Morning-after-pill update

Plan B prevents unwanted pregnancies

By Shandley McMurray

April 6, 2005

Did you know that there are approximately 200,000 unwanted pregnancies in Canada each year? Of these, about 125,000 end in abortion, according to the Society of Obstetricians and Gynaecologists of Canada (sogc). Dr. AndrÃ½ Lalonde, executive vice-president of the sogc, is astounded by this number, but says there is a solution that could reduce these figures by as much as 50 per cent. It's an emergency contraceptive called Plan B (a.k.a., the morning-after pill), and Dr. Lalonde believes that when this pill becomes more accessible, women will gain more options.

Where can I get it?

Plan B is currently available without a prescription only in British Columbia, Saskatchewan and Quebec. The rest of the country requires a doctor's prescription to get the pills, which will set you back about $45 per dose. And therein lies the catch: since the drug only works when taken within 72 hours of unprotected sex, it's often difficult to get a prescription in time, especially on weekends and holidays. That's why doctors such as Lalonde and experts at Health Canada are working hard to make the morning-after pill available without a prescription through-out Canada. But that could take several months, so in the meantime, the sogc says you may want to get a prescription for Plan B in advance and keep it on hand for an emergency.

How does it work?

Plan B's main ingredient is levonor-gestrel, a synthetic form of the progestin hormone. If taken during the first part of your cycle, Plan B either suppresses or delays ovulation, depending on how close you are to ovulating. And if you're in the second phase of your cycle, the pill prevents the egg and sperm from meeting in the Fallopian tube. (If you happen to be pregnant when you take Plan B, there will be no adverse effects on the fetus.)

Because Plan B prevents rather than terminates a pregnancy, it is totally different from the abortion pill RU-486. It merely keeps a pregnancy from happening, explains Dr. Lalonde.

Is it effective?

If used correctly, Plan B is between 80 and 90 per cent effective in preventing pregnancy. The treatment consists of two pills, which must be taken 12 hours apart. "The sooner you take it after unprotected intercourse, the more effective it is," says Dr. Jodi Shapiro, obstetrician and gynecologist at Toronto's Mount Sinai Hospital. Best results occur if both pills are taken within the first 24 hours after sex and dramatically decrease after 72 hours. Side effects – nausea or vomiting, irregular menstrual bleeding, breast tenderness and headaches – are minimal and last about 24 hours.

Although Plan B can be effective in preventing pregnancy, it's not a magic pill. "It is very important to remember that Plan B is emergency contraception and is not meant to replace other forms of contraception," says Dr. Shapiro. In fact, the World Health Organization says that women who used emergency contraceptive pills frequently had a greater risk of pregnancy than if they consistently took oral contraceptives or used other methods of protection. And, of course, there is no contraceptive pill that protects against stds.

What are my other options?

A copper intrauterine device also has a high rate of effectiveness in preventing pregnancy, if inserted into the uterus within five days of unprotected sex. However, it is not recommended for women with endometriosis, anemia or pelvic inflammatory disease. An iud also requires a prescription and must be inserted by a doctor.

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