Do I Really Need the “Morning-After” Pill?


Jim Depuy, pharmacist checking in orderThere can be a lot of anxiety surrounding a trip to the pharmacy to buy emergency contraception such as the “morning-after” pill, but keep in mind, a trip to the doctor to confirm an unplanned pregnancy would probably be even more anxiety-inducing! Emergency contraception is used in the first few days after unprotected sex to prevent unplanned pregnancy. If you’re worried about what pharmacy employees may think about you, rest assured that they’ve dispensed emergency contraceptives enough times that they probably won’t think anything of it. Having the pharmacy run it on your insurance (if you have a prescription) may make your purchase visible to the policy holder (e.g. your parent), but paying with cash or credit may prevent anyone from ever finding out.

Did you know half of all pregnancies in the United States each year are unintended? As a busy college student, chances are you may not be ready to commit to parenthood just yet, so it’s important to take necessary precautions to protect against pregnancy.

So what happens when things don’t go exactly as planned?
Maybe the condom broke. Or you just didn’t have one. Perhaps you forgot to start your new pack of birth control pills. It could be anything really, but what matters is that you are at an increased risk for pregnancy. Fortunately there are options available for when mishaps happen.

Plan B® (a.k.a. the “morning-after” pill) is probably the most well-known option, thanks to a catchy name and “over the counter” status. The active ingredient is a progestin called levonorgestrel, and there are generic versions of Plan B® available that have the same ingredient and dose. Many hormonal birth control options contain levonorgestrel, but one difference between birth control pills and emergency contraceptives is the dose. Plan B® contains 1.5 mg, whereas some birth control pills (e.g. Orsythia™) contain as little as 0.1 mg.

Flash mob demands morning-after pill

So why not just take a bunch of my regular birth control pills instead of buying an emergency contraceptive pill?
The other key difference between Plan B® and birth control pills is the estrogen component (i.e. estradiol) that is included in birth control pills but not emergency contraceptives. Some websites recommend women take multiple birth control pills at once (instead of something like Plan B®), but this frequently causes vomiting. Not only is vomiting unpleasant, but more importantly, it means the medication is much less likely to be effective. Some women may vomit after taking an emergency contraceptive pill, but the incidence is much lower than taking multiple birth control pills containing estrogen.

Should I go ahead and buy Plan B® (or the generic equivalent?)
Not so fast! There are some reasons why Plan B® may be less effective or not recommended in certain women. A copper intrauterine device (IUD) or ella®, another emergency contraceptive pill, may be better options.

What’s ella®?
ella® is the brand name for a pill called ulipristal, which is a progestin receptor modulator, meaning it blocks progestin from binding to the progesterone receptors, thereby delaying ovulation. Listed below are some key similarities and differences between Plan B® and ella®. Keep in mind, neither of these medications causes abortion, and they should not be used in women who are already pregnant.

Plan B® or generic (levonorgestrel) ella® (ulipristal)
Available over-the-counter; can be purchased by a man or woman; no age restriction Requires a prescription from a physician or a Campus Health pharmacist
Cost $30-70 Cost $40-70
Effective when used up to 72 hours after unprotected sex (perhaps up to 120 hours) Effective when used up to 120 hours after unprotected sex
Most effective in women with a BMI < 25* Most effective in women with a BMI < 35*
Plan B® available at almost every pharmacy Not yet stocked in all pharmacies; ella® is available from the Campus Health Pharmacy
If vomiting occurs within 2 hours after taking dose, a repeat dose is needed. If vomiting occurs (unlikely) within 3 hours after taking dose, a repeat dose is needed.
Does NOT protect against sexually transmitted infections (STIs). If STI exposure is a concern,   visit a doctor to get medications that can treat or prevent infection. Does NOT protect against sexually transmitted infections (STIs). If STI exposure is a concern,   visit a doctor to get medications that can treat or prevent infection.
For women taking hormonal birth control (e.g. pill, ring, etc.), a barrier method (e.g. condom) must be used in addition to the hormonal birth control for the remainder of menstrual cycle. For women taking hormonal birth control (e.g. pill, ring, etc.), a barrier method (e.g. condom) must be used in addition to the hormonal birth control for 2 weeks after taking ella®.

*BMI = body mass index. A BMI calculator can be found here. Recent news reports claim the morning-after pill may not work in obese women, so ella® or the copper IUD are likely preferred in overweight or obese women. In women with a BMI>35, the copper IUD is the most effective option.

Which emergency contraceptive method is the most effective?

  • The copper IUD (Paragard®) is the most effective method of emergency contraception available for any woman. Of the approximately 12,000 copper IUDs that have been placed for emergency contraception in the United States since 1976, only 12 women (0.1%) have become pregnant. The copper IUD is a reversible birth control method that is effective for up to 10 years. While it may be considerably more expensive than emergency contraception pills or birth control pills, it often offers a long-term cost savings and may even be fully or partially covered by your health insurance plan.
  • ella® is considered the next most effective method. Pregnancy is prevented in about two-thirds of women who would have otherwise become pregnant (i.e. were in a fertile time of their menstrual cycles) with the use of ella®.
  • About half of expected pregnancies are prevented with Plan B®.
  • All forms of emergency contraception are more effective when they are used as soon as possible!

What should I expect from “the pill?”
A few things happen; most importantly, ovulation is delayed and changes occur in the uterine lining to prevent implantation of any fertilized eggs. Unfortunately, you may experience some side effects of emergency contraceptives:

  • Nausea/vomiting
  • Irregular menstrual bleeding, delayed menstruation, or “spotting”
  • Abdominal discomfort
  • Headache or dizziness

If your period has still not occurred 7 days after the expected time or if you think you may be pregnant, make an appointment with a doctor.  For further answers or advice on emergency contraception, consider calling Campus Health at 919-966-2281, visiting the Campus Health website, or checking out some of the additional resources listed below.

If you believe you may have been sexually assaulted, call 919-966-3650 or come directly to the Women’s Health Clinic located on the third floor of Campus Health Services (CHS) as soon as possible after the incident.

Additional emergency contraception resources can be found at the following websites:

Sources:

  • Lexi-Comp
  • James Trussell, Elizabeth Raymond, and Kelly Cleland. “Emergency Contraception: A Last Chance to Prevent Unintended Pregnancy.” http://ec.princeton.edu/questions/ec-review.pdf. 11/2013.
  • Glasier A. “Emergency contraception: clinical outcomes.” Contraception. 2013;87(3):309.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s