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Ask Dr. Sue
THE MORNING AFTER PILL
Dear Dr. Sue,
My friend and I would like to know how the morning after
pill works. Someone said that it is the same as
having an abortion. Is that true? And is it
dangerous? Is it more dangerous for teenagers?
(I heard adults can get it without a prescription but
teenagers need a prescription - is that why?)
Dear Friend,
Morning after pills contain hormones that have been used
in birth control pills for a long time. The most
readily available morning after pill, Plan B, has just
one hormone, levonorgestrel, a progestin. It does not
contain any estrogen. Another morning after pill
contains both progestin and estrogen.
Morning after pills work by interfering with the
processes necessary for pregnancy to take place.
Pregnancy is defined medically as the attachment of a
fertilized egg to the lining of the uterus
(implantation). When a woman is trying to become
pregnant, on any given day she might not ovulate, sperm
might not reach an egg that has been released, or an egg
might get fertilized but fail to implant. These
are all natural processes that occur on a regular basis
in a sexually active female who is not using
contraception.
Morning after pills might affect each of these steps.
It appears from all available evidence that the pills
most likely work by delaying or preventing ovulation or
making fertilization of an egg more difficult. It
is possible that there may sometimes be interference
with implantation of an egg that has been fertilized,
though the available research supports the first two
actions as being the most important. (1)
Morning after pills do not cause abortion, since a woman
is not pregnant, by medical definition, until a
fertilized egg implants in the uterus. This is
true whether she is trying to get pregnant or trying to
avoid pregnancy. If an egg has implanted in the
lining of the uterus and is exposed to the hormones in
the morning after pill, the pregnancy will not be
disrupted. The baby will grow and develop in the
same manner that it would have otherwise and the
pregnancy will last as long as it would otherwise last.
There has been no evidence of any harm to a developing
baby when exposed to the hormones in morning after
pills.
Morning after pills, particularly the single ingredient
Plan B, are quite safe. The World Health
Organization Medical Eligibility Criteria for
Contraceptive Use does not exclude anyone from using
either type of morning after pill (2). The
American College of Obstetricians and Gynecologists (ACOG)
has stated firmly that women of all reproductive age
should have unrestricted access to emergency
contraception. An ACOG news release in August of
2006 made its position quite clear:
“By restricting its OTC availability to women age 18 and
older, the FDA has missed an unparalleled opportunity to
prevent teenage pregnancies. Each year there are
more than 800,000 teen pregnancies in the US, with many
ending in abortion. Pregnancy itself is not
without risk, especially for a young woman. There
is no scientific or medical reason to impose an age
restriction and to withhold EC (emergency contraception)
from this population. EC is safe for
over-the-counter use by women of all ages.” (3)
Plan B is dispensed as two tablets of levonorgestrel.
The first is to be taken as soon as possible after
unprotected intercourse, and the second twelve hours
later. Alternatively, both tablets can be taken at
once, with no increased risk of side effects.
Emergency contraception should not be taken beyond 72
hours after intercourse, as it is very unlikely to be
effective at that point. When taken before this
time, Plan B prevents pregnancy approximately 80% of the
time. Some medications, including St. John’s Wort
and some seizure medications, could decrease the
effectiveness of levonorgestrel.
The most common side effect of high dose hormones is
nausea. Nausea is more common with the combination
pill, but about ¼ of the women who take Plan B also
experience nausea, sometimes to the point of vomiting.
If you take a morning after pill and then throw up,
please call your doctor or pharmacist for advice.
Other possible side effects include abdominal pain,
fatigue, headache, dizziness, breast tenderness, and
diarrhea. Side effects rarely last more than 24
hours.
The Plan B website states that approximately 2.7 million
unplanned pregnancies occur every year in the United
States, and that 54% of those end in abortion. (4)
Prevention of unwanted pregnancy is certainly the goal,
whether through avoiding sexual activity, faithfully
using reliable birth control, or, if all else fails, the
appropriate use of emergency contraception.
References:
1. James Trussell, PhD, Director, Office
of Population Research, Princeton University,
Princeton,NJ 08544, on the website maintained by
Princeton University regarding Emergency Contraception
(not-2-late.com). Also available is an Emergency
Contraception Hotline sponsored by Princeton, at
1-888-NOT-2-LATE.
2. who.int/reproductive-health/publications/mec/
3.
www.acog.org/from_home/publications/press_releases/nr08-24-06.cfm.
4.
www.go2planb.com/ForConsumers/AboutPlanB/AboutEmergencyContraception.aspx.
 
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