Summer Emergency: Plan B

by Dr. Ann L. Engelland

(August 10, 2007) “Summertime and the livin’ is easy.” Sultry nights, lazy days, sleeping in. For some, a new kind of work, a job rather than school. That means a paycheck and places to spend it. Time to hang out with friends, new and old.

Summer is also a time of connecting with friends in new ways. Couples re-configure. Many experience love for the first time. Many have their first sexual experience. Many move on to intercourse for the first time. One of the guaranteed calls from my answering service used to be a call for help when the condom slipped. “Oh my god, what should I do, Dr. Engelland?”

Fortunately we have a good, reliable, safe and accessible solution. It is called emergency contraception, sometimes called EC. It used to be called “the Morning After Pill,” but thanks to modern advances in design and study of EC, it is now good for a few “mornings after.” The brand called Plan B is the most commonly used type of EC and so “Plan B” is also synonymous with emergency birth control. In short, when Plan A fails or isn’t implemented at all, there is an answer to those desperate weekend phone calls. Here is a list of terms that all mean to convey the same thing is:

  • Emergency contraception
  • Emergency birth control
  • Morning After Pill
  • Post Coital contraceptive
  • Plan B
  • Back-up birth control

The cleverly named Plan B has been manufactured by Pomona, NY based Barr laboratories since the license to manufacture it was acquired in 2003 from the developers of the drug, the Women’s Capital Corporation. It is a two-pill regimen of the hormone levonorgestrel (a frequent component of oral contraceptive pills) and was developed to minimize the unpleasant side effects of a large dose of estrogen, which had previously been part of the standard “morning-after pill.”

Emergency Contraception has been around for as long as birth control pills have existed. Plan B, per se, has been in existence for some ten years but only recently was widely publicized when the FDA debated whether to allow it to be sold over the counter (more about that later). In spite of Plan B’s great track record for safety and efficacy, I have found that the majority of my sexually active high school patients do not know much about it. Along with other aspects of sex education and contraception in our schools, the subject seems to get short shrift.

What is emergency contraception?

EC is a safe and effective method of birth control that is taken after intercourse to prevent a pregnancy. I also recommend it after “risky sex” that often happens when inexperienced partners have close contact that they don’t consider “sex” but that puts them at risk for pregnancy. Sperm can be very wily!

Plan B is the only product that is specifically marketed as an EC. It is a set of two pills

Plan B can be taken up to 120 hours (that’s 5 days) after intercourse (or risky sex).

How does EC work?

It works in at least two ways. It not only stops or delays ovulation, but it prevents fertilization of the egg by the sperm. Hence it exerts its action before conception and therefore can truly be called a “contraceptive,” in addition of course to “birth control.”

Plan B is not the same as “the abortion pill”-RU486. Plan B should not substitute for regular contraception and birth control. Plan B does not protect against sexually transmitted infections (STI’s).

How does one take EC?

Simple. A pack of Plan B from the pharmacy consists of two pills. Most providers recommend that one pill be taken ASAP and the second within 12 hours. However, many doctors now prescribe “off-label” but with a proven regimen of both pills at the same time ASAP.

How effective is EC?

When taken as soon as possible, Plan B reduces the chances of becoming pregnant by about 95%. After 5 days it reduces the likelihood by 50%. So the sooner the better.

How safe is Plan B?

Plan B is safe. Very safe. And it is much safer than pregnancy. Twenty percent of women will feel some nausea with Plan B but it lasts only a day or two. Other mild symptoms (headache, dizziness, mood changes, tiredness) may occur but are also short-lived. Severe side effects (related to clotting problems) are very rare.

Who can take EC?

Any woman who has had unprotected or risky sex within the last five days (120 hours) may safely use EC. Any victim of sexual assault must be offered Plan B.

If a woman is already pregnant she should not use EC. However, it will not harm a developing fetus or jeopardize the pregnancy.

How much does Plan B cost?

A phone poll of five local pharmacies (CVS, Almark, Rye Beach, Buck's and Cherry Lawn) discovered that the price of the two tablets is between $40 and $45 if they carry it. The only one of these five that does not dispense Plan B without a prescription is Buck's in Larchmont. All others dispense to men or women over 18 with ID.

For women who cannot afford to pay, Plan B is available at low or no cost from Planned Parenthood, at Open Door in Port Chester, at Community Health Centers in Mount Vernon and Yonkers, and at All Women's Health and Medical Services in White Plains. Medicaid covers Plan B.

How does someone get EC?

In New York State, Plan B is available “behind the counter” to patients over age 18 with ID. In some pharmacies, there may be hurdles to getting the Plan B. Pharmacists have no right to ask why patients need the medication. Men (over 18 and with ID to prove it) can get Plan B for their partners.

Young women under 18 can have a prescription filled confidentially if they have one from their provider. Prescribing Plan B does not necessarily require a visit to the doctor; and it does not require a prior pregnancy test. Under New York State law, parental notification is not required at any age.

The American Academy of Pediatrics and the Society for Adolescent Medicine have encouraged primary care providers to give sexually active girls who may be relying solely on condoms an advance prescription for Plan B. Studies have shown that providing advance EC to teens is not associated with more unprotected intercourse or less condom use. Since the window of opportunity for effectiveness is relatively narrow, it is a good idea to have the prescription filled and waiting in the top drawer. I tell my patients: “I guarantee you someone will need it in the next year or so if you don’t.”

I would much rather be bothered by a call for Plan B than by a call informing me of a positive pregnancy test. Mistakes happen. We can fix them.

Following are a few resources for those who wish to learn more:

Dr. Engelland has a practice in Mamaroneck devoted to Adolescent Primary Care. She can be reached at 698-5544. Her website is: annengellandmd.com