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Volume CXXXII, Number 5 |
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Emergency contraception
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: "Is the "Morning After Pill" available at the Health Center? Are there any side effects?" M.W.
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Dear M.W.: 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, levonorgestrel, which 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.
Plan B is generally very well tolerated. Common side effects include mild nausea, mild fatigue and breast tenderness. The medication may throw off the timing of your next period, making it either earlier or later than expected. If it is 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).
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 implantation. If the timing is right, like regular birth control pills, EC will suppress ovulation and cause changes in cervical mucus that make it impenetrable to sperm. It will also impede transport of a fertilized egg through the fallopian tubes to the uterus, as well as implantation of the egg in the endometrial lining of the uterus. None of these medications will harm an implanted embryo.
All forms of emergency contraception should be taken as soon as possible after unprotected intercourse. A second dose needs to be taken 12 hours after the initial dose. The sooner EC is taken, the more effective it is. While this was always intuitively clear, recent studies have demonstrated that every 12-hour delay in starting EC may decrease its effectiveness by as much as 50 percent.
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. In three states now (California, Washington and Hawaii), women are able to obtain emergency contraception directly from pharmacists without having to visit a clinic or health care provider first.
Plan B has been available at 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." Our goal is to have all women who might be at risk for unprotected intercourse (even if they have never had sex before, and even if they are taking birth control pills) to have Plan B on hand, before they have a need for it.
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," when we'll be able to streamline visits and dispense Plan B more efficiently.
Remember, the sooner after unprotected intercourse Plan B is started, the more effective it is.
If 100 women have completely unprotected intercourse during the second or third week of their cycles, studies have shown that 8 will likely conceive. Plan B is 89% effective, and so reduces this number to one.
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, none of which, unfortunately, is 100% effective. Accidents happen: condoms break, diaphragms slip, birth control pills are sometimes forgotten. Sometimes sex is unplanned - or unwanted. Very sadly, 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.
At the Health Center, we consider emergency contraception 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.
Come on in to see us and pick up your Plan B!
Jeff Benson, M.D.
Dudley Coe Health Center