Plan B

On our last trip to Wal*Mart, I saw something I've never seen before:


Now, I theoretically knew Plan B was available over the counter in Canada, but I've never actually seen a box of it on a shelf before, especially one snuggled so innocently beside the yeast infection treatments and the condoms in a store known for upholding "family values."

This is a good thing. A very good thing, in fact. (The Plan B, not the "family values" thing.) Unlike the 'States and many European countries, Canada went a step above and beyond when it decided to make hormonal emergency contraception available without a prescription: there is no age restriction. Anyone who needs it can buy Plan B.

Some of you may know that birth control is my field of geekery. It is the only subject in which I am comfortable calling myself an expert - or, more significantly, a geek. I read papers out of the Contraception journal in my spare time because I find it fascinating. Strangely, like what happened with sex, I just haven't managed to actually whip up any many posts regarding the absolutely fascinating field of birth control, menstrual cycles, hormones and conception. Well, I'm going to change that today, starting with Plan B. (There's a pun in there somewhere, but I can't seem to find it)

First, I think it is extremely important to point out that Plan B is not abortive. Plan B contains a fifteen thousand microgram dose of the synthetic progesterone levonorgestrel, which is also used in lower doses in several oral contraceptives. (Alesse, Microgynon, Seasonale and Nordiol, to name a few). It is not in any way some sort of voodoo abortion chemical. Voodoo magic or not, that is still a massive dose of progesterone, and many people go ahead and make the mistake of believing that such a gigantic dose of hormone will interfere with a fertilized egg or prevents implantation. The short truth is, "NOPE!" and the long explanation is extrapolated from this chart:


A rough sketch of the levels and time frame; not actual data points

Note how there is very little progesterone while the egg is developing, and then that the level of progesterone increases only after the fertile period? Progesterone has a negative relationship with the hormone that signals the ovaries to ovulate (that particular hormone is not shown on the chart, but it's triggered by a daisy chain of hormones starting with estrogen). The basic effect is that the presence of high levels of progesterone in the body will prevent ovulation. Some people like to say that hormonal contraceptives "trick" the body into "thinking" it's pregnant, but that's not . If a woman's body was tricked into "thinking" it was pregnant, she would start lactating and would come up with a positive on pregnancy tests, which test for pregnancy hormones. A far more accurate explanation is that hormonal contraceptives trick a body into thinking it has already ovulated by raising hormone levels to a post-ovulation level.

In addition to halting the ovulation phase, progesterone thickens the cervical mucous, which makes it much harder for sperm to pass through. (This is the mechanism of action that progesterone-only pills rely on because progesterone in lower doses only inhibits ovulation about 50% of the time.)

Also note how during the "possibly pregnant" phase, there is naturally a high level of progesterone? That's because progesterone is the hormone that tells the uterus to prepare for implantation of a fertilized egg. The presence of progesterone will not interfere with an already fertilized egg; the only contraceptive action it has is to prevent ovulation and inhibit sperm movement.

That's why Plan B is extremely time critical - when using progesterone-only emergency contraception, you have to
  • Hope that you haven't already ovulated
  • Hope that if you HAVE ovulated, that the action of the progesterone will halt sperm mobility

The effectiveness period of Plan B is about 72 hours after unprotected sex. After 72 hours, there is only a slim chance that it can prevent ovulation or fertilization. And this leads to the main point:

Plan B should be available over the counter, for cheap and without stigma, for anyone who needs it, regardless of age.

Many people do not have the money to visit a doctor and get a prescription for Plan B. Many young girls don't have the transportation, time or money to visit a doctor secretly without their family knowing. Many males are being denied access to Plan B for their partners. All of these are solved by making Plan B available over-the-counter.

Condoms break. Girls forget their pills. Women take antibiotics or get a stomach flu. Shit happens and there is a completely safe, easy-to-use backup plan. There is no reason to restrict such a backup based on fucking family values or morality or whatever the shit you want to call it. It should be a woman's choice whether she wants to be pregnant, not the choice of legislators who get squeamish at the thought of sixteen-year-olds having sex.

Do I fully support the idea of fourteen year old girls walking into Wal*Mart and walking out with a huge dose of hormones? Hell no. A woman's menstrual cycle and hormone levels affects many more things than when she gets a period. A dose of hormones like that which is available in a Plan B pack can and will fuck you up. You're going to bleed at weird times in weird ways. You will probably be emotionally unstable for a while. It can take months for your menstrual cycle to recover from such a huge disruption. In general, I think we are far too quick to give women hormones for contraception: they have hundreds of possible side effects from the severe (stroke) to the minor (dry eyes) that few people, including doctors, are aware of.

In another world, I might demand that Plan B be prescription-only so that patients can get accurate information about the potential side effects. I've personally advised countless women who took Plan B and experienced unexpected bleeding or a delayed period, and each time I'm shocked that their pharmacist did not go over the side effects (Or worse: they went over the side effects but got them wrong). I feel unnerved by the idea that people can just buy Plan B without receiving correct and valuable information about what to expect, but the benefits of having Plan B readily available far outweigh the stress and slight confusion caused by being unfamiliar with the side effects.

With Plan B, timing is everything, and that takes priority over everything else. In fact, Plan B is so time-critical that I would advise any women who use a method of birth control that has significant chance of user error to buy Plan B and keep it in their medicine cabinet just in case. Methods with significant user error are any barrier method (condoms, diaphragm, cervical cap, etc), hormonal methods that require timely user activity (Pills, patch, ring) and methods that are easy to mess up if you have a brain fart (fertility awareness/calendar method and withdrawl). Having Plan B on hand when you need it is even better than being able to quickly buy it, which far, far beats requiring a prescription.

In summary, Plan B is a fairly clever (if brute force) way to prevent a pregnancy should something go wrong with your primary method. I am extremely proud to live in a country that allows it to be sold over the counter to anyone who requires it.

8 things about

Plan B
  1. Normally I'll leave a snarky, humorous, or sarcastic comment... but this issue is a little more serious for me (not that there isn't humor, of course :)...

    ...I have two daughters... and family values... and I couldn't agree more... Thanks for taking the time to teach in this post and not just post the photo and be done with it... there is far too much misinformation and disinformation surrounding these sensitive issues; which shouldn't be sensitive at all, really.

    -Scoop

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  2. I can get Plan B over the counter too! XD

    Good god, I think I'd be fucking terrified to live in America.

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  3. Scoop: I completely agree, these issues shouldn't be sensitive. I'm actually very glad about my own sex education in school: we covered things like emergency contraception. Not in the depth that I'd personally prefer, but I've since gathered it was much better than the average! I'm so glad children are growing up with the Internet, where they can anonymously get access to valuable information like this... (sometimes at the unfortunate price of misinformation, though)

    Hannah: Some places there are bad... but Planned Parenthood is very good, from what I hear. They'll give you a script for anything birth-control related, and often for free or very cheap if you can't afford it. Many work solely on donations - "give what you can" sorts of things. The stigma on Plan B is getting to be less and less as people come to understand that emergency contraception isn't a abortion.

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  4. Plan B doesn't require a prescription in the US, but you do have to show an ID that says you're 16(?) or older.

    Taking those Plan B pills totally effs me up, as in, batsh*t insane PMS the next month. (On that note, I couldn't handle normal pills either. Oh well.)

    Digging your menstrual cycle diagram : >

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  5. If you're under 16, most states require a prescription. Otherwise it's OTC. But that does vary state-to-state.

    I've never taken Plan B and probably never will (my birth control is extremely effective, and there's no user error so if it didn't work I wouldn't know about it)... but I was on normal pills for a month or so in high school and.. Never again. It turned me into a monster. :P

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  6. I have 5 kids. Call me a "late bloomer" in the birth control world.

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  7. *Giggle*

    Well, we all learn eventually.

    Even when "eventually" is "at death."

    Or, a few hours later.

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  8. Sometimes I wonder about all the things I'm likely to learn a few hours after death.

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