Thursday, December 8, 2011

Teens Need a Plan B (but they can't get it over the counter)

Written by: Dr. Melisa Holmes, Co-founder of Girlology and Board Member of the SC Campaign

Emergency contraception (EC), marketed as the product Plan B, is largely misunderstood. As a parent, do you understand it? If not, you’re certainly not alone as evidenced yesterday by a surprising move by the Department of Health and Human Services Secretary, Kathleen Sebelius, who overrode the decision of the FDA to remove the age restriction on emergency contraception availability.  Using science and research to prove safety and effectiveness, the FDA concluded that Plan B One Step should be available over the counter to all ages and no longer require a prescription for those under 17. In political move that ignored the science, the decision was blocked.

As a parent of teens, and a physician to teens and their moms, I understand the concern about moving Plan B from behind the counter into the aisles so that anyone can pick it up along with condoms, pregnancy tests, cold medicine and band-aids. But even though it’s not readily available to all ages, all reproductive age girls and women should know about it and know how to access it, because knowing what to do in case of an emergency is always a good idea. And teens, in particular, need a Plan B (for themselves, or when they are helping a friend).

So, if you understand what EC is and how it works, you’ll realize that there’s little to worry about, but a lot to talk about – especially with your teen. Here’s the lowdown on Plan B.

What is it?
Plan B is a synthetic progesterone pill that is taken after unprotected sex to prevent pregnancy.  It is recommended after unprotected sex, misuse of usual contraception (i.e. forgotten pills, late patch change), and after rape.

If it’s taken within 72 hours of unprotected sex, it is 75% effective in preventing pregnancy, but the sooner it’s taken, the more effective it is – up to 95%.

Remember that the “standard” birth control pills contain estrogen and progesterone.  The “mini-pill” that is used for nursing mothers and women who can’t take estrogen contains only progesterone.  Interestingly, progesterone is also the hormone that is often prescribed to women with past miscarriages because progesterone provides important support to an early pregnancy. That means, if a girl or woman is already pregnant, Plan B will not affect, harm or abort the pregnancy.  This is NOT the abortion pill, RU486 or mifepristone (which blocks progesterone).

How does it work?
Basically, Plan B works in similar ways to “traditional” birth control pills, but faster.  How it works depends on when it is taken in relation to the menstrual cycle and unprotected sex.  It has been shown to prevent ovulation (the release of the egg from the ovary), which would obviously prevent fertilization.  It also has been shown to change the endometrium and make is less hospitable for implantation, therefore preventing the fertilized egg from “taking hold.” This is where the controversy comes in for some: if you have ethical problems with preventing a fertilized egg from settling into the endometrium when it arrives in the uterus, then all hormonal birth control should be off your list because that’s one of the ways hormonal birth control works (it also prevents ovulation most of the time, but the other mechanisms improve effectiveness).

Is it dangerous?
Nope.  In fact, it is safer than ibuprofen.  Although most drugs, including “traditional” birth control pills, have a list of contraindications (you hear them listed in pharmaceutical-speed-talk on commercials), Plan B has none. The contraindications and complications that accompany birth control pills are caused by the estrogen in them. Plan B is only progesterone. A progesterone overdose isn’t dangerous, but it might make you moody, nauseated, bloated and mess up your period.

Will teens abuse or overuse it?
Plan B is definitely not a mood enhancer (think premenstrual symptoms), so recreational use won’t be a problem.  But will teens change their behavior and have more unprotected sex if EC is readily available? The research says no. Specifically, research on EC and risk taking has shown that teens (and adult women) that have EC readily available do not increase their bouts of unprotected sex, but they are more likely to use EC appropriately compared with girls and women that have been told about EC but don’t have a prescription or dose on hand. Teens shouldn’t be expected to abuse Plan B anymore than they “abuse” condoms. And at $49.99 a dose (at my local pharmacy), it’s definitely not a first line choice for birth control.

If there’s Plan B, what happened to Plan A?
The naming of this branded emergency contraception formulation is brilliant because it acknowledges that this is a back up plan.  There should always be a “Plan A,” but when it falls through, it’s nice to have a Plan B, too.  This is where parents can step in and have the conversations that matter around this topic.
For teens, sexual abstinence is a preferred Plan A. There’s no question that the most reliable way to prevent pregnancy is to not have sex.  For high school students, this is what most of them are choosing these days (yay). But there are still plenty of teens that choose to have sex, and way too many teen pregnancies occurring in our country.  Plan B provides one more method that can help prevent the far-reaching impact of teen pregnancy.

Most physicians that work with teens and young adults liken the game plan for sexual health to a “belt and suspenders” approach. That means we recommend a hormonal method to prevent pregnancy and condoms to prevent infections.  So for teens, an acceptable Plan A would be to use condoms PLUS birth control pills, the patch, the vaginal ring, hormonal injections, implants or an IUD.  The best method for a teen is the method she can use consistently, correctly and confidently.

As parents, we have to acknowledge that there will be a day when our teen or young adult child chooses to have sex.  Before that happens, we should help her make a plan for staying safe and healthy.  Part of that is making sure she has a good plan in place, and that she thinks through a back up plan, an emergency plan of sorts. Having a back up plan is simply a smart strategy for life. Plan B emergency contraception is a back up plan that she may never need, but it is one more method she can put in her contraceptive tool kit.

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