Sex Advice

Dear Dr. Locker: Why can teens get Plan B, the morning after pill, at any drug store? Is Plan B the abortion pill?

Answer from Dr. Locker

There are many misconceptions about Plan B (also called emergency contraception, ec, and the morning after pill). This will clear up some things about Plan B, and also about teen's access to it.

Misconception #1: It causes an abortion.

Reality Check: Plan B does not cause an abortion. Plan B is not “the abortion pill.” The “abortion pill,” called RU486, causes an abortion in pregnant women when they take it within 60 days from the first day of their last period. RU486 contains medications that will end a pregnancy: Mifepristone (steroid) and Misoprostol (prostaglandin). Those medications block progesterone, a hormone needed to continue a pregnancy. RU486 is only administered by a doctor, and costs about $500. RU486 is not Plan B, and Plan B does not cause an abortion.

Plan B is taken by women who are not pregnant. Plan B is progesterone. Plan B consists of two pills taken 12 hours apart (within the first 3 days after unprotected intercourse, preferably within the first 24 hours, possibly within the first 5 days). Plan B’s 2 pills are made of progesterone only (a total of 1.5 mg of Levonorgestrel), which prevents ovulation – it does not end a pregnancy. If you don’t know what that means, then here’s the brief explanation. Sperm and egg need to both be present in a woman’s reproductive system in order for her to get pregnant (for the sperm to fertilize the egg). Once sperm is ejaculated into a woman’s reproductive system, sperm lives for a few days and can fertilize an egg if it arrives during that time. When sperm is present, the woman’s egg may not be there yet, because she may not have ovulated yet. So if hormones prevent her ovulation for just a couple of days, then that will prevent the egg from being there to be fertilized by the sperm, and therefore, prevent pregnancy. That is how Plan B works. Sperm never meets egg. No conception occurs. Sometimes Plan B can make it so that if the egg has already been released then the egg and sperm will not have an environment in which they would unite. But that still is preventing pregnancy before sperm meets egg, not ending a pregnancy. Some researchers think that if fertilization had just occurred then there is a possibility that Plan B could end the potential pregnancy by making it so that the fertilized egg does not implant in the wall of the uterus; however, there is no medial evidence that Plan B prevents implantation. Most importantly, Plan B will not work once implantation has begun, which is about 5 days after fertilization. If a woman has a positive pregnancy test, then Plan B will NOT end her pregnancy. Plan B will not affect an existing pregnancy, will not cause a miscarriage or abortion, and will not harm a developing fetus at all, according to the FDA.

Misconception #2: It causes major side effects and creates lasting problems.

Plan B may have short term side effect, but it is usually well tolerated, and has no lasting side effects. When taking Plan B, some women may experience nausea, fatigue, headache, dizziness, breast tenderness, vomiting, and slight abdominal cramps. However, not all women would feel these, and they may feel them only slightly. Research found that 23% of women taking Plan B experienced nausea and 5.6% vomiting. Also, the side effects would go away in a couple of days. Most women (87%) have their period on time after taking Plan B, but some may be late or early. By the next cycle their ovulation and period would be normal. There are no lasting effects on fertility from taking Plan B, according to the FDA.

Misconception #3: It is new and may be dangerous.

Plan B is not really new. Post-sex birth control was researched in the 1960s and began to be used in the 1970s in Europe. Other brands with other combinations of hormones have been used all these years. The progesterone pills in Plan B have been used as a component of regular birth control pills for 35 years. Plan B is just a newer way of administering the pills. Plan B, with its use of progesterone-only, was first approved by the United States FDA in July 1999, and became available with a prescription. In 2006, Plan B was approved to be use without a prescription by people 18 years and older. Plan B is FDA approved, and also by many other medical sources, including the American Medical Association and the World Health Organization. It is currently used in at least 50 countries.

Misconception #4: Allowing 17 year olds to purchase it without a prescription changes the need for parental consent that had previously been in place.

Reality Check: This has never been the need for parental consent to get Plan B. Since approved by the FDA in 1999, Plan B has always been available in the US without parental consent for people of any age. Even people under age 18 who would need a prescription for it, can still get a prescription without parental consent. Any person of any age, including a teen, can get a prescription from a doctor or health clinic with no consent. Parental consent was never needed for Plan B. Why? Because it prevents conception, similar to birth control pills, and no parental consent is ever needed for teens to buy any type of birth control.

Misconception #5: It is easy for teens to get it over the counter.

Plan B is a “behind the counter” medication. In order to buy it, someone has to go to a pharmacy and show a government issued ID for proof of age 18 (which will soon change to proof of 17). School ID is not a government ID. At most pharmacies, it costs about $50. So, while parental consent is not — and never has been – needed for Plan B, there are challenges for teens to buying it. If parents are concerned about their teens being able to purchase Plan B, then why are they not concerned about their teens taking real “over the counter” medications without parental consent? Over the counter diet pills, cough medicines, pain pills, are extremely widely available, easy to buy, under $5 in many cases, require no ID, have a high risk of abuse or misuse, and much greater side effects.


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