it is to be effective. Some birth control pills can be used as emergency contraception, too. But it's not meant to be used as a regular method of birth control. Not only is it expensive as regular methods go -- for one dose, you may end up paying as much or more than a full month of birth control pills cost -- it's also less effective than BCPs, a bigger dose of hormones, and it can often make you feel pretty blarghy when you take it, so it really is best saved for emergencies. Plus, it carries all the risks and side effects of regular birth control pills, so taking it very often, especially given it's a bigger dose of hormones, isn't advised. It's only designed to be used for emergencies.

In the U.S., Plan B is unfortunately only available over-the-counter (without a prescription) for those who are over 18. So, a friend who was over 18 could get it for you if you wanted it, or you could get it yourself by having your doctor or any other healthcare professional write you a prescription, which you can fill when you get it, or just keep on hand to fill if it's ever needed.

However, if you're using condoms properly, just having a prescription for EC on hand may be enough backup for you to feel comfortable with, especially given that when used consistently and properly, condoms are highly effective at preventing pregnancy as well as STIs.

But if you don't feel comfortable using condoms alone, then obviously you'll want another method, and the person for you to speak with is a sexual healthcare professional. They can sit and talk about your options with you -- including talking about other non-hormonal choices, too, as hormones aren't the only option -- and if you've a strong preference for one going in, they can figure out if it's right for you. Again, you can either see your regular doctor for that if they provide sexual/reproductive healthcare services, but a) you should ideally make sure that's someone you're going to be okay seeing regularly for your sexual healthcare, and are also cool with having a pelvic exam with, and b) that may not work out if you're insured and your folks get the statements. if you're not down with that doctor for sexual healthcare, don't feel safe with them per your confidentiality, or don't want that showing up on insurance, then a sexual health clinic, like a Planned Parenthood branch, will be a better bet for you.

One last thing? We generally advise teens thinking about becoming sexually active to be honest with their parents. Why? Well, for starters it can really cut down on enjoying sex if you're sneaking around all of the time, or worried to death about being caught or discovered. Too, parents DO usually find out -- it's actually easier to figure out than you'd think. And when that happens, not only is trust broken, the level of drama which usually ensues is usually just not worth it for anyone. Plus, when you get busted for having sex, you're busted themn for TWO things: for the sex AND for lying. So, if you can find a way to be honest, I'd encourage you to do that. And if you would have to keep any sex a secret from them, I'd encourage you to forestall sex until you're out of the house and don't have to do that anymore.

Here's some extra information for you about Plan B/emergency contraception, birth control pills and condoms:

written 01 Nov 2007 . updated 01 Nov 2007

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