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  • FRIDAY FEBRUARY 9 2007 6:30 PM

How Does This Plan Work?

Submitted by Bitch_PhD

Edited by Rahodeb

Tags: birth control, science, media



Anybody who follows reproductive rights news (and if you ever have sex, or plan to, you should) knows that Plan B, the much-discussed morning after pill, is the first non-barrier method of birth control that you can get over the counter. 'Course, you still need an ID to prove you're over 18—or you can get a legal adult friend to come with you—and the price varies ridiculously, from $10 at, say the Hennepin County Medical Center in Minneapolis to $54 at my local CVS. It doesn't prevent STDs, it's slightly less reliable than the regular pill, it's not a substitute for other forms of birth control, yadda yadda. But. It's a good thing regardless, now that we know we can get it.

What most people do not know, however, is how it actually works. The great Christian War on Sex (I'm copyrighting that, by the way) propagandists have successfully convinced most people that Plan B is an abortifacient, because the manufacturer's drug information says that it "may" prevent a fertilized ovum from attaching to the uterine wall.

So let me explain a few things. First, how the drug actually works. Plan B consists of two pills that contain a synthetic form of progesterone, one of the two main female hormones (the other is estrogen) that occur naturally and are used in birth control pills. Men, by the way, have progesterone too, though in lower doses. When you take Plan B—two pills twelve hours apart—you get a very large dose of progesterone that lasts for a day or two.

When a woman is pregnant, her body produces a lot of progesterone, which keeps her from ovulating—thereby preventing her from getting pregnant a second time and trying to carry them both, which would be a disaster. So progesterone prevents ovulation. Which, if you're a woman who doesn't want to get pregnant, is a pretty useful thing for it to do.

So let's say for some reason a woman who isn't on birth control finds herself with sperm floating around inside her: a condom broke, she was raped, she and her partner were sloppy and overly enthusiastic, whatever. If she's already ovulated within the last 24 hours, all she can do is cross her fingers: you can't stop something that's already happened. But if she hasn't, and is unlucky enough that she's just about to, she can take a big dose of progesterone that will stop her from popping an egg long enough for the sperm to die, and no pregnancy. Hurrah!

But, you ask, what if she's already ovulated, and the sperm luck out, and there's a zygote floating around but it hasn't yet stuck itself to the wall of the uterus? Would Plan B work then? And if it does, isn't that technically a kind of abortion?

Nope, and nope. If you've ovulated, the zygote either is or isn't going to be lucky enough to find a resting place. A lot of them don't, which is why pregnancy starts once the zygote takes root in the uterine lining. If you're not pregnant, you can't abort.

Okay, but. What if there's a zygote, and you personally see fertilization as the beginning point of life, even if it happens before pregnancy actually starts? If Plan B prevents implantation—and their own literature says they "may" do that—then that feels iffy to me.

This is the second thing that needs explaining. There is no evidence that Plan B prevents implantation. That's not a known effect of progesterone. But because science can't prove a negative—you can't prove that something doesn't happen, because if it doesn't happen, there is, by definition, no evidence—the drug company puts that little "may" in there. All "may" means is "even though we've never seen it happen, we can't prove that it doesn't." It's kind of like saying, "well, it might cause your skin to turn blue," or "it might cause you to grow a third arm," although they don't bother to say *that*, because it's not a possibility that would occur to anyone. But there is no evidence—none, zilch, nada—that Plan B prevents implantation. All it does is help you control the timing of ovulation; sort of the women's equivalent of guys thinking about baseball or their mother in order to keep from coming. For a guy, orgasm and ejaculation are the same event: for a woman, orgasm and ovulation aren't. If you're a guy, you can usually prevent the latter by controlling the former; if you're a woman, all you have to do is take a pill.


I got a lot of the details about this stuff from PZ Myers at Pharyngula: see Why the Wingnuts Hate Plan B and Plan B, Again.


Bitch_PhD writes the Bitch, Ph.D blog, may or may not still be a professor, and paid $45 for Plan B last month, but is happy to say she finally renewed her regular birth control prescription yesterday.

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Metta

Metta

I'm lost
September 2006

FEB 09, 2007 06:40 PM

Alright.. I cant believe i am admitting it.. But I got pregnant after I took the PLAN B.
I took Plan B 10 hrs after the "Incident" and still got preggers.

So This is NOT a birth control method obviously... But I totally agree with it.

In canada We can get Plan B without a precription and as far as I know Without ID...

When I took it It wasnt availabel in this fashion and I had to wait for a while in a walk-in clinic. Who knows? Maybe if I could have gotten it sooner (10hrs?!?!?) I could have prevented the circumstances that followed.

And For the record : I terminated my pregnancy. My CHOICE... My RIGHT... ( I am not trying to be a shit disturber)..

joeywrists

joeywrists

Lake Grove, NY
March 2006

FEB 09, 2007 07:52 PM

Metta said:
Alright.. I cant believe i am admitting it.. But I got pregnant after I took the PLAN B.
I took Plan B 10 hrs after the "Incident" and still got preggers.

So This is NOT a birth control method obviously... But I totally agree with it.

In canada We can get Plan B without a precription and as far as I know Without ID...

When I took it It wasnt availabel in this fashion and I had to wait for a while in a walk-in clinic. Who knows? Maybe if I could have gotten it sooner (10hrs?!?!?) I could have prevented the circumstances that followed.

And For the record : I terminated my pregnancy. My CHOICE... My RIGHT... ( I am not trying to be a shit disturber)..



i had the same problem obviously i was not preggers, but i got someone preggers and plan b didnt work. she took it 2 or 3 hours later and still had to get an abortion, which was totally her decsion i just supported whatever she wanted. i also believe its a womans right to chose.

Bitch_PhD

Bitch_PhD

I'm lost
February 2007

FEB 09, 2007 08:26 PM

It is birth control, it's just not 100% effective. If you've already ovulated, you're fucked. So to speak.

I'm curious how much each of you paid for it? The price seems to vary incredibly widely.

Bitch_PhD

Ngila

Ngila

Portland, OR
June 2006

FEB 09, 2007 08:33 PM

I get Plan B for free with my regular birth control. smile

Also I would like to point out that even though Plan B is technically legal, otc, it can still be difficult to get because some pharmacists will not give it to you or make you give out very personal information and some will say that they don't even carry it!

joeywrists

joeywrists

Lake Grove, NY
March 2006

FEB 09, 2007 08:47 PM

i think it was 30 or 40 bux and ya if a 230 pound guy is askin for something he tends to get it just my experiance in life biggrin

MissMir

MissMir

USA
November 2004

FEB 09, 2007 08:49 PM

Plan B comes in two little pills. And let me just say from experience. Blessed are those two little pills. kiss

jessikaaaa

jessikaaaa

Brooklyn, NY
December 2006

FEB 09, 2007 11:22 PM

i feel like an idiot for saying this, but i have taken plan b and not exactly known how it works until this article.

i got it about 4 years ago, three individual packets (each with the 2 doses), one of which i lost, one of which i gave away, and one i took. i got them all for free from a free clinic near my high school.

i was under the impression that it did prevent implantation.

that said, i've been taking ortho-tri-cyclen for years and i'm pretty happy with the whole keeping me baby-free deal. i also didn't really "get" how that worked until i went to that clinic to ask about it, too (but, yanno, now i do).

Wendy

Wendy

SUICIDEGIRL

Israel

FEB 10, 2007 12:00 AM

Bitch_PhD said:
This is the second thing that needs explaining. There is no evidence that Plan B prevents implantation. That's not a known effect of progesterone. But because science can't prove a negative%u2014you can't prove that something doesn't happen, because if it doesn't happen, there is, by definition, no evidence%u2014the drug company puts that little "may" in there. All "may" means is "even though we've never seen it happen, we can't prove that it doesn't." It's kind of like saying, "well, it might cause your skin to turn blue," or "it might cause you to grow a third arm," although they don't bother to say *that*, because it's not a possibility that would occur to anyone. But there is no evidence%u2014none, zilch, nada%u2014that Plan B prevents implantation.



To start, science doesn't actually prove anything. Science disproves, and science supports. Science hypothesizes and science revises. Science does not prove.

I think that your "no research, none, zilch, nada" statement is a bit of an oversimplification. "May" on an FDA label certainly does not mean "even though we've never seen it happen, we can't prove that it doesn't." If this was the case, then, like you said, warning labels would have things such as "it may cause your skin to turn blue," or "it may cause your teeth to fall out."

Here are just a couple of things I've found so far.
I'm not arguing in one direction or the other. There is obviously a heated debate on this issue, but to say that the only reason that the FDA states that it may prevent implantation is "because they can't prove that it DOESN'T cause it," is just, well, plain silly.



Postfertilization effect of hormonal emergency contraception
C Kahlenborn, JB Stanford, and WL Larimore

OBJECTIVE: To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency contraception (EC) used in the US and to explore the ethical impact of this possibility. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (1966-November 2001) was done to identify all pertinent English-language journal articles. A review of reference sections of the major review articles was performed to identify additional articles. Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel, mechanism of action, Plan B. DATA SYNTHESIS: The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect). The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory, or postovulatory phase of the menstrual cycle. CONCLUSIONS: Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.




The following is an excerpt from Dr. Vivian M. Dickerson's article on emergency contraception entitled, "Emergency Contraception: Out of Sight, Out of Mind?" The full text of the article, including her references, can be found here


Plan B does not interrupt an implanted pregnancy and, if taken after implantation, is not associated with adverse outcomes. However, while the FDA defines pregnancy as commencing with implantation, others believe it starts with fertilization. There are rare instances (just as with the intrauterine device) in which the use of levonorgestrel after fertilization could%u2014although with less efficacy%u2014prevent implantation. This is not the primary method of action and indeed occurs rarely. However, when informed about this possible mode of action, particularly if the pill is used after the 72-hour window, some women may choose not to use EC on this basis. Availability over-the-counter vs availability by prescription only has no bearing on this method of action. In
addition, no complications, such as severe bleeding, have been associated with late use. Again, it is to be emphasized that Plan B does not interrupt an implanted pregnancy.

Priest_

Priest_

USA
January 2007

FEB 10, 2007 05:37 AM

So basically the study saying it may interfere with implantation says that it happens only rarely and primarily only if you wait a while before going out and getting it.

So if you have concerns about that (which seems weird to me since people who take such a view tend to be uber-christian and shouldn't be having sex unless they're married and ready for a baby anyway) then take the pill right after the sex.

Or for christ's sake, just get on one of the huge variety of regular contraceptive methods. It's a guy's job to make sure he's stocked with condoms if he's gonna get any and it's the girl's job to make sure she's on the pill. Right?

seme

seme

Czech Republic
July 2005

FEB 10, 2007 05:47 AM

Sphinxter said:
So if you have concerns about that (which seems weird to me since people who take such a view tend to be uber-christian and shouldn't be having sex unless they're married and ready for a baby anyway) then take the pill right after the sex.



WOW, stereotypes are super fun.

Bitch_PHD, thanks for posting this, my personal feelings aside, I thought it was pretty informative biggrin

NickFaust

NickFaust

USA
April 2004

FEB 10, 2007 07:01 AM

Wendy said:

SPOILERS! (Click to view)

Bitch_PhD said:
This is the second thing that needs explaining. There is no evidence that Plan B prevents implantation. That's not a known effect of progesterone. But because science can't prove a negative%u2014you can't prove that something doesn't happen, because if it doesn't happen, there is, by definition, no evidence%u2014the drug company puts that little "may" in there. All "may" means is "even though we've never seen it happen, we can't prove that it doesn't." It's kind of like saying, "well, it might cause your skin to turn blue," or "it might cause you to grow a third arm," although they don't bother to say *that*, because it's not a possibility that would occur to anyone. But there is no evidence%u2014none, zilch, nada%u2014that Plan B prevents implantation.



To start, science doesn't actually prove anything. Science disproves, and science supports. Science hypothesizes and science revises. Science does not prove.

I think that your "no research, none, zilch, nada" statement is a bit of an oversimplification. "May" on an FDA label certainly does not mean "even though we've never seen it happen, we can't prove that it doesn't." If this was the case, then, like you said, warning labels would have things such as "it may cause your skin to turn blue," or "it may cause your teeth to fall out."

Here are just a couple of things I've found so far.
I'm not arguing in one direction or the other. There is obviously a heated debate on this issue, but to say that the only reason that the FDA states that it may prevent implantation is "because they can't prove that it DOESN'T cause it," is just, well, plain silly.



Postfertilization effect of hormonal emergency contraception
C Kahlenborn, JB Stanford, and WL Larimore

OBJECTIVE: To assess the possibility of a postfertilization effect in regard to the most common types of hormonal emergency contraception (EC) used in the US and to explore the ethical impact of this possibility. DATA SOURCES AND STUDY SELECTION: A MEDLINE search (1966-November 2001) was done to identify all pertinent English-language journal articles. A review of reference sections of the major review articles was performed to identify additional articles. Search terms included emergency contraception, postcoital contraception, postfertilization effect, Yuzpe regimen, levonorgestrel, mechanism of action, Plan B. DATA SYNTHESIS: The 2 most common types of hormonal EC used in the US are the Yuzpe regimen (high-dose ethinyl estradiol with high-dose levonorgestrel) and Plan B (high-dose levonorgestrel alone). Although both methods sometimes stop ovulation, they may also act by reducing the probability of implantation, due to their adverse effect on the endometrium (a postfertilization effect). The available evidence for a postfertilization effect is moderately strong, whether hormonal EC is used in the preovulatory, ovulatory, or postovulatory phase of the menstrual cycle. CONCLUSIONS: Based on the present theoretical and empirical evidence, both the Yuzpe regimen and Plan B likely act at times by causing a postfertilization effect, regardless of when in the menstrual cycle they are used. These findings have potential implications in such areas as informed consent, emergency department protocols, and conscience clauses.




The following is an excerpt from Dr. Vivian M. Dickerson's article on emergency contraception entitled, "Emergency Contraception: Out of Sight, Out of Mind?" The full text of the article, including her references, can be found here



Plan B does not interrupt an implanted pregnancy and, if taken after implantation, is not associated with adverse outcomes. However, while the FDA defines pregnancy as commencing with implantation, others believe it starts with fertilization. There are rare instances (just as with the intrauterine device) in which the use of levonorgestrel after fertilization could%u2014although with less efficacy%u2014prevent implantation. This is not the primary method of action and indeed occurs rarely. However, when informed about this possible mode of action, particularly if the pill is used after the 72-hour window, some women may choose not to use EC on this basis. Availability over-the-counter vs availability by prescription only has no bearing on this method of action. In
addition, no complications, such as severe bleeding, have been associated with late use. Again, it is to be emphasized that Plan B does not interrupt an implanted pregnancy.



Thank you, for posting this, you beat me to the punch and did a better job than I would have.

Reporting research consists of people making careful statements about findings. This is why most popular publications muck up the discussion of research; they want to speak in generalities and generalities smooth over the nuances of research findings.

Anything (anything) that changes the character of the endometrium has a potential effect on implantation. This is why the inserts say "may," not because they can't prove the negative, but because there is an unexplained aspect of the data and results.

That being said, It comes down to this: either you don't get pregnant or you do. If you do, you carry a pregnancy to term or you interrupt it. Those are the options.

If you are going to have sex, you should familiarize yourself with the options, and be comfortable with the choices you have to make.

This is called personal responsibility and it applies to all voluntary actions a person may take.

LePoseur

LePoseur

Missoula, MT
October 2005

FEB 10, 2007 11:11 AM

0_o

And here I was thinking it was the 'miracle pill' that works every time.

Side note: Planned parenthood charges on a sliding scale. If you're a poor college student, you can get it for free. Huzzah!

coleen

coleen

USA
January 2007

FEB 10, 2007 01:02 PM

Metta said:
Alright.. I cant believe i am admitting it.. But I got pregnant after I took the PLAN B.
I took Plan B 10 hrs after the "Incident" and still got preggers.

So This is NOT a birth control method obviously... But I totally agree with it.

In canada We can get Plan B without a precription and as far as I know Without ID...

When I took it It wasnt availabel in this fashion and I had to wait for a while in a walk-in clinic. Who knows? Maybe if I could have gotten it sooner (10hrs?!?!?) I could have prevented the circumstances that followed.

And For the record : I terminated my pregnancy. My CHOICE... My RIGHT... ( I am not trying to be a shit disturber)..



Ten hours and you still got preggo? That seems like enough time, maybe the sperm was expecially aggressive? It does work better the sooner you take it obviously. My husband and I had a little condom accident as I was getting off my depo shot. I was pretty sure that I was going to be fine, but we got the Plan B about 14 hours after the incident. I still had depo in my system so I was probably fine anyway, but we wanted piece of mind. It was 37 bucks for us at a Rexall which is worth the piece of mind.

The list of things they have to go through with you before they give it to you is pretty hilarious. No, it doesn't 'kill' a baby inside of you, and No it doesn't cure AIDS. Jesus...the pharmacist lady and I had a good laugh.

dem_z

dem_z

United Kingdom
June 2004

FEB 10, 2007 01:52 PM

I believe you when you say it's not an abortificant, but so what if it was?

Bitch_PhD

Bitch_PhD

I'm lost
February 2007

FEB 10, 2007 02:35 PM

Well, the fact that a lot of people think it is has a lot to do with why making it OTC got held up for over a year, and why you have to show i.d. to get it, and why a lot of pharmacies won't carry it and a lot of pharmacists won't give it to you if you ask.

Bitch_Ph.D.

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