Morning After Pill

So, you had unprotected sex, and thoughts are racing through your head . . .

What if I’m pregnant? What if he has an STD and gave it to me? What if . . . ?

The “what if” questions can be scary

You’ve probably heard about the morning-after pill. Some call it “emergency contraception.” Now you need more information, and soon , because one of your “what ifs”—pregnancy—is a real possibility.

What is the morning-after pill?

The morning-after pill isn’t a single drug. There are two drugs that are used as emergency contraception:

1. Plan B One-Step ®

  • It’s a drug intended to be taken as soon as possible within the first 72 hours after unprotected sex or contraceptive failure (for instance, if a condom tears) to prevent pregnancy.
  • It contains a high dose of a progesterone (levonorgestrel) that is found in many kinds of birth control pills.
  • At the dosage found in Plan B One-Step, levonorgestrel may work on rare occasion to prevent an embryo from implanting in the uterus (see below). 1
  • It is often referred to by the brand name that started it all—Plan B ® .
  • It’s also available in generic forms.

2. ella ®

  • This drug is supposed to be taken as soon as possible within 5 days of unprotected sex or contraceptive failure.
  • ella is the trade name of the drug ulipristal acetate.
  • It is chemically related to mifepristone (RU-486), the “abortion pill,” and works by a similar mechanism of action. 2
You should know . . . It is not possible for a woman to get pregnant about 26 days a month. Many of the days when women take the morning-after pill, it is impossible to get pregnant anyway. This fact makes “effectiveness” statistics for emergency contraception look much better than they really are. 3
How do they work?

Depending on where you are in your menstrual cycle, morning-after pill drugs could affect you in one of several ways:

1. Plan B One-Step

  • It may prevent ovulation: The egg will not be released to meet the sperm—so fertilization, sometimes known as conception, can’t occur.
  • It may affect the lining of your fallopian tubes so that sperm cannot reach the egg. This also prevents fertilization.
  • It may irritate the lining of your uterus. If an egg has already been released and fertilized by the sperm, this irritation could make it harder for the embryo to implant in your uterus. 4

2. ella

  • It may prevent ovulation: The egg will not be released to meet the sperm—so fertilization can’t occur.
  • It also acts to block progesterone, a hormone produced by the ovaries which helps a woman’s body sustain a pregnancy. This reduces the chances that an embryo would successfully survive and grow in the uterus.
Are there side effects?

Yes.You may experience several short-term side effects when taking Plan B One-Step.

These include:

  • nausea and vomiting
  • irregular and unpredictable menstrual periods
  • cramping and abdominal pain—which might also be the sign of an “ectopic pregnancy” (see next question)
  • fatigue
  • headache
  • dizziness
  • breast tenderness 5

Possible side effects for ella include:

  • headache
  • nausea and vomiting
  • irregular bleeding or spotting
  • cramping and abdominal pain—which might also be the sign of an ectopic pregnancy (see next question)
  • fatigue
  • dizziness
You should know . . . ella can function as “emergency contraception” when taken up to 5 days after unprotected sex because it’s on about the 5th day after ovulation and fertilization of the egg that the new baby begins to implant in the lining of the womb—but can’t because the uterine lining function is disabled by ella. The hormone progesterone is blocked by ella so the proteins needed to begin and maintain pregnancy are not produced. This is not a true contraceptive action (that is, it doesn’t prevent sperm and egg from joining in fertilization) but an abortifacient one. The same applies to Plan B if it prevents an embryo from implanting by irritating the lining of the uterus.
What is an ectopic pregnancy? And why does it matter?
  • This is a potentially life-threatening condition in which a fertilized egg implants outside of the uterus—most often in the fallopian tubes.
  • The morning-after pill won’t end an ectopic pregnancy.
  • If you have severe abdominal pain three to five weeks after using the morning-after pill, or if you miss your next menstrual period, you should see your health-care professional to rule out a pregnancy (either ectopic or within the uterus).
  • An embryo growing in a fallopian tube will require emergency care. 7
You should know . . . The cramping and abdominal pain that may result from the use of a morning-after pill can mask the symptoms of an ectopic pregnancy, which requires emergency care.
You should know . . . After the sperm penetrates and fertilizes the egg, 46 human chromosomes come together in a one-of-a-kind genetic design that determines a person’s eye and hair color, gender, skin tone, [ ] height and even the intricate swirl of the fingerprints.
You should know . . . The morning-after pill can’t guarantee that you won’t get pregnant, nor does it protect you from HIV/AIDS or other sexually-transmitted infections or diseases.
 
What happens if I use emergency contraception after fertilization?
  • The high dose of levonorgestrel found in Plan B One-Step may irritate the lining of your uterus. That irritation may keep the embryo inside you from implanting, ending its life.
  • With ella, the drug blocks progesterone, a hormone that helps your body maintain a pregnancy. While an embryo may have already been created, ella can keep it from implanting in your uterus and being sustained by your body, ending its life.
  • If either of these happens, an abortion will occur, because each human life begins as an embryo.8
So, how can I know if an egg has been fertilized?
  • That’s the problem—you can’t know.
  • TBut we do know that sperm can reach the fallopian tubes mere minutes after intercourse, and if an egg has already been released, fertilization could occur.
  • So, by the time you wake up on the “morning after,” a new human life may have already begun.
  • If that’s the case, using emergency contraception might cause a very early abortion.

Think carefully before you use emergency contraception, and make sure you understand the side effects and risks.

Do you know the difference? Sometimes, these pills get confused

Sources
End Notes:

  1. FDA Prescribing and Label Information for Plan B® One-Step;
    Rev July 2009;
  2. FDA Prescribing and Label Information for ella®;
    Rev March2015;
  3. ELLA, An Introduction. American Association of Pro-LifeObstetricians & Gynecologists;
  4. FDA Prescribing and Label Information for Plan B® One-Step;
    Rev July 2009; See endnote 1
  5. FDA Prescribing and Label Information for Plan B® One-Step;
    Rev July 2009; See endnote 1
  6. FDA Prescribing and Label Information for ella®; Rev March
    2015; See endnote 2
  7. FDA Prescribing and Label Information for Plan B® One-Step;
    Rev July 2009; See endnote 1
  8. Keith L. Moore and T.V.N Persaud, The Developing Human:
    Clinically Oriented Embryology, 6th Edition (Philadelphia, PA: Saunders, 1998), pp. 2-3.
  9. L. Speroff and M.A. Fritz, Clinical Gynecological Endocrinology
    and Infertility, 7th Edition (Baltimore, MD: Lippincott Williams& Wilkins, 2005), p. 235
 

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