Understanding Plan B

Dear Sexpert,

 My friend told me that she went to McCosh this morning to get Plan B after having unprotected sex with her boyfriend.  I am curious to find out more about how Plan B works.  Is it the same as an abortion?

–Plan A Preferred 

Dear Plan A Preferred,

I am happy to answer your questions about emergency contraception.  People may seek emergency contraceptive services for many reasons, including contraceptive failure (such as condom breakage) or forgetting to take birth control pills.  Options for emergency contraception include Plan B One-Step® or other generic progestin pills, ella® or other pills containing progesterone receptor modulators, some estrogen-progestin combination pills, and copper intrauterine devices (ParaGard® IUD).  Although there are sometimes stigmas around seeking emergency contraceptives, there should be no shame in seeking them when unexpected things go wrong.  As long as you are using non-emergency contraceptives regularly or as your primary form of contraception, it is useful to be knowledgeable about back-up options (hence the name “Plan B”).

I’ll now go into the physiological explanations about how these different methods work.  During the menstrual cycle, the pituitary gland in the brain releases the follicle-stimulating Hormone (FSH) which initiates the growth of follicles and a premature egg in the ovaries.  These follicles then release the hormone estrogen, which thickens the lining of the uterus and signals to the brain to release the luteinizing hormone (LH), which then triggers ovulation.  Birth control pills work by monitoring hormone levels; by increasing progestin levels, the pills decrease FSH and LH levels which prevent ovulation.  Plan B, or “the morning after pill,” works in essentially the same manner as birth control pills.  Plan B contains a higher dose of levonorgestrel, a synthetic form of progestin.  Therefore, it works to prevent ovulation just like birth control does.  Emergency contraceptive methods that prevent ovulation should be taken as soon as possible after unprotected sex to be most effective.  Levonorgestrel in Plan B thickens the mucosal lining of the uterus to create an environment where sperm will not survive.  Taken up to 3 days after sex, Plan B is able to prevent ovulation with an 89% success rate. Other emergency contraception methods can be effective when taken up to 5 days after sex.

Similar to Plan B, Ella also works to prevent ovulation.  Ella contains a progesterone receptor modulator, which actually has been shown to have a more direct inhibitory effect on ovulation.  Unlike Plan B, ella is only available by prescription. As opposed to preventing ovulation, the copper IUD prevents pregnancy after unprotected sex through impeding sperm function.  The copper IUD can be inserted up to 5 days after sex to prevent pregnancy at a 99% rate. Since the copper IUD is also a form of regular birth control (categorized as LARC or long-acting reversible contraception because it can remain in place for up to 10 years).  If you think long-term birth control could be right for you, you should talk to a healthcare provider at UHS. Also, emergency contraception is not the same as abortion because all methods only work pre-implantation (or the attaching of a fertilized egg to the uterine wall).  An implanted egg will not be affected by any emergency contraceptive method.

If you wish to obtain emergency contraception, or learn more about emergency contraceptive methods, you can make an appointment at McCosh Health Center via University Health Services.  To obtain emergency contraception, you do not need to make an appointment.  The morning after pill is available by appointment during regular hours and through the infirmary after business hours.  You can also go to the local Planned Parenthood, or get Plan B or the generic form from the local pharmacy in the family planning aisle (Call ahead to make sure they have it in stock!). I hope this article has cleared up your questions regarding emergency contraceptives.  Although they should under no circumstances be used as a primary form of contraception and do not protect against sexually transmitted infections, it is always useful to have a “plan b.”

Information regarding Plan B obtained from: The Emergency Contraception Website (Princeton), Planned Parenthood, American College of Obstetricians and Gynecologists (ACOG), AsapScience, and K. Gemzell-Danielsson et al. (2013).