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Plan B: Effective method or hazardous to women’s health

Lauren Johnson

November 10, 2008

                     

 

Introduction:

In 1960, the FDA approved the first form of oral contraception. In the past few decades improvement in contraceptives have led to a variety of methods becoming available to women such as implants, patches, vaginal rings, shots, etc .Birth control offers women control over their reproduction, and the latest innovations  have made contraception more effective, convenient, and personalized. Unfortunately,in the case of contraceptive failure (condom breaking, improper use of birth control, sexual assault or unprotected sex) in the past there was no readily available postcoital emergency method except an abortion to terminate the unwanted pregnancy. Plan B has changed that. Plan B was among the first and presently is the most effective method of emergency contraception. If taken within 72 hours, Plan B reduces the chance of pregnancy by up to 89%. Its active ingredient levonorgestrel is used in high doses to essentially do what birth control does on a cyclical basis. Emergency contraception is possible through the fact that conception rarely occurs right after intercourse; the sperm must first travel through the fallopian tubes to join the egg when it arrives. What levonorgestrel does is create a thickening of the cervical mucus and keeps the woman’s ovaries from releasing the egg so that it cannot join with the sperm. That all being said, this method is not 100% effective, the scenario used most commonly to express the efficacy of Plan B states that if used within the recommended three days about 7 out of 8 women who would have become pregnant will not become pregnant. Using the information I’ve gathered on this pill, we will be able to determine whether plan B is a safe and effective method of contraception for women.

                                                                                                  

 

Use and Implementation

So, how do you get Plan B? Plan B is available over the counter at drugstores or health centers such as Planned Parenthood for women over age 18. If under 18 it is necessary to see a health care professional in order to get a prescription. Although Plan B was FDA approved and made available in 1999, only a mere 3 years ago did it become available on a nonprescription basis at pharmacies. With its introduction in pharmacies there has been numerous cases of pharmacists who have refused to fill emergency contraception prescriptions. Those who object base their decision off of their “professional right of conscience” which in essence means they feel they are acting immorally and against their personal beliefs by distributing emergency contraceptives (http://www.ncbi.nlm.nih.gov/pubmed/16648422?ordinalpos=41&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum). Non-cooperation by pharmacists hinders women from gaining access to drugs they need in a specific and short period of time. On a positive note, measures have also been taken to limit the occurrence of these episodes through communication with pharmacist and personnel by the pharmacy administration. They often make clauses to confidentially determine personal views and make sure they staff individuals willing to dispense it. Also, as a convenience to women who may be uncomfortable asking the pharmacist for Plan B, request cards have been made available to fill out and hand in like a prescription. So, after a woman has received Plan B, the first pill is taken immediately and the subsequent pill exactly twelve hours later. (http://www.go2planb.com/ForConsumers/TakingPlanB/faqs.aspx)  

Controversy and questions surrounding Plan B

The controversy surrounding Plan B mostly surfaces from ambiguity; it is hard to tell exactly how Plan B intercepts fertilization or discontinues a possible pregnancy.  Evidence supports the idea that the hormones prevent the sperm from joining with the egg, yet some also believe that it works by keeping a fertilized egg from attaching to the uterine wall. Although there is no evidence that points towards this, there is also no exclusionary evidence that proves it to be untrue. Thus, if this were the case, religious factions believes the pill carries out a “chemical abortion” in the first few days of pregnancy.  Other beliefs about Plan B are that through its availability it encourages sexual irresponsibility. This notion was addressed by many medical journals and resources; however it was essentially summed up by a bulletin on emergency contraception by The American College of Obstetricians and Gynecologists (ACOG) that states:

 "A prominent concern among both women and health care providers is that making emergency contraception more readily available could encourage irresponsible sexual behavior, which would increase the risks of both unintended pregnancy and sexually transmitted diseases. However, numerous studies have shown that this concern is unfounded."

                                     

Moreover, even though Plan B availability has increased there has still not been a significant decline or effect on the pregnancy or abortion rates. (http://www.ncbi.nlm.nih.gov/pubmed/18051234?ordinalpos=20&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum).Therefore its cost effectiveness and benefit has been questioned due to it being underutilized by women. This issue could most likely be helped if widespread education about Plan B was made available to all women. There is a growing population of organizations to help educate women on EC and the benefit of having Plan B in their medical cabinets in case of an emergency. Web sites, Planned Parenthood, and national campaigns such as back up your birth control (BYOC) try to increase emergency contraception education and awareness (www.backupyourbirthcontrol.org).  However, when it comes to utilizing Plan B, there have been some reservations due to a variety of reasons. Primarily, it is because Plan B is a relatively new form of birth control and women are wary of its adverse affects; not only for possible effects on their overall health but future fertility as well. There have been a range of side effects noted from use of the pill such as nausea, irregular menstrual cycles, blood clots, cardiovascular related issues, etc that cause people to question not only short term but long term consequences of its use. Other questions raised by the pill are in regards to it being a contraceptive as opposed to an “abortion pill”. Due to many individuals misconceptions they are likely to believe that it causes an abortion in the early days of pregnancy, however if you are already pregnant the pill is ineffective.  The main point is that Plan B is a form of contraception, not a means of pregnancy termination. (http://jama.ama-assn.org/cgi/content/full/296/14/1775?ijkey=qsS31RMdFZfdU&keytype=ref&siteid=amajnls)

 

 

Study

The study I chose, “Safety and effectiveness of hormonal postcoital contraception: a prospective study” illustrates the effectiveness and safety of emergency contraception. The study was done to evaluate the success of the hormonal postcoital contraception and see what side effects occurred.  Originally 503 women were given questionnaires to provide information on demographics and contraceptives. After the questionnaire, the women were given the first postcoital contraception pill including both ethinylestradiol (synthetic estrogen) and levonorgestrel; the second pill was given 12 hours later. The results were as follows: only 487 women were available for analysis of demographic data, 77 had to be excluded because of irregularities in their menstrual cycle, and 55 could not be found for follow up. The mean age of the participants was 22.6 and 36% of participants arrived within the first five hours after partaking in unprotected intercourse. The most common reason that the pill was necessary was due to condom breakage representing 81.9% of the cases. Out of the 355 cases only two pregnancies occurred, according to Dixon’s method 15.5 pregnancies should have occurred.  The Dixon method is one of the most common uses of prediction when it comes to emergency contraception efficacy (http://www.gfmer.ch/Endo/PGC_network/Efficacy_of_emergency_contraception_Enciulescu.htm). When it came to side effects there were no seriously harmful ones noted, 16.33% reported nausea or vomiting while 59% reported menstruation at their regular interval. Delayed menstruation only occurred in 6% of the cases, and all of the side effects cited tend to occur in women using regular methods of birth control. The study appropriately concluded that the use of ethinylestradiol and levonorgestrel in low doses is both an effective and safe method of postcoital contraception. (http://www.ncbi.nlm.nih.gov/sites/entrez)

Conclusion

Plan B gives a second opportunity to prevent an unwanted pregnancy and does so with reduced risks to a woman’s health. Contraception has advanced greatly in the past few decades, giving women access to options they did not use to have as well as providing an alternative to abortion. The amount of medical literature on emergency contraceptives has grown greatly in the past few decades; risks and misconceptions have been addressed and overcome with advances made in all hormonal contraceptive drugs. Despite controversy, Plan B is a useful advancement in contraception and has proven to be not only a safe and effective method, but one that has credence through our vast knowledge of oral contraceptives that use the same hormones as Plan B but in lower doses. Of course there are downsides, Plan B does not protect against STD’S or HIV/AIDS and there has been some reservations due to our inability to predict long term effects, however the risks are rather slight due to our familiarity with the hormones. So, can Plan B be used more than once, yes it can. However, should Plan B be used as a primary method of contraception? No, it should not; its purpose is simply as a backup method. Studies have shown an increase in the prevalence of side effects if it is used as a primary mean of contraception after every instance of unprotected sex. Side effects include Nausea, Abdominal pain, Fatigue, Headache, Heavy Menstrual Bleeding, Dizziness, Weakness, Breast Tenderness, Vomiting, Loss of libido and Depression.

(http://www.ncbi.nlm.nih.gov/pubmed/10906500?ordinalpos=13&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum) Nevertheless, the clinical effectiveness of Plan B is superb when it comes to preventing pregnancy. The awareness and education out there for Plan B, however is lacking particularly for young women. Easily accessible information should be made available through web sites, toll free numbers, and campaigns to address this issue. It is important that women understand its availability, age requirements, and time sensitivity (http://www.fda.gov/cder/foi/label/2006/021045s011lbl.pdf). In addition, along with birth control, health care professionals should begin to express the utility of keeping Plan B at home simply in case of an emergency. So in conclusion, it is not a contraception method that should be used frequently or as a means to continuously partake in sexually irresponsible behavior, but if one method fails or unprotected intercourse occurs, at one point or another everyone needs a Plan B.

 

References

Brown, D., & Wall, L. (2006, May). Refusals by pharmacists to dispense emergency contraception: a
     critique. Obstet Gynecol , 107(5), 1148-51

Davidoff, F., & Trussell, J. (2006, October 11). Plan B and the Politics of Doubt . The Journal of
     the American Medical Association , 296(14), 1775-1778.

FD, S. (2007). Emergency contraception with levonorgestrel. Medicina (B. Aires), [Medicine] 67(5), 481-90.

No authors listed. (2000, May). Efficacy and side effects of immediate postcoital levonorgestrel
     used repeatedly for contraception. Contraception, 61(5), 303-8.

Turner, N. A., & C, E. (2002). How safe is emergency contraception? Drug Safety, 25(10), 695-706.

 

 

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