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Volume CXXXIII, Number 5 |
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Keep EC nearby
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: I keep hearing about "Emergency Contraception". Is that the same thing as the "Morning After Pill"? Is it available through the Health Center? L.M.
Dear L.M.: All "Morning-After Pills" ("Emergency Contraception" or "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 for this purpose, although they do cause considerable side effects. "Plan B" contains only the progestin, levonorgestrel. It 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.
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 a few states now, women are able to obtain emergency contraception directly from pharmacists without having to visit a clinic or health care provider first. In Maine, there is growing support for this option, but for now, EC remains controlled by prescription only.
In the meantime, though, we can bridge this gap, at least here at Bowdoin. Plan B is one of the Health Center's in-house formulary medications, and we dispense it to students free of charge. We would really 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 or 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, 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. 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.
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 suppresses ovulation and causes changes in cervical mucus that make it impenetrable to sperm. EC also impedes 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. EC is not capable of dislodging an implanted embryo.
If 100 women have unprotected intercourse during the second or third week of their cycle, 8 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% reduction.
Plan B consists of 2 pills, taken 12 hours apart. The sooner it's started, the more effective it is. While this always made intuitive sense, studies have now demonstrated that every 12-hour delay in starting the medication may decrease its effectiveness by as much as 50%.
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 abort a pregnancy. It will not work if a woman is already pregnant, and it will not harm a developing fetus.
You won't need a GYN exam to get Plan B. To get your pack of Plan B, give us a call at X3770 to schedule a brief, confidential visit.
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center
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