Plan B: Indications For Use

Plan B may, or may not, become available over-the-counter (OTC) depending on what political mood the FDA's in, but you knowing when to use Plan B shouldn't hinge on that.

In July of 2004, Barr Labs resubmitted its application to sell Plan B OTC to women age 16 and older. [No sales to those under 16 because...umm, the planets aren't aligned properly I suppose.]

While we're awaiting the FDA's decision, let's review the indications for Plan B [emergency contraception (EC)] use.

Basically, you use Plan B (EC) anytime you have unprotected intercourse and you don't want to become pregnant.

To help you ascertain if a) you need to use EC, and b) if using EC will be beneficial, you need to ask yourself 3 questions:

1. Did I have unprotected sex in the past 5 days?

[The sooner you take EC the better. So, ideally, you won't wait for 5 days to use EC. Also, it doesn't matter how many times you had unprotected sex, or how many times your partner ejaculated (tsk, tsk, tsk--why are you having recurrent unprotected intercourse?)]

Here are some examples:

You have unplanned sex without protection

Barrier method (condom, diaphragm, modified diaphragm, cervical cap, sponge) breaks, slips, or dislodges

You miss 2-n combination bc pills (or 1 progestin-only one) in a row

The patch (Ortho Evra) is off for more than 24 hrs or more during patch-on weeks; you leave patch on for more then 9 days straight; you're more than 2 days late putting the patch back on [after the patch-free week]

You take out the ring (NuvaRing) for more than 3 hrs during ring-in weeks; you leave ring in for more than 5 weeks in a row; you're more than 2 days late putting the ring back in [after the ring-free week]

Your last progestin-only shot (Depo-Provera) was 14 or more weeks ago

Rape

2. Was my last menstrual period (LMP) less than 4 weeks ago?

3. Was the timing and duration of my LMP normal?

[The questions about your LMP screen for pregnancy. In other words, if you're already pregnant--you have regular, monthly, periods, but you haven't had a period for the past 2 months, or you had a period last month but it wasn't "normal" for you (fewer days, less flow, etc.)--you shouldn't use EC. The reason EC is not indicated is because it will have no effect, not because it will harm the pregnancy. Remember, you use EC *to prevent* a pregnancy. Once you're already pregnant, EC is useless. It will not terminate a pregnancy, nor will it cause birth defects.]

If you answered "Yes" to all three questions, you need to use EC.


Plan B

One important note about the EC pill regimens. For the progestin-only (Plan B) regimen, the label instructs you to take on dose (one pill) as soon as possible after the act of unprotected sex, and a second dose (one pill) 12 hours later. However, most Ob/Gyns will tell you to take both doses (two pills) at the same time [as soon as possible after the unprotected sex, up to 120 hrs, or 5 days]. Outside the U.S., the EC (Levonelle One Step) already reflects this updated regimen--the package contains only one pill.


Levonelle One Step

Once you take EC, if you still do not get a period in 3 weeks, follow-up with your Ob/Gyn for a pregnancy test. Also, very important: If the reason you had to use EC in the first place was a problem with your regular method of birth control--you either don't have one, or you do but you're not using it consistently, either because of side effects, or a change in your lifestyle/health--now is the perfect time to review your bc needs with your doctor.