Dear Dr. Jeff: "How does Emergency Contraception work? Is it basically medical abortion?" J.K.
Dear J.K.: All "Morning-After Pills" ("Emergency Contraception" or "EC") contain some combination of progesterone and/or estrogen. Multiple doses of birth control pills can be taken for this purpose, but cause considerable side effects.
"Plan B" contains only the progestin and levonorgestrel, has far fewer side effects, and is the most effective form of EC available in this country. Plan B is the formulation we dispense at the Health Center.
The exact mechanism of action of EC is complex. Human and animal studies have shown effects at several stages of the reproductive cycle: ovulation, fertilization, egg transport and hormonal support, and finally, implantation.
If taken during the first half of your menstrual cycle, EC will suppress ovulation, just like regular birth control pills. EC also causes changes in cervical mucus that make it impenetrable to sperm (again, just like birth control pills). EC slows transport of a fertilized egg through the fallopian tubes to the uterus and impedes implantation of the egg in the endometrial lining of the uterus. EC will not harm an already implanted embryo.
So: is EC a form of medical abortion? At the Health Center, we consider EC a safe, effective, back-up birth control method. By delaying or inhibiting ovulation or fertilization, or preventing transport or implantation of a fertilized egg in the uterus, EC prevents pregnancy. Emergency contraception will not interrupt a pregnancy, and it will not harm a developing fetus.
If 100 women have unprotected intercourse during the second or third week of their cycles, eight will likely conceive. Plan B is 89 percent effective, and so reduces this number to one.
All forms of EC should be taken as soon as possible after unprotected intercourse. Plan B comes as two pills, which can be taken together as a single dose, or taken as two separate doses 12 hours apart. The single, "two-pills-at-once" dose may be slightly more effective, and might be easier to take (no need to wake up in the middle of the night to take a second dose, etc.). It might also cause slightly more side effects.
Plan B is usually extremely well tolerated. Possible side effects include mild nausea, mild fatigue, and breast tenderness. These are always short-lived. The medication may throw off the timing of your next period, making it either earlier or later than expected. If it were delayed more than three weeks after taking Plan B, you'd need to return to the Health Center for a pregnancy test (as always, free and confidential).
Emergency contraceptive pills are available in the U.S. only by prescription. There has been much discussion about how to improve women's ease, speed and cost of access to EC. The Bush administration recently struck down the FDA Science Committee's recommendations that Plan B be made available over the counter.
In several states now, including Maine, women are able to obtain emergency contraception directly from pharmacists without having to visit a clinic or health care provider first. Although a significant expansion of ready access to EC, this arrangement can obviously only occur during business hours, at a pharmacy with a trained and
willing pharmacist on duty, and also at not insignificant out-of-pocket expense.
Plan B has been available through the Health Center for some time. It is one of our in-house formulary medications, and 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" (even if they have never had sex before, even if they only have sex with women, even if they are taking birth control pills).
You can make an appointment any weekday at a time convenient to you for a brief visit with any of our staff and pick up some Plan B. We will only ask you a few questions about your health and give you directions on how to take the medication. You will not need a GYN exam, and as always, your visit will be confidential and free.
We will also be setting up special "EC Clinics," during which we'll be able to streamline those visits and dispense Plan B more efficiently. Melissa Walters will be hosting our first Plan B Clinic next Thursday, September 23, between 2:00 PM and 4:00 PM at the Health Center.
Remember, the sooner after unprotected intercourse Plan B is started, the more effective it is.
Come on in to see us and pick up your Plan B!
Jeff Benson, M.D.
Dudley Coe Health Center