Plan B: The New Morning After Pill
What is Plan B?
Plan B is a new emergency contraceptive (morning after pill) that was approved by the FDA in July 1999. It is made up of two progestin-only pills containing levonorgestrel.
Progestins are the "pregnancy" hormone. Levonorgestrel is used in regular birth control methods, such as Norplant. Previous formulations had used progestins in combination with estrogens, the "female" hormone. It is the first progestin-only pill that has been approved in the U.S. for emergency contraception after either unprotected sex or a contraceptive accident, such as a condom breaking.
Why do we care? Is Plan B better?
A common side effect of the morning after pills is nausea. Plan B causes nausea much less often than the next best formulation, which is called the Yuzpe method. Plan B causes nausea in about 23 % of those who take vs. about 50% of those on Yuzpe. It is also more effective. Plan B's pregnancy rate was only 1% vs. about 3% for Yuzpe.
This one-two punch of decreased side effects and increased effectiveness may have a hidden advantage. More eligible women may decide take it, because it is less life disrupting. Then, the unwanted pregnancy rate for reproductive age women as a group could be improved beyond the extra 2% drop in pregnancies due to the drugs themselves.
However, progestin tends to be more expensive. It is likely that Plan B will cost more than Yuzpe.
Step By Step Guide for Plan B
1. Find Out Who to Contact to Get Plan B
In the U.S.: Since Plan B is a prescription medication, you must get it from a doctor. The doctor may require you to have an appointment. Since it is new medication, it may take time to obtain. The only providers currently giving it are those listed on the Planned Parenthood (1-888-NOT-2-LATE), or found through the Emergency Contraceptive website at Princeton.
There are plans to make it available through pharmacists in Washington State. Hopefully, this will spread.
In the UK, the two pill pack is not available. Following the regimen is done by taking about 25 separate levonorgestrel pills that add up to the total required dosage.
2. Get on the Phone Right Away--Effectiveness Drops with Each Passing Day
When a woman needs Plan B, she will have to get it very quickly. She can only start it within 72 hours (three days) after intercourse. But, sooner is better than later. On day one, 95% of pregnancies are prevented, compared with 85% on the second day, and 60% for those starting on the third day.
Be assertive on the phone. Let the staff know that there are time constraints.
3. Talk with a Health Professional about Eligibility for Plan B
Plan B should not be used by anyone who is or suspects she is pregnant. It should also not be used if the woman has been experiencing abnormal vaginal bleeding for an undetermined reason. If a woman has had an allergic reaction to any part of the pill, they should not use it. A past reaction to Norplant, would be an example.
Chinese women experience a higher pregnancy rate with Plan B (which is the true with the Yuzpe method). While the reason is not known in this case, typically racial/ethnic group related decreases in drug effectiveness are due to a genetic tendency to metabolize the drug faster. This means that those of Chinese descent will be affected, no matter where they live. Typically, such differences are dealt with by increasing the dose or simply using a drug regiment that doesn't show this difference.
4. Talk with a Health Professional about Medical History and Medications
Plan B may throw off blood sugar control a bit in diabetic women, so they should be monitored by a doctor. Plan B interacts with anti-convulsants like phenytoin, carbamazepine, and barbituates, as well as rifampin, a drug used to treat tuberculosis. However, no interactions have been found with antibiotics. Breastfeeding mothers don't need to worry.
5. Taking Plan B
Plan B can be taken at any time during the menstrual cycle, and should be taken as soon after unprotected sex as is possible. It must be started within 72 hours (three days). A second dose is taken 12 hours after the first. If a woman vomits within an hour after taking either of the two doses of Plan B, she should talk to your doctor to find out if she should repeat the dose.
6. The Immediate Experience
While the chance of nausea is dropped in half, it still afflicts about a fourth of its patients. This may cause a woman to take some time off of work or school in order to deal with this side effect. Some doctors suggest adding an anti-nausea medication to combat this. The woman may need to speak up and ask for it. Many anti-nausea medications cause drowsiness.
Other immediate common side effects reported by women taking Plan B include abdominal pain (17.6%), fatigue (16.9%), and headache (16.8%). Women will need to consider these factors in planning activities the two days after starting the medication.
Some women may find that they experience some spotting for a few days after taking Plan B. Wearing a pantyliner for two to three days is a good idea.
Fertility returns within a cycle or two after a course of Plan B. A significant percentage notice differences in their next period. Some notice heavier (13.8% of all users) and some lighter (12.5%) menstrual bleeding.
8. Follow-up and If Pregnancy Occurs Anyway
Women do not need to go for a routine follow-up physical exam after using Plan B. A visit for birth control is appropriate in many cases.
If a woman does become pregnant, it is more likely to be an ectopic pregnancy. Plan B doesn't cause ectopics per se. But since the uterus is not very receptive to the eggs that wind up there, by process of elimination, the tubal pregnancies become a higher percentage of the ones left. A woman should see a doctor right away if suspects she is pregnant, has pelvic pain, or any other concerns about her health.
The good news is that if a post-Plan B pregnancy goes to term, there hasn't been any adverse effects on the babies reported.