OP: Emergency Contraception Confusion

There have been several questions lately regarding "Emergency Contraception" or "Morning After Pill." The questions and answers, including mine, have been confusing. Those terms, EC and MAP, are imprecise and can actually refer to three different approaches. The three different approaches work differently and have different periods of effectiveness. The one thing that is applicable to all three is: THE SOONER, THE BETTER, or, all three approaches to emergency contraception are more effective when taken soon after exposure than when after waiting a while.

1. Levonorgestrel is marketed as Plan B. This is essentially a "megapill" that swamps the system with progestin. This can do one of several things. If taken before ovulation, it can stop ovulation and prevent conception. If ovulation has taken place, it can make the egg resistant to sperm and prevent conception. If conception has already taken place, it reduces the chance of the the fertilized egg implanting on the uterine wall and growing into a baby. This will not cause abortion if the egg is already healthily implanted. Plan B is said to reduce the likelihood of unprotected sex resulting in pregnancy by about 90%. I do not accept all the numbers the company uses but it is quite effective if taken within 72 hours of intercourse. Availability and manner of dispensing vary from country to country from over the counter to any woman to requiring prescription. There are two (or four) pills taken several hours apart. Side effects are about like a difficult period.

2. Mifeprestone is known in parts of the world as RU-486 and has raised a firestorm of controversy because it is an "abortion pill." This acts the opposite of Plan B and deprives a fresh pregnancy of progestin thereby terminating the pregnancy. It is effective to about seven weeks. It is said to be effective 75% of the time that pregnancy has occurred. This requires prescription everywhere I am aware of. It is also known, inaccurately, as "chemical abortion.” The side effects can be very uncomfortable. I have known women who have both used the mife and also had a mechanical abortion. They have told me that they would rather have a mechanical (D&C) abortion than take the pills.

3. Of the forty or so birth control pills on the market in different countries, a handful are also approved for use as emergency contraception. Many doctors have dispensed these for years and the needed information can be found in any university women's housing or at any women’s society. It has become common practice. Even those pills not approved for emergency contraception have been used. There is a real problem here because, depending on the pill and its ingredients, anywhere from four to forty pills are required. There are websites that list what pills are approved and what dosages are required. You take some real risks in using these approaches without a doctors advice. Side effects are again similar to a difficult period.

Many people will also recommend herbal or "natural" supplements, including some common household cooking or, even, cleaning ingredients. Do not mess around with these. If they work, you will become quite sick and if they do not work there is a very high chance of harming the baby. Even herbalists recommend that before trying these you be prepared to finish with a real abortion.

Trust me, girls, all these are for true emergencies and should not be used frequently or regularly. At the very least your menstrual cycle will be messed and you can have some terrible side effects. Taking proper precautions before spreading your legs is the healthier and more responsible approach.

OK, some examples:

All sexually active women should have thought through the possibilities - including pregnancy - and have a plan.

1. You are having sex and when he withdraws you discover the condom has split. ACTION: As soon as possible obtain Plan B and take the first dose followed as directed by the second dose. Alternatively, if you have access to birth control pills approved for emergency contraception, take the first dose as soon as possible followed by the second dose as directed. The sooner you take the first dose, the higher the likelihood of successful protection. You have a maximum of 72 hours but 12 is better.

2. You have been carefully using condoms and spermicide during sex since your last period. Your first indication that they may have failed is your period is ten days late. ACTION: Get two home pregnancy tests and do them both according to the individual tests' directions a day apart. If either of them show positive for pregnancy, immediately contact your doctor or clinic and, if you do not wish to be a mother, arrange for mifeprestone or a mechanical abortion. In either case, the sooner the better. In this case, the Plan B or BC pills will do you no good. You have seven weeks from becoming pregnant (two plus weeks from now) for the mifeprestone to work. If it does not work, there is still time for a mechanical abortion. (note: I am not pushing abortion; I am laying out your alternatives)

3. You are on the pill (or other hormonal birth control) and your period does not arrive. Call your doctor. You do not want to add other hormones to your system. It is still possible to use mifeprestone (RU-486) but that requires prescription and you should be checked anyway. Some women do miss periods in the early months of taking the pill. This applies whether you have been very regular in taking your pills or whether you are a bit lackadaisacal in taking your pill. Being erratic in taking the pill can actually increase the likelihood of pregnancy. In this case and if the doctor says you are pregnant, mifeprestone or mechanical abortion are your alternatives

4. You are partying a bit too heartily and usually depend upon condoms and spermicide. You wake up with a strong smell of semen in your pants. ACTION: Get Plan B, or approved BC pills, and immediately take the first dose. Then try to figure out whom you screwed and get checked for STD.

5. You only had half a glass of wine and seemed to black out. You awaken feeling somewhat hungover, do not remember leaving the bar and have a smell of semen in your pants. Get to a clinic or emergency room immediately. Do not wash, change underclothes or urinate until you get there. If you MUST urinate, use a clean jar and take it with you. You will be examined under blacklight and swabs will be taken to check for semen and STD. The traces of date rape drugs disappear from your system very quickly; hence, the initial urine sample. In this setting you will be offered Plan B or equivalent. Let the cops find the bastard. Then go home, bathe, soak in a tub and consider counselling - while warning all your girlfriends away from that place.


Posted: 28 Sep 09:04


The thread here by prettynonsense regarding mifepristone as emergency contraception (morning after pill) has gotten me to thinking. Mife is not recommended as a morning after pill in much of the world because of the belief that it can harm an unaborted foetus. Using hormonal EC will not affect an established pregnancy. I do recommend to my patients that they ALWAYS have emergency contraception available.

The simplest way to do this is to always have Plan B with you - or in your medicine cabinet. Another way is what we used for decades before Plan B was brought to market - regular birth control pills used in different dosage. Many pills are approved for this purpose and for those, we have recommended doses: http://ec.princeton.edu/questions/dose.html#dose

These are US brands because that is the best website I found. You can cross reference to any brand, whether or not generic, to figure other pills available. I will not prescribe over the net and am not doing so. This site is a great resource for those who have a condom disappear inside them or wake up with a strong smell of semen emanating from their vaginas.

I leave it to your imagination to acquire the pills but recommend that any women not on hormonal birth control have something available.

By prettynonsense post, in India mifepristone is available in single dose 200 mg tablets for this purpose. My further research indicates that the same is true elsewhere. I cannot recommend that because I have no experience and my NHS has not approved mife for that purpose.

If you are on hormonal birth control and discover you are pregnant or do not discover pregnancy until a period is missed, the hormonal approach will not work. You will need to see a doctor and, perhaps, use mifepristone. Whether or not you choose to abort, see a doctor as soon as you supect pregnancy.


Posted: 30 Sep 04:23

issues with purchasing Plan B
I recently returned from a pharmacy(Walgreens) where I purchased Plan B(One-step 1.5mg, $50). They only offered that particular one while CVS pharmacy and planned parenthood also offer the two dose 0.75mg and generic at lower cost. The pharmacist was quite condescending and resistant to selling it to me wanting to only issue it to a woman. He finally relented after I provided a birthdate of a woman who would use it. This is *NOT* necessary, and FDA guidelines state that any person, men included, over the age of 17 may purchase this without a prescription. I am in my late 20's.

Unfortunately, this has been an issue in the past with this pharmac,,, Cites Walgreens For Refusing Emergency Contraception to Men – TIME Healthland ) and apparently still is. I at least managed to purchase it, though I imagine that many uninformed and timid teens could easily be intimidated into not purchasing the product. You have a right to purchase it so please stand up for yourself and don't take unnecessary risks because of others trying to force their beliefs or ignorance upon you.

I would highly recommend going to CVS or Planned Parenthood over Walgreens if the option is available to you.


Posted: 30 Sep 04:25

Here in Holland it's obtainable for everyone at drugstores and pharmacies and local centers for abortion and sexuality (where it is a lot cheaper; 7 instead of 16 euro's). No questions asked, accept "are you familiar with the use of the product?", which they also ask when you're buying aspirins ;)

I've bought one while in Scotland (Glasgow). I was sorta surprised. We asked if they sold emergency contraception and the lady at the counter immediately got me to one of her special colleagues. They were very sweet to me. Taking me out back, asking my bf kindly to not follow, asking if I'd like a chair and a glass of water or anything. Then she picked this questionnaire that she said was necessary to be filled out before selling (anonymously off course). She asked me mainly about my menstruation cycle and any other medicines and medical history. After answering, I asked why they needed this information and she said it was mainly because they are not allowed to sell it to women that could be pregnant. So if my answers had risen doubt, I would have needed to take a pregnancy test first. Then she thoroughly explained to me how it should be used, how it works in your body, what side-effects I could encounter, what to do if I'd throw up, etc. Giving me time to repeat what she had told and think whether I had any more questions, just to make sure I understood. Before leaving I asked if they took each woman separately; yes, because sometimes people do things that they just not want the rest of the world incl their current partner to know (previous failed pregnancies, perhaps sleeping with someone else, etc). They are not there to judge just to ensure you get the best of care in privacy.

From this point of view, and I don't know if it was true that the laws there require them, I can imagine how this pharmacist would have also insisted on seeing me, had my bf tried to buy it for me. And one way or another; I actually felt very comfortable by their response. It was the first time (and only so far) I used one and it was so nice to have someone really take her time to explain everything to me.


Posted: 30 Sep 04:25

That is encouraging and exactly the way Plan B should be dispensed. Whilst it should have no effect on an established pregnancy, it is not a good idea to take hormones during pregnancy. Too many careless couples pay no attention to the time limits and try it after a period is late. The woman at the chemist was merely assuring that it could help you and would not harm a baby. Too many places dispense this, and other medications, with no concern.


Posted: 30 Sep 04:25

Brandye, I very much agree. Like I wrote; surprised, yet I felt comfortable and was happy with this response. I mean; I was already nervous enough about a condom that failed as I was sure to be ovulating that day or the next, while being in a foreign country in the middle of nowhere, driving 2 hours to get to the city and not even sure they'd sell this stuff and not entirely sure about how these things work, while being deprived of my precious books and internet to search for information before swallowing :eek: Not to mention my serious doubts on whether I really wanted to take that pill or not... The latter alone was mind-consuming.

Next to your recommended "under the sink", I'd advice: pack one in your luggage when going on holiday next to the condoms! :)

O, question I've wondered about since the next day; could it be true that the slight rise in bodytemperature you get after ovulation, could also triggered by the hormones in personal emergency contraception? Specifically it was Levonelle one step- 1500 microgram tablet (call me crazy but I still have the little booklet I got back then ;))

Also: does it still work after you've ovulated? A while back I had a discussion with a meds student who said it doesn't, yet the booklet says it does, since according to this Levonelle works in 3 ways: "stopping ovaries from releasing an egg, preventing sperm from fertilizing any egg you may have released, stopping a fertilized egg from attaching itself to your womb lining" therefor stopping pregnancy before it is established.


Posted: 30 Sep 04:25

Good advice. Always pack one with you! Levonelle 1500 is a very good drug.

Messing with the hormones could cause that temp rise. The mechanism is a bit different but related and with the same result - increased basal temp.

The "morning after approach" can work three ways:
1. If you have not ovulated, it inhibits ovulation.
2. If you have ovulated and the egg is still in the fallopian tubes, it reduces the egg's "acceptance" of fertilization.
3. If the egg has been fertilized but not implanted in the uterine lining, it can prevent implantation.

Exactly as your booklet states. For some many decades, some of the contraceptive pills on the market were approved for morning after use. The dosage varied by which pill was being used for the emergency, from a total of four pills to a total of twenty. That worked exactly the same way. I kept pre-made packets in my medical bag for dispensing. Only gave out a few but those women were thankful.

A young German couple, both 19, were on honeymoon and a B&B proprietor called me. The woman was hysterical and they both had lost all their English. They had had a condom "disappear" and she was in mid-cycle. I made a house call, was very motherly, retrieved the lost condom, gave her a packet and told them to screw their little hearts out that night because she would be feeling poorly for a few days.


Posted: 30 Sep 04:25

Thank you for your reply Brandye! Always a pleasure to read your posts :)

That story is rather similar. But we both activated different coping mechanisms, which was sort of lucky. He lost his head first. This was a complete surprise to me; those eyes were filled with fear, like I've never witnessed again so far. Since I can find my own cervix, I was also able to retrieve the condom (with some effort). I calmed him down and immediately drew a plan of what we'd do; starting with a shower. It started to creep up on me while in the car, while he was slightly nervous, but calm and comfortable with the plan I had made up. He nearly panicked again while I was very doubtful on actually taking it. The real "bang" to my head came early the next morning; I think I've cried for hours. Apart from feeling poorly physically, I felt mentally exhausted and all the emotions I had cut away from my mind for an entire day came bursting out. You can imagine I wasn't well rested at all once we got back on Dutch soil :rolleyes: Then followed 2 very long weeks of waiting on whether or not I'd have a menstruation. Reconsidering what we'd do if it should be the case it hadn't worked. It hardly ever left my mind. So at the end of my 3 weeks of holidays, I announced him the great news of menstruation and we went back to work... I don't remember how many times I heard: "You look so tired, are you ok?". It eventually took me 4 months to tell him how much I regretted ever doing this. And instead of time providing healing, it made my regrets grow. I guess there was a greater emotional aspect to it, then I had predicted at the time.

In our case we had discussed prior (to even having sex, but that's another story ;)): a) the desire for kids; me: yes, him: a positive maybe. b) abortion, which for me was: no, unless for health-reasons of me or the baby or when it was conceived through violence. Him: he'd never even ask me to. c) ways of contraception we'd use and had decided on this together. We had agreed on this excluded the regular BC-pill; I had just stopped using that a few weeks before we started dating and I had never felt better in my life. Apparently; we missed to discuss Plan B prior. And apparently; while time is ticking an best results of emergency contraception is within 12 hours, that's still rather short to really think about it. Silly me had added up a, b and c and had figured the logical outcome was that in the case of a failing condom we'd do nothing and just wait for the result. The practical outcome turned out different

Perhaps this points out that it's worth to discuss with at least yourself and possibly with your partner; what to do when the condom fails?


Posted: 30 Sep 04:26

All women should read RedRoses post. The emotional side is at least as important as the physical and you will experience similar no matter how well prepared.


Posted: 30 Sep 04:26

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