Dear Dr. Jeff: Is "Emergency Contraception" the same thing as "RU-486"?
- T.G.R.
Dear T.G.R.: Absolutely not! Emergency Contraception (EC) is contraception that is used, well, in an emergently?that is, post-coitally. Like all other forms of contraception, EC prevents pregnancy. RU-486 is the name given mifepristone, a medication used to induce an abortion. Like all other abortifacients, mifepristone terminates an established pregnancy.
The most common forms of EC contain some combination of progesterone and/or estrogen, the same hormones found in birth control pills. In fact, multiple doses of birth control pills can be taken precisely for this purpose. Plan B, the form of EC we dispense at the Health Center, contains only the progestin, levonorgestrel. It has far fewer side effects and is the safest and most effective form of EC available in this country.
Mifepristone, by the way, acts as an anti-progestin. In fact, this is the biochemical basis of its abortifacient activity. Plan B will not abort a pregnancy. It will not work if a woman is already pregnant, and it will not harm a developing fetus.
As a form of contraception, Plan B works in a number of ways. If taken prior to ovulation, it will stop that egg from being released. That is its primary mechanism of action, exactly the same as birth control pills. Plan B also thickens cervical mucus, making it less penetrable to sperm, and hinders egg transport through the fallopian tubes?again, exactly like birth control pills. Finally, Plan B may interfere with the hormonal support necessary for the successful implantation of a fertilized egg?once again, like birth control pills. Note, too, that Plan B's secondary mechanisms of action are precisely those of other contraceptive modalities as well. Barrier methods like condoms and diaphragms prevent contact between eggs and sperm. IUD's (intrauterine devices) prevent implantation, and, if containing progestin, also create an environment that hormonally impedes egg transport and implantation.
Despite the unanimous finding by FDA scientists that Plan B is safe and effective, and despite the unequivocal recommendations of these same scientists that Plan B be made available over-the-counter, EC remains available in the U.S. only by prescription.
Even before these recommendations were politically trumped, there was much discussion about how to make EC easier to obtain and purchase. In Maine, like several other states now, women are able to obtain Plan B directly from pharmacists without having to visit a clinic or health care provider first. Unfortunately, this service is not inexpensive, and in any case is not yet available at any of the pharmacies in the greater Brunswick area.
At Bowdoin, we have tried to bridge this gap for a number of years by including Plan B in our Health Center in-house formulary. We dispense it to students free of charge. We would like all women to have some Plan B on hand, in their medicine cabinets, immediately available, just in case, before they have a need for it?even if they are taking birth control pills, even if they have never had sex before, even if they are not having sex with men.
Three million unintended pregnancies occur each year in this country. Half of all American women will have at least one unintended pregnancy. The majority of these women use a regular method of contraception, not one of which, unfortunately, is 100 percent effective.
Accidents happen: condoms break, diaphragms slip, birth control pills fail or are sometimes forgotten. Sometimes sex is unplanned. Sometimes sex is unwanted. Each year, thousands of American women are the victims of rape. Emergency contraception can at least help eliminate one associated trauma?the prospect of an unwanted pregnancy.
As Dr. Susan Wood argued so eloquently Tuesday evening, Plan B is a contraceptive, and its use and over-the-counter availability have absolutely no place in the abortion debate. No place except this: like all contraceptives, Plan B prevents unintended pregnancy. Fewer unintended pregnancies mean fewer abortions.
If 100 women have unprotected intercourse during the second or third week of their cycle, eight will likely conceive.
If those women take Plan B within the first 24 hours, that number will be reduced to one. That's nearly a 90 percent reduction.
Plan B consists of two pills, taken either together or 12 hours apart. The sooner it's started, the more effective it is. Every 12-hour delay in starting the medication may decrease its effectiveness by as much as 50 percent.
You won't need a GYN exam to get Plan B. To get your pack of Plan B, just mention it when you're in for any visit. Or come to one of our "EC-Does It" sessions. We would like you to have some-and we're always looking for ways to get it to you!
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center