The other day, I was having coffee with one of my girlfriends. As we were discussing our latest sexcapades (or sexcapade on my end), she casually mentioned that she uses Plan B and the pull-out method as her primary form of birth control.
“I just time my cycles so I know I'm not ovulating, and if I get nervous about it, I just take Plan B,” she said, sipping her Americano.
Not wanting to judge, I asked, “How many times have you taken Plan B?”
“Oh, probably like 60 times,” she said.
I was flabbergasted. SIXTY TIMES? Sure, I've taken Plan B a bunch of times. Who hasn't? Now that it's available over the counter (in the US), it's easy to get, and when you screw up, it's there for you.
That's the key, though, the “when you screw up” part. It's not there to act as your surrogate condom when you're not in the mood to use them. That's a pretty expensive mistake. In most states, Plan B is around $40 to $50.
All of this got me thinking: What do we know about Plan B?
I decided to recruit some experts and get all of my questions answered. With help from Melanie Lucash, a sexuality educator who works with the Center for Sexual Pleasure and Health, and Dr. Dan Nayot, a Reproductive Endocrinology and Infertility Specialist at TRIO Fertility, I'm here to give you all the dirty deets.
We deserve to have all the information right at our fingertips. So, here we go:
Q: What exactly is Plan B? What's in it?
Dr. Nayot: “Plan B” is one of several emergency contraceptive options available to women. It is essentially a pill containing a type of hormone called progesterone. (Plan B equals levonorgestrel.)
There are other forms of emergency contraceptive pills on the market, each with a unique regimen of estrogen and progesterone, but the critical component is progesterone.
The hormone progesterone comes from the word “pro-gestation,” and it's the pregnancy hormone. It's the same reason pregnant women don't get pregnant while pregnant.
Q: When is it OK to take it?
Lucash: Plan B (levonorgestrel) should be taken as soon as possible after unprotected sex. It's up to 95 percent effective if taken in the first 24 hours after unprotected sex and up to 89 percent effective if taken less than 72 hours after unprotected sex.
It's still shown to be somewhat effective up to 96 hours after unprotected sex, but doctors recommend the user take Plan B as soon as possible, as its effectiveness does decrease quickly with time. It works by preventing a person from ovulating; it won't prevent an already-fertilized egg from implanting into the uterine lining, and it won't cause an abortion.
Plan B and other progestin-only emergency contraception methods are most sensitive to the user's weight; they're most effective for folks who are 170 pounds or less.
Q: Are there other forms of Plan B out there?
Lucash: There are two other lesser-known forms of emergency contraception available.
[One is] Ella (ulipristal acetate), which is a pill someone can have prescribed by a doctor. (Getting to the doctor to get this prescription is one of the big barriers to using Ella; it's tough to get an appointment in such a short window of time and some pharmacies don't keep it in stock.) Ella works the same way as Plan B, but since it's a "combined" pill (not just progestin, like Plan B), Ella is effective for up to 120 hours (five days) after unprotected sex.
That means Ella is more effective for a longer period of time than Plan B, especially on days four and five after unprotected sex. In addition, Ella is less sensitive to the user's weight, so it will be more effective than Plan B for folks who are over 170 pounds.
The copper IUD (Paragard) can be used as emergency contraception. It can be inserted into the user's uterus up to five days after unprotected sex (the longest window to take emergency contraception). The copper IUD doesn't prevent the user from ovulating, but it works by stopping the sperm and egg from reaching each other, and it will prevent an already-fertilized egg from implanting in the uterine lining.
Q: How often can you take Plan B?
Lucash: Hormonal emergency contraception is extraordinarily safe and shouldn't cause any harmful or unwanted effects if it's taken more than once. That being said, doctors don't recommend taking Plan B or Ella more than once per cycle; it's only designed to protect against one instance of unintended pregnancy per cycle.
Using other forms of birth control consistently will be much less expensive and much more effective than just relying on emergency contraception.
Q: Can it affect your fertility?
Dr. Nayot: It is a short-acting medication and won't impact your future fertility. It may delay your next period though (by delaying ovulation) and has some side effects as well. If you're using Plan B regularly, you should speak to your doctor about a more appropriate form of birth control.
Q: Can you take it if you're on birth control pills and forget to take one? Or when a condom breaks?
Dr. Nayot: Emergency contraceptives contain progesterone. Birth control pills contain estrogen and lower doses of progesterone. So in essence, you can use your own birth control pills to make up the same progesterone levels as Plan B (a little OB/GYN trick).
If you've had unprotected intercourse and don't wish to conceive, there is little downside of taking Plan B, other than possible side effects or an irregular menstrual cycle.
Q: What are the side effects?
Dr. Nayot: Side effects of emergency contraceptives depend on the specific hormones in them (type and dose). Most women don't experience any side effects, but many do. The side effects are generally temporary (less than 24 hours) and can include nausea, vomiting, fatigue, headaches, dizziness, breast tenderness and abdominal discomfort.
Q: Can Plan B be used as a primary form of birth control?
Lucash: Plan B and Ella are meant to be used occasionally in emergency situations and not as a replacement for other forms of birth control. They're less effective and more expensive than using condoms.
And don't forget, none of these emergency contraception methods prevent STI transmission, and using condoms correctly and consistently is one of the best ways to avoid getting an STI.
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