Item: Plan B

Like everyone, you or your friends can get stuck in a situation where you don’t use contraception, or if you do - it fails. Now that Plan B, a type of emergency contraception, is available without a prescription (but behind-the-counter) Street Cents has what you need to know about getting and using Emergency Contraceptions.

Birth control and emergency contraceptions are effective ways of preventing pregnancy, but nothing is as effective as abstinence. But for those of you that are sexually active, here’s what you need to know.

What is Emergency Contraception?

OK - so you had sex without contraception, or maybe the condom broke. In emergencies like these there's a solution and it's called emergency contraception (EC). Unlike other forms of contraception, EC is birth control taken after sex to prevent pregnancy. You might consider using it if you had sex in the last few days and:

• You didn’t use any birth control.
• The condom broke, tore, slipped or was misused.
• You missed two or more birth control pills in a row.
• You were late for your birth control shot.
• The diaphragm slipped or was removed too early.
• You miscalculated your fertile period.
• Your partner didn’t ‘pull out’ in time.
• You were forced to have sex.

The term EC covers several methods that can be used within a few days of unprotected sex or contraceptive failure to prevent an unwanted pregnancy. There are two main methods of EC:

1. You can take EC pills within three days or 72 hours of unprotected sex. A Planned Parenthood doctor pointed out that “some research suggests EC pills may work up to five days after unprotected sex, but the pills are more effective if they are taken earlier.”

2. You can have an Intrauterine Device (IUD) inserted into your uterus by a doctor up to seven days after unprotected sex. This is the most effective form of EC. IUDs are normally used as a method of long-term birth control.

Plan B is the newest EC and it has recently been made available behind-the-counter. Street Cents investigated the process, the pills and the price so you know what your options are.

Plan B

What is it?

Plan B (the brand name for the drug levonorgestrel) is an emergency contraception that significantly reduces the risk of pregnancy after unprotected sex or when your contraception fails. It’s called Plan B, because it is a backup method for when “plan A” fails. And now, women across Canada, can get Plan B without a prescription, from their pharmacist. This is a big deal because it means you can get the drug on the weekends, holidays - whenever. And remember, the sooner you get Plan B, the more effective it will be.

Although it is known as “the morning-after pill,” Plan B can be effective in preventing pregnancy as we mentioned, within 72 hours of unprotected sex or contraceptive failure. But timing is everything here. It’s 95% effective within 24 hours of unprotected sex, 85% effective between 25 and 48 hours and 58% effective between 49 and 72 hours.

How Does It Work?

Plan B takes advantage of the fact that conception doesn’t occur right after ejaculation. It takes up to 24 hours for sperm to fertilize an egg and longer for the egg to move to the uterus. According to the makers of Plan B and EC pharmacists, it will do one of three things to your body:

• 1. Temporarily stop the release of an egg from the ovary (ovulation).
• 2. Prevent fertilization of the egg.
• 3. Prevent a fertilized egg from attaching to the uterus (by making the uterus inhospitable).

Plan B isn’t an abortion pill says the Canadian Pharmacist Association. It won’t work if you already have a confirmed pregnancy - that is, the fertilized egg has attached to the wall of your uterus. If you are pregnant and you take Plan B, there is no evidence that the EC will harm the developing embryo.

Where can I Get it?

After years of lobbying, the government recently responded to calls to make Plan B more accessible to women. As of April 19, 2005, you can buy Plan B without a prescription in pharmacies across Canada. That means that even on weekends, holidays or evenings – you can get your hands on Plan B (this used to be the case in only Saskatchewan, BC and Quebec). You don’t have to take time off from school or work to go a doctor’s office or an emergency room. You can still get Plan B at emergency rooms, sexual health clinics, women’s clinics, university clinics or other health centers. You won’t need a medical exam before getting Plan B.

Plan B is a behind-the-counter product now, so you’ll have to ask the pharmacist for it. They will have a short discussion with you to make sure Plan B is right for you. Before you ask to speak to the pharmacist remember you have the right to privacy. The Canadian Pharmacists Association has laid out guidelines for pharmacists in their new role of distributing Plan B and one of those is “pharmacists should respect patient autonomy, confidentiality and privacy when dealing with requests for emergency contraception.”

Ask whoever’s at the counter to speak to the pharmacist – you don’t have to tell them why. When the pharmacist comes – ask to speak to them privately and then tell them you think you might need Plan B. It’s not a bad idea to call in advance to make sure your pharmacy has Plan B. Most provinces and territories have a policy that gives the pharmacist the right to refuse to dispense medication for moral reasons. However, it’s expected as a “standard of care”, that pharmacists refer the woman to another pharmacists or physician who WILL give her Plan B.

Who Can Get Plan B?

Plan B is safe for most women. The Plan B manufacturer’s site says: “There are few side effects and no evidence of any long-term impact on your health or future fertility.” Women with serious medical conditions or women who take other medications should let their pharmacist know about these things. Women with some serious medical conditions may be unable to take Plan B.

Will you be able to buy the EC pill without your parent’s consent? The answer is yes. “EC can be made available to a minor (as determined by provincial law) without the consent of their parents or legal guardians, if, in the opinion of the pharmacist, they are able to comprehend the information being presented to them,” says the Canadian Pharmasict Association guidelines.

Can I buy Plan B before I need it? Yep. There’s always a chance contraception might fail. Be ready and have Plan B as an emergency backup plan if you need it.

Can someone else pick up Plan B for me? Yes, but only under very rare circumstances. Call your pharmacist to discuss this with him or her. Some pharmacists may not be willing to do this.

Can the pharmacy deliver Plan B? “Usually the pharmacy will want to counsel you and talk to you before giving you Plan B, so it’s best if you visit the pharmacy to talk to the pharmacists. Your visit will be confidential and will only take 5 or 10 minutes. If there’s a reason you can’t make it to the pharmacy call and discuss the situation with your pharmacist,” says the Plan B site.

What should I expect from the pharmacist?

Once you’ve asked to speak to the pharmacist and they’ve taken you to a private or semi-private area for a consultation (most, but not all pharmacies have a place like this where you can talk) you’ll be asked a few questions. Pharmacists have been trained to distribute EC. Again, the CPA has laid out guidelines for pharmacists and provided suggested screening questions for pharmacists to ask you during an EC consultation. These questions are suggestions, not standard practices (because laws governing pharmacists vary from province to province) – but to get an idea of what you might be asked – you can check out the CPA suggested screening form and Pharmacy Prep Kit here. The questions help the pharmacists figure out if a) you need Plan B and b) if Plan B is a safe choice for you. Pharmacists need to know if you’re taking other medicine that might effect how Plan B works or if you have health conditions or allergies. They’ll also give you advice on how to restart your regular birth control, after you take Plan B.

You should be treated sympathetically and confidentially. If you are uncomfortable with how a pharmacist is treating you, remember that you have the right to visit another pharmacist for EC.

How much will it cost?

Plan B will cost about $26. There will also be a counseling/professional fee charged by the pharmacy – that’s usually about another $20. These costs will vary a bit from store to store and from province to province. Remember, Plan B is covered under most, but not all, public and private insurance plans in Canada – check with yours. If you’ll have trouble paying, see a family planning clinic or an emergency room where the fees will be less. Some places provide it for free, others at a reduced rate and some ask for a $5 donation, said the doctors Street Cents spoke with.

You’ll get a pack with two pills. Take one pill immediately (within 72 hours of unprotected sex.) Take the second pill 12 hours later.

EC is very safe and has been around in Canada for over 30 years. Almost all women can safely use EC pills. There’s no evidence that Plan B has any long-term effects on a woman’s fertility. Most women won’t experience any major side effects from taking Plan B, and can carry on with their normal routines. Some women (23%) report nausea (feeling sick to your stomach), 6% report vomiting, 18% cramps, 17% fatigue and 17% headaches. Some women also report breast tenderness, dizziness, and diarrhea. Call your doctor if you have extreme nausea, migraines, itching all over your body, cramping or severe pain in your stomach or belly prior to your next period.

Important info that you need to know

You can take an anti-nausea medicine (like Gravol) about a half hour before you take a dose of Plan B. It’ll help reduce any nausea or vomiting.

If you vomit within one hour of taking EC, you'll need to retake the dose because you might not have absorbed the medication in that pill. Take an anti-nausea medication (like Gravol) right away. Wait half an hour for it to kick in and then take the second pill in the Plan B pack. Then go back to your pharmacist for another Plan B package so that you can take your second pill as scheduled – 12 hours later. Remember to take an anti-nausea medication a half hour before taking that pill too.

The only way of knowing Plan B has worked is when you get your next period. Your next period may start a few days earlier or later than usual. If your period is later than one week, pregnancy should be considered. See your doctor or a health care professional.

There are some medications that may interact with Plan B and reduce its effectiveness. You should tell your pharmacist or doctor if you’re taking any other medicine or herbal remedies.

If you have headaches, breast pain or cramps - you can use a pain reliever. Ask you pharmacist for advice about these medications.

Plan B does not protect against STIs and HIV/AIDS. If you’ve had unprotected sex or a contraceptive has failed, you should think about the risk of STIs and STDs. Health Canada says teens should “use a condom when having sex to prevent STI transmission.”

To restart your birth control pill after taking Plan B, or to go on birth control for the first time after taking Plan B, ask your pharmacist for specific instructions. These may be different depending where you are in your birth control cycle.

Plan B does not provide long-term protection from future pregnancy.

Plan B shouldn’t be used as a regular birth control and is not a replacement for your regular birth control. Plan B is not as effective as other methods of birth control and can have some side effects that are unpleasant. It’s called emergency contraception for a reason! If you don’t have a regular form of birth control, check out our Question of the Week to learn about what birth control options are available. That said, there’s no reason why you can’t use Plan B more than once. “Don’t be afraid to use Plan B when you need to, but remember it shouldn't replace long-term methods of birth control," says Dr. Plaxton, of Dalhousie University Health Services.

Does EC use cause an abortion?

No. The Canadian Pharmacist’s Association says: “no – EC pills can only prevent a pregnancy. If a woman is already pregnant and uses ECPs, they will have no effect on the pregnancy.” The CPA goes on to explain that “women don’t get pregnant right after they have unprotected sex. There may still be time in the first 72 hours to prevent or delay ovulation (the release of the egg from the ovary), to prevent the sperm from reaching the egg or to interfere with the fertilization process. Pregnancy is defined as beginning with the implantation of a fertilized egg in the lining of a woman’s uterus. This occurs five to seven days after fertilization. EC pills work before implantation and do not displace an implanted embryo. Thus they can’t terminate an established pregnancy or cause an abortion.”

Some people do have moral, religious or ethical concerns over using Plan B. “If you're uncertain about taking Plan B, first speak to your doctor or talk to a professional who shares your background and beliefs,” say the manufacturers of Plan B on their site.

Anti-abortion activists oppose the sale of Plan B in Canada, describing it as an “abortifacient,” but the Society of Obstetricians and Gynecologists in Canada say that “EC is not an abortifacient and has no affect if pregnancy has been established.” RU-486, the so-called abortion pill (which makes a medical abortion possible as soon as a woman confirms she’s pregnant) is not available in Canada.

What else do you need to know?

Double check! If you’re doing your own research on emergency contraception be careful with the sites you use. For example, Seventeen magazine reported that www.morningafterpill.org seems official but it is really sponsored by a “radical anti-abortion group.” Check out the side bar for more links to helpful sites and make sure you play safe!