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Going to Plan B?

The best contraception plan is the one that best meets your needs. Unfortunately, all contraceptive-including sterilization-have some failure rate, albeit small. The biggest contraceptive failure factor, however, is failure to use contraception. Regardless of the success rate of contraceptives in clinical trials, they won't work if they're in the medicine cabinet or bedside drawer. Previously a crisis, women are now able to turn to Plan B, otherwise known as "emergency contraception", after unintended or unprotected sexual intercourse. Also called "the morning after pill", this is NOT RU486 or "the abortion pill". Plan B therapy consists of two doses of levonorgestrel (a common birth control pill ingredient) given 12 hours apart within 72 hours of unprotected intercourse. Therapy is most effective, however, when initiated within 24 hours of unprotected intercourse.

The availability of this therapy has the potential to significantly reduce not only the number of unwanted pregnancies in the United States-currently 3 million per year-but the rate of abortions as well (currently apr. 1.5 million). But the biggest barrier to using this therapy is the fact that a prescription is required. While many gynecologists will prescribe this therapy over the telephone, the time required to make that happen may take longer than the 24 hour window for optimal efficacy or even longer than the 72 hour window required to initiate therapy. To overcome this barrier, an FDA advisory panel has recommended that the FDA grant over-the-counter (OTC) approval status for Plan B. While this decision is clearly controversial for political reasons, it is not considered controversial for medical reasons. Plan B is relatively safe and has a minimal likelihood of being used inappropriately.

The most common side effects affect fewer than 15% of women and include nausea, headache and abdominal pain. The pregnancy rate which resulted in women who used this therapy as recommended was less than 2%. While this is far from perfect, the current availability of emergency contraception has been estimated to have reduced the number of abortions by more than 50,000 per year so far.

For sexually active women who do not wish to become pregnant, using a reliable contraceptive is highly recommended. For those who are not in a mutually monogamous relationship, using one that provides protection against sexually transmitted diseases (STD's) is also strongly recommended. However, for those women who don't want to become pregnant but have failed to use contraception (or the contraceptive method has failed them), Plan B-emergency contraception-is still only a phone call to your doctor away.

Created: 3/11/2004  -  Donnica Moore, M.D.

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