Tag Archives: levonorgestrel

Morning-After Pill Still Strong

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June 20 marks the fifth anniversary of the U.S. Food and Drug Administration’s (FDA) approval of over-the-counter Plan B One-Step, a type of “morning-after pill” (itself a type of emergency contraception), without age restrictions. The first morning-after pill was approved by the FDA in 1998, but political backlash prevented easy access to it for more than a decade.

In 2011, the FDA was poised to approve over-the-counter access for Plan B for people 17 and older. The Department of Health and Human Services intervened, raising concerns that young girls might not be able to use the drug safely — even though studies have shown that Plan B is safer than taking an aspirin. The Obama administration, however, claimed that younger people still needed a prescription to ensure they understood the proper use of Plan B.

Access to Plan B gives teenagers another chance to avoid unwanted pregnancy.

The wrangling continued. In early April 2013, a federal district court judge dismissed that claim, stating that the Obama administration’s restrictions were a “politically-motivated effort to avoid riling religious groups and others opposed to making birth control available to girls.” On April 30, the FDA announced that the morning-after pill would be available without prescription to users 15 years of age and older.

The fight to expand over-the-counter access for the morning-after pill wasn’t over. Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research, stated that “over-the-counter access to emergency contraceptive products has the potential to further decrease the rate of unintended pregnancies in the United States.” It wasn’t until June 2013 — five short years ago this week — that the FDA approved Plan B One-Step for over-the-counter sale without age restrictions, after the Department of Justice dropped its appeal. In February 2014, certain generic morning-after pills were similarly approved.

Today, let’s celebrate this expanded access to the morning-after pill by reviewing what we need to know about this important form of contraception. Continue reading →

Do Birth Control Pills Cause Breast Cancer? The Latest Study

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Last month, you might have seen headlines warning you that hormonal birth control increases risk for breast cancer. This news came from a study that examined the medical records of nearly 1.8 million Danish women — and the huge sample size lent heft to the findings, several of which stood in stark contradiction to commonly held beliefs about modern hormonal contraception.

Some types of hormonal contraception could increase breast cancer risk, while others may not. But the Pill also reduces risk for endometrial and ovarian cancers.

Birth control comes in two “flavors” — hormonal and nonhormonal. Hormonal contraception is among the most effective, and includes birth control pills, hormonal IUDs, the shot, the vaginal ring, the implant, and the patch. Nonhormonal contraception ranges from very effective, including surgical sterilization and the copper IUD, to the not-quite-as-effective, including condoms, diaphragms, and withdrawal. (With the exception of condoms, birth control does not provide protection against STDs.)

Hormonal contraception is one of the greatest achievements in the history of medicine, and offers those wishing to control their fertility an array of effective options. However, as with all effective medications, there is potential for side effects. And, because many forms of hormonal birth control contain types of estrogen, and exposure to estrogen is a risk factor for breast cancer, many people wonder if hormonal birth control might increase users’ chances of developing breast cancer later in life.

Most birth control pills contain a combination of two hormones: estrogen and progestin (synthetic progesterone). Other hormonal methods, such as the ring and the patch, also use combinations of these two hormones.

There are also pills that don’t contain estrogen, called POPs, or progestin-only pills — aka the “minipill.” Additionally, hormonal IUDs, the implant, and the shot are progestin-only methods.

What Previous Studies Have Shown

The connection between hormonal contraception and breast cancer is murky, because the association is difficult to study properly. There are so many different types of hormonal contraceptives, each with different dosages, different chemical formulations, and different ways of entering the body. We can’t tease these differences apart on the one hand, but make blanket statements about hormonal contraception as a whole on the other hand. But we can look at the available evidence and see where it points. Continue reading →

No, the Morning-After Pill Is Not the Abortion Pill

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The other week, I was talking to a family member about the threats to contraception access in this country, “thanks” to our new president and his fanatical administration. He thought it was ridiculous that abortion opponents also fight tooth and nail to put obstacles in front of birth control — after all, reliable contraception prevents unintended pregnancies, which itself prevents untold abortions. It seems like a win-win for everyone, regardless of where their opinion on abortion falls.

The morning-after pill prevents pregnancy. The abortion pill ends pregnancy.

Then he said, “Of course, I understand them not wanting tax dollars going toward the morning-after pill, since that causes abortion.”

I had to stop him right there: “Nope.” A bit self-conscious of appearing to be a persnickety know-it-all, I summarized the vast differences between the morning-after pill and the abortion pill — differences that many people, even full supporters of reproductive rights, don’t understand. Opponents of abortion and contraception exploit this misunderstanding, pretending these two pills are one and the same, hoping to elicit “compromise” from “reasonable” people. Compromises that harm real people with real lives and real families. Just as women’s health opponents have been so successful at chipping away at abortion access, so too do they hope to erode access to contraception.

The morning-after pill and the abortion pill are completely different medications, used for different purposes and made up of different ingredients. Let’s look at a quick rundown of the two. Continue reading →

IUDs and Implants: It’s Not Too Late for LARCs

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Access to contraception is coming under attack, and reproductive-health advocates are scrambling to find ways to protect it. In December, Obama did what he could to protect Planned Parenthood from losing its ability to serve Medicaid patients. In New York, the state’s attorney general has moved to ensure that New Yorkers will continue to receive no-copay birth control as part of their insurance benefits, and Massachusetts moved to defend Medicaid patients’ right to use Planned Parenthood’s services in the event of federal interference. And, across the country, people at risk for unintended pregnancy are clamoring for highly effective, long-term birth control to see them through the next four tumultuous years.

IUDs and implants can help you and your uterus make it through the Trump administration.

Tom Price, who was confirmed as secretary of health and human services last month, represents the most immediate threat to our birth-control access. As HHS secretary, Price has the power to declare that contraception is not a “preventive” service insurers must make available to their customers with no copay. In one fell swoop, Price could undo the enormous progress the Obama administration made in expanding access not just to all forms of contraception, but to highly effective forms of contraception that had for so long been out of reach to so many.

Before the Affordable Care Act, long-acting reversible contraception (LARC) methods like IUDs and implants were known to be highly effective — not just cost-effective, but also simply the most effective in terms of preventing pregnancy. However, the high upfront costs closed the door to many potential users. Let’s do some quick-and-dirty math: A copper IUD could set you back anywhere from $500 to $932, but it lasts for 12 years. That means it costs $3.50 to $6.50 per month, compared to the Pill, which can cost $10 to $50 a month out of pocket. Clearly, the IUD makes the most financial sense, but for many of us, a medical bill charging upward of $500 doesn’t fit into our budgets. Better to rely on methods like the Pill, which cost more over time, but aren’t as hard on the wallet of someone living paycheck to paycheck or on an otherwise tight budget. Continue reading →

Let’s Talk Contraception: New Contraceptives and HIV Protection

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This ring, currently under development, can be inserted into the vagina to prevent both pregnancy and HIV transmission. Image: USAID

This ring, currently under development, might reduce risk for both pregnancy and HIV transmission. Image: USAID

The World Health Organization estimated that in 2012 there were 35.3 million people worldwide living with HIV. A whopping 69 percent of them live in sub-Saharan Africa. Save the Children reports that 2 out of 5 children born in developing countries are the result of unintended pregnancies.

Condoms remain the gold standard for protection against HIV transmission. But not all women are able to negotiate condom use. The same can be said for contraceptives. Health-care providers in some areas of the world are not even able to provide condoms consistently due to political or financial pressures.

An intravaginal ring under development might protect against pregnancy, HIV, and genital herpes.

But there are nonprofit groups researching and developing products to meet the needs of women in these countries. With the financial backing of the U.S. Agency for International Development (USAID), CONRAD, a nonprofit committed to improving reproductive health globally, is testing a new intravaginal ring that combines a hormonal contraceptive, levonorgestrel, and an HIV microbicide, tenofovir, in the same product. When inserted vaginally, it slowly dispenses both drugs to prevent pregnancy and HIV transmission. Continue reading →

Let’s Talk Contraception: Emergency Contraception

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The Centers for Disease Control and Prevention (CDC) recently reported that 1 in 9 American women — 11 percent — has used the “morning-after pill.” This means that in the United States, 5.8 million sexually active women between the ages of 15 and 44 have used emergency contraception, an increase in use of 4.2 percent from 2002. Most women say their reasons for using emergency contraception are because they engaged in unprotected sex or feared that their method of contraception failed.

The best way to prevent pregnancy is reliable birth control. But sometimes we need a back-up method.

It has also been reported that half of all pregnancies in the United States are unintended. For that reason, the availability of a range of contraceptive options is very important. Emergency contraception is the last choice for a woman to decrease her chance of becoming pregnant after unprotected sex. There are several products available for emergency contraception in the United States. There are many options, and they include:

  • regular birth control pills in specific doses
  • PlanB One-step
  • Next Choice
  • ella
  • copper IUD or intrauterine device (Paragard)

The Yuzpe regimen, which used ordinary birth control pills in specific combinations, was named after a Canadian physician who developed the method in the 1970s. Several brands of birth control pills are approved for this use to prevent pregnancy. This method uses the combined estrogen and progesterone hormones in your regular birth control pills in certain prescribed combinations.

Research showed the progesterone component of contraceptive pills was most effective at preventing pregnancy, so Plan B was developed as a two-pill regimen of levonorgestrel (a type of progesterone). When Plan B was first released, it consisted of one pill taken as soon as possible and another taken 12 hours later. Plan B One-Step, the newest version of Plan B, now has the same dosage of levonorgestrel in just one pill. It should be taken as soon as possible after unprotected sex. This one-dose regimen has been shown to be more effective with fewer side effects. Continue reading →