Emergency Contraception Confusion

[Brandye]

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.

[Brandye]

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.