SEASONALE BIRTH CONTROL BLOG

Blog it: and I wasted all that birth control

April 30, 2007

With partial-birth abortions in the news again, thanks to a recent Supreme Court decision, there’s a blog that people on both sides of the issue should check out: “… and I wasted all that birth control”

It’s written by Cecily, a 38-year-old mother of one, on “parenting after infertility, preeclampsia and loss, sobriety, being fat, politics and more.”

And relevant to the recent Court decision to uphold a ban on a certain type of late-term abortion:

“We spent four years trying to get pregnant (male factor being the major issue). We finally got pregnant on our first IVF cycle in 2004, after much ado, only to lose our twins boys (and nearly me) at 22 weeks gestation to severe preeclampsia. We did a medical termination of that pregnancy (one twin had already passed away), making me the poster girl for “partial birth abortion’ (apparently my health was too fragile to induce labor at that point).”

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In the last week or so, Cecily has written several passionate posts on what happened to her and how it’s relevant to the recent Court decision. Posts have garnered hundreds of responses.

There’s lots of other great stuff here too: parenting, searching for a job, dealing with a flood, etc.

Ultimately, if you’re engaged in the current debate on abortion, this site is worth a look.

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New birth control pill Lybrel eliminates period altogether

April 26, 2007

For many women, being able to eliminate their monthly period would seem like a dream come true.

Thanks to a new birth control pill called Lybrel, this dream may become a reality.

Next month, the Food and Drug Administration is expected to approve Lybrel, the first contraceptive pill designed to eliminate periods as long as the woman takes it.

“I think as long as this new pill is competitively priced, women will probably like it. Women that I’ve talked to who use Seasonale seem to like having only four periods of year so I think as long as it is kept affordable, I think women will like Lybrel as well,” Jim Almeda, health educator said.

While some women may welcome not having a period, others may find this to be a topic of concern.

“I think there are a substantial amount of women that would like not having a period. However, there are others that would probably have concern. It may not seem natural to them,” Dr. Jean Swearingen, assistant medical director at Student Health Services, said.

According to some researchers, some women view their periods as fundamental signs of fertility and health. These women carry on a complex love-hate relationship with them.

Studies have found no extra health risks associated with pills that stop menstruation, although some doctors caution that little research has been done on long term effects.

“Because there really hasn’t been enough research on this, we don’t know all the side effects, risks and long term effects of these types of pills,” Swearingen said.

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While eliminating menstruation may seem like a completely new concept, this is actually not true. Women who take any kind of oral contraceptive do not have real periods.

Because the hormones in pills stop the monthly release of an egg and the buildup of the uterine lining, there is no need for the lining to shed, as it occurs in real menstruation.

However, typical oral contraceptives are designed to mimic the natural 28 day menstrual cycle to assure women using the pill that their bodies were functioning normally.

Birth control pills are generally packaged as regimes of 21 days of hormone pills and 7 days of inactive pills. During the inactive part of the regimen, bleeding that resembles a mild period occurs. This is caused by unstable hormone levels.

Although there are benefits to not having a period, one student is unsure about the concept.

“It would make me feel uneasy. I guess I could go a few months without having a period, but it just seems wrong. I don’t understand how you would know if you were actually pregnant or not,” Dana Sponholz, sophomore family and consumer sciences major, said.

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Would you take this pill?

April 24, 2007

St. Petersburg, Florida – For many women, it seems almost too good to be true: a pill that stops menstrual periods and the cramps, bloating and moodiness that come along with them.

The Food and Drug Administration may approve Lybrel next month, but the ultimate test will be whether women jump on the no-period bandwagon.

“I just feel like we have our period for a reason, and to take it away, I wouldn’t want that,” said 20-year old Lindsey Ahles as she wrapped up an appointment at her St. Petersburg gynecologist’s office Monday.

“You might not be able to have kids later in life, and obviously, I’m young and might want that!” she added.

Dr. Jennifer Gilby of Absolute Health and Wellness in St. Petersburg says that’s a common misconception. In most cases, she says, women who don’t menstruate can still have children.

“Some women have an old wives tale in their head that it’s the cleansing and if you don’t get the period out, it’s going to be stored and there’s going to be this back up,” she says, “and it doesn’t.”

Dr. Gilby says Lybrel might well offer women a choice they didn’t have before: take a pill to end periods.

“I think it’s a mixed picture. I do think there’s a good majority of women that do not want a period,” she says.

Dr. Gilby expects Lybrel will catch on with young, active women; for instance, competitive swimmers or athletes who are training for marathons. Also, she says, women who experience extreme cramping or sick stomach during their periods might be inclined to give the drug a try.

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Lybrel’s makers say the drug is intended for a modern woman, a woman who doesn’t have kids until later in life, has fewer kids, doesn’t breastfeed and doesn’t have time for monthly periods.

But avoiding periods is nothing new.

Depo-Provera, a shot patients take every 3 months to stop periods, has been around since the 60’s. By the 90’s, more than 30 million women had used the drug in more than 90 countries. The FDA approved its use in the U.S. in 1992.

There’s also what doctors refer to as ‘continuous birth control’ where patients take the first 3 weeks of oral contraceptives in their monthly pack, throw away the dummy pills and start a new month.

Also, drugs like Seasonale and Seasonique offer seasonal birth control. Patients take a pill a day and experience periods just 4 times a year.

There are also implantable devices that stop periods and can last up to 5 years.

The idea of eliminating periods raises red flags for some groups, including the Red Web Foundation, which aims to educate about menstrual health.

Executive Director Anna Yang says not enough research has been done on the long-term effects of stopping the menstrual cycle.

Menstruation brings wisdom, she adds, and doesn’t get the reverence its due in our fast-paced society.

As always, it’s best to check with your doctor before making any decisions about birth control.

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A Federal Court of Appeals Gets it Wrong on Birth Control: Why Contraceptive Exclusions in Health Coverage Discriminate Against Women

April 18, 2007

Last month, the U.S. Court of Appeals for the Eighth Circuit decided In re Union Pacific Railroad Employment Practices Litigation, an important case about sex discrimination and birth control. The court held that employers may lawfully exclude contraceptive coverage from the health insurance that they provide to their employees. According to the court, such an exclusion does not violate Title VII of the Civil Rights Act (Title VII), as amended by the Pregnancy Discrimination Act (PDA).

Union Pacific represents the first ruling on the contraception question from a federal court of appeals, and it explicitly rejects the Equal Employment Opportunity Commission (EEOC) position on the matter. It also happens to be wrongly decided.

Title VII and the Pregnancy Discrimination Act

In General Electric v. Gilbert, the U.S. Supreme Court held that employers could lawfully exclude pregnancy from coverage under their short-term disability plans for employees. Pregnancy discrimination, accordingly, would not count as sex discrimination under federal law.

In response to this ruling, Congress enacted the Pregnancy Discrimination Act, which explicitly prohibits employers from discriminating against women for pregnancy, childbirth, and related conditions. The relevant language states:

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[W]omen affected by pregnancy, childbirth, or related medical conditions shall be treated the same for all employment-related purposes, including receipt of benefits under fringe benefit programs, as other persons not so affected but similar in their ability or inability to work.

Congress intended this legislation to reverse the earlier conclusion of the U.S. Supreme Court that discrimination on the basis of pregnancy is not sex discrimination. Critics of Gilbert were relieved that Congress was - only two years after the decision had come down - prepared to acknowledge officially that pregnancy is an exclusively female biological experience that has numerous and profound consequences. By explicitly referring to fringe benefits programs, moreover, Congress made plain that the employer’s actions in Gilbert - its placement of pregnancy-related disability outside the scope of otherwise available disability protection - would no longer be tolerated.

In addition to prohibiting discrete employment practices, the PDA introduced into employment law a significantly new way of thinking about sex discrimination. It provided that men would no longer represent the standard human being, from which deviations (like pregnancy) could be handled in whatever manner an employer saw fit. A woman could experience uniquely female biological events and still demand that her employer treat her as well as it treats her male counterparts. This development enabled women to embrace their own reproductive lives - distinct as they are from those of men - without apology and without retribution.

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PMS: Oh It’s Real!

April 17, 2007

When I was growing up, I remember being in a bad mood and some stupid boy saying, “Oh, you must be on the rag!” That really pissed me off. Just because I’m not happy does not necessarily mean I have or am getting my period!!

Although the truth is, right before my period, I really do feel crappy and not myself. It’s not just a dumb joke between guys - it’s completely REAL, but why does it happen?

Premenstrual Syndrome (PMS) happens because your body goes through a series of hormonal changes in the 2 weeks leading up to your period. The female hormone estrogen starts to rise after menstruation and peaks around mid-cycle (ovulation). It then rapidly drops only to slowly rise and then fall again in the time before you finally get your period. These crazy changes can trigger disruptive symptoms that affect you both emotionally and physically.

PMS affects women differently, and its effects can also vary from month to month. For most women, symptoms include mood swings (1 minute you’re happy, 1 minute you’re mad), uncontrollable crying, feeling depressed or anxious, and feeling “out-of-control.”

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Want to know what else PMS causes? Then

You can also experience headaches or migraines, dizziness, abdominal pains, backache, constipation, fluid retention (that’s my fave right there), acne, breast tenderness, weight gain, heart palpitations, painful joints, cravings for certain foods like chocolate, or fatigue. Fun stuff.

The severity of your symptoms may be hereditary, and some women experience symptoms that disrupt their ability to function. If you’re concerned about your symptoms, keep a calendar and write down how you feel each day. This way, when you see your gynecologist, your doctor may have some ideas for treatments.

Fit’s Tips: Going on the Pill may help to regulate your hormone levels, and because you’re not ovulating, your symptoms may become greatly alleviated. Monophasic birth control, like the Nuvaring or Seasonale may be a better option since they deliver an equal amount of hormones to you each day.

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Report Shows Popular Birth Control Pill, ORTHO TRI-CYCLEN(R) LO, Not Associated With Increased Pregnancy Risk in Heavier Women

April 12, 2007

WASHINGTON, May 9 /PRNewswire/ — The popular birth control pill, ORTHO TRI-CYCLEN(R) LO (norgestimate/ethinyl estradiol) Tablets, is not associated with an increased risk of pregnancy in heavier women, according to findings(1) presented today at the 54th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists (ACOG).

Previous research suggested that higher weight or body mass index (BMI) may compromise the efficacy of birth control pills leading to a greater number of unintended pregnancies.(2,3) This analysis evaluates the risk of pregnancy in heavier women using ORTHO TRI-CYCLEN LO.

“A significant number of women with a wide range of weights and BMIs were included in this analysis, creating a rich source of data to evaluate the association between body weight and efficacy,” said Dr. Katherine LaGuardia, director, medical affairs, Ortho Women’s Health & Urology. “These results reinforce ORTHO TRI-CYCLEN LO as an effective birth control option for women in a broad range of body weights.”

Study Details

The report is based on a retrospective analysis of ORTHO TRI-CYCLEN LO Phase III efficacy data to determine the association of pregnancies with body weight and BMI, a standard measure of weight-for-height. The data were from 1,673 ORTHO TRI-CYCLEN LO users, weighing from 90 to 240 pounds, for 11,003 use cycles.

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Investigators found that a total of 20 pregnancies occurred - 14 likely due to “method failure” (eg, the Pill did not work) and six due to failure on the part of the individual (eg, forgetting to take the Pill). This translated into a total pregnancy probability of 1.9 percent and a probability of failure of the Pill of 1.5 percent.

The probability of total and method-failure pregnancies was the same across different body weights. ORTHO TRI-CYCLEN LO users weighing 155 lbs. or more (n=435) did not experience significantly higher pregnancy risk than those less than 155 lbs. with either method-failure pregnancies (relative risk 1.03, p=0.95) or total pregnancies (relative risk 1.42, p=0.46). The results were the same when other weight criteria (median weight of 139 lbs. and over vs. less than 139 lbs., over 175 lbs. vs. less than or equal to 175 lbs., and 198 lbs. and over vs. less than 198 lbs.) and BMI criteria (25 and over vs. less than 25) were applied. The study was conducted and funded by Ortho Women’s Health & Urology, a division of Ortho-McNeil Pharmaceutical, Inc.

About ORTHO TRI-CYCLEN(R) LO (norgestimate/ethinyl estradiol)

ORTHO TRI-CYCLEN LO is indicated for the prevention of pregnancy in women who elect to use oral contraceptives as their method of contraception.

Important Safety Information

Serious as well as minor side effects have been reported with the use of oral contraceptives. Serious risks include blood clots, stroke and heart attacks. Cigarette smoking increases the risk of serious cardiovascular side effects, especially in women over 35. Women who use oral contraceptives are strongly advised not to smoke. The Pill does not protect against HIV or sexually transmitted diseases.

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‘The pill’: Long-lived standard

April 10, 2007

Forty-seven years after the FDA approved the first oral contraceptive, “the pill” remains the most popular form of reversible birth control in the United States.

“No. 1 on the hit parade was, and continues to be, the birth control pill,” says Dr. David Butler, an OB/GYN at Englewood and Holy Name hospitals.

But the options are many.

Here’s an overview of the most popular and newest reversible birth-control methods, according to several local practitioners.

Hormonal methods

The pill

What it is: The common name for oral contraception — formulations of synthetic hormones that simulate those made by a woman’s ovaries. There are more than 40 brand names, but two basic types: combination pills, containing estrogen and progestin, and progestin-only pills.
How effective are they?

* Effectiveness of birth control methods (if they are used consistently and correctly)
* Birth control pill: 99-plus percent
* Injection: 99-plus percent
* Contraceptive patch: 99-plus percent
* Vaginal ring: 99-plus percent
* IUD: 99 percent
* Male condom: 98 percent
* Female condom: 95 percent
* Diaphragm: 94 percent (cervical cap, 91 percent)
* Contraceptive sponge: 91 percent
* Spermacides: 85 percent

Source: Planned Parenthood’s “Sex Ed 101 Manual”

Some of the newer formulations are:

Seasonale and Seasonique: Both regimens result in a woman having just four periods a year. Seasonique, the next-generation version of Seasonale, was approved last May and became available in July.

Loestrin 24 Fe: This regimen of 24 “active” white pills (instead of the typical 21) plus four brown “reminder” tablets that are iron supplements, typically results in lighter periods of three days or less. “This kind of helps you in a perimeno-pausal transition,” says Dr. Elizabeth Boyle, a Clifton gynecologist.

YAZ: This contains 24 active combination-hormone pills and four placebos. Its maker, Berlex, says it offers shorter, lighter periods, a more regular cycle and even reduces cramps. It is also FDA-approved to reduce premenstrual symptoms.

On the horizon:

Lybrel: A low-dose-combination-hormone pill that a woman would take daily, 365 days a year (with no placebo or pill-free phase). Its maker, Wyeth, says Lybrel should even out women’s monthly hormone fluctuations. For some women, it also could eventually eliminate periods altogether. Awaiting FDA approval.

Safety of the pill

Not for smokers: “You really do not give oral contraception to people who are over 35 years old and smoke, because of the increased risk for blood clots and other complications,” says Dr. Jill Satorie, an OB-GYN and attending physician at Hackensack University Medical Center.

Newest controversy: Recently, the advocacy group Public Citizen filed a petition with the Food and Drug Administration that seeks to stop the sale of newer (”third-generation”) oral contraceptives that contain a type of progestin called desogestrel, which the group says can double the risk of blood clots. (Labels of birth-control pills containing desogestrel already list that increased risk in fine-print.)

“While the use of any type of combined oral contraceptive holds an increased risk of venous thrombosis, third-generation birth control pills double that risk without preventing pregnancy any more effectively than older pills do,” Dr. Sidney Wolfe, director of Public Citizen’s Health Research Group, told The Record. “If [a woman] can take the pill that is half the risk, she should take it.”

Bottom line, Boyle says: “I think all birth control pills are safe when you weigh the benefits vs. risks.”

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The Ring (Nuva Ring)

What it is: Small flexible ring that releases synthetic estrogen and progestin. Placed in the vagina once a month, it is left in for three weeks. The fourth week, the woman takes it out.

Plus: “It’s a nice option, not having to think about your contraception except for once a month,” Satorie says.

Says Boyle: “That’s the lowest amount of hormone on the market, and what’s nice is that it bypasses your digestive tract. It’s only absorbed through the vagina to inhibit ovulation.” She cites two age groups this method might benefit. “The person who really isn’t ovulating that much anymore, like the over 40, and the person who can’t remember to take a pill — like a teenager.”

Minus: “Not everyone is comfortable with having to … put it in and pull it out,” Satorie says.

The Patch (Ortho Evra)

What it is: Thin plastic patch, which releases synthetic estrogen and progestin, that sticks to the skin of the buttocks, stomach, upper outer arm or upper torso. Once a week for three weeks, a new patch gets placed. No patch is used the fourth week.

The controversy: “We got a letter from Ortho that the patch had a steady-state estrogen level that was much higher than even the old pills that we don’t write [prescriptions] for anymore, so it increases your risk of blood clots dramatically,” Boyle says.

The Shot

What it is: This progestin-only injection (Depo-Provera) can prevent pregnancy for 12 weeks at a time.

Plus: “The obvious big advantage is you don’t have to worry about your contraceptive coverage for three months,” says Jeffrey Brand, president and CEO of Planned Parenthood of Greater Northern New Jersey. “For many women, that’s a very powerful convenience.”

Minus: Women have to get the shot from a clinician every three months. And while Planned Parenthood facilities can provide the shot “on the spot,” Brand says, in many practices, the doctor writes a prescription, which the woman has to take to the pharmacy to get filled, before going back to the doctor’s office for the injection.

On the horizon

Implanon: Thin, flexible, matchstick-sized implant containing progestin that is inserted under the skin of the upper arm. Though results of long-term studies will not be available for some time, researchers estimate that Implanon will be up to 99.9 percent effective for up to three years. (Implanon is similar in concept to the controversial six-rod Norplant system, which Wyeth stopped marketing in the United States in 2002.)

Status: Not yet widely available in the United States. “It’s been approved, but it’s not quite out there yet,” Satorie says.

Other methods

IUDS

What they are: Far more popular in Europe than in the United States, these small, T-shaped intrauterine devices are inserted by a clinician and prevent sperm from joining with an egg. In the United States, they are available in two types, one with a hormone, one without.

ParaGard (Copper T 380A): Plastic wound with copper, this can be left in place for 10 years.

“It’s really intended for someone who’s had a baby already, because the uterus would be a little bit larger for placement,” says Boyle. It’s a good option if someone can’t take a hormone, but this is a foreign object that’s placed in the uterus and it does give a heavier, crampier bleed.”

Mirena: Billed as an IUC (intrauterine contraceptive), this continuously releases a small amount of progestin and is effective for five years.

“This works both hormonally and as an intra-uterine device, and this often quells heavy bleeding,” says Butler.

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Birth Control Debate At An Impasse

April 5, 2007

The Bush administration is putting pressure on California to stop illegal immigrants from participating in a program that offers free birth control.

The Bush administration is pressuring California leaders to require that poor women prove they are legal residents or citizens before they receive free birth control. It currently costs the state a little over $300 million dollars a year to provide the service, most of which the federal government reimburses.

Stan Rosenstein, CA Dept. of Medical Care Services: “They want us to ask for passports or birth certificates before we provide family planning services to people.”

The state says the requirement would scare away some of the estimated 14-percent in the program who are illegal immigrants.

Planned Parenthood believes legal citizens would also stop using the program because it’s not that easy or fast to get a birth certificate or passport.

Yali Bair, Planned Parenthood: “We know that a significant portion of those patients either can’t or won’t go through that process. It’s a lot easier to do nothing than it is to go through a lot of steps in order to access preventive services.”

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States that have already complied with the citizenship requirement have seen an estimated 20 to 30-percent drop in enrollment. California leaders have been trying for nearly three years to be permanently excluded, but negotiations are at an impasse.

The temporary waiver is set to expire at the end of this month, worrying these young mothers.

Marta Ramos, Teen Mother: “I’m 16. I have a baby. I don’t want to have more kids. Everybody needs birth control, especially teens. Papers shouldn’t make a difference.”

A University of California San Francisco study found the 10-year-old program prevented more than 200,000 unintended pregnancies a year, saving two billion dollars in taxpayer money that would have been spent on medical care and social services.

Federal health officials did not answer our repeated calls today for comment.

Another interesting side note — state health officials estimate the administrative costs of confirming the legal status of patients is twice as much as the cost of simply examining them and giving them birth control.

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Advancements in birth control give women more options

April 3, 2007

Several FDA approvals during the past few months are providing more birth control options for women and offering protection against viruses that can cause cervical cancer and genital warts.

Two of the approvals involve oral contraceptives, while a third is for the HPV (human papillomavirus) vaccine Gardasil.

Approved by the federal Food and Drug Administration on May 25, Seasonique is an oral contraceptive that reduces the number of menstrual periods from 13 each year to four and reduces the risk of problems such as breakthrough bleeding with its low-dose estrogen in place of the placebos that are common in other types of oral contraceptives. With Seasonique, patients take active tablets containing the progestin levonorgestrel (.15 mg) and the estrogen ethinyl estradiol (.03mg) for 84 consecutive days, followed by seven days of .01 mg of ethinyl estradiol.

The majority of oral contraceptives are based on a 21-day regimen of active pills followed by seven days of placebos.

Seasonique manufacturer Barr Laboratories Inc. in Woodcliff Lake, Bergen County, follows in the mold of its predecessor, Seasonale, an extended-regimen oral contraceptive which gained FDA approval in September 2003. Although Seasonale also allows only four menstrual cycles per year, its 84 active tablets are followed by seven days of inactive tablets.

Even before the introduction of Seasonique and Seasonale, women who wanted the convenience of delaying periods would do so by taking all of the active pills in their 28-day prescriptions, said Dr. Christina Chao of PennCare-Pine-lands OB/GYN Associates in Medford and Mount Holly.

The active pills prevent a wo-man’s body from building up the lining of the uterus, eliminating the need for the lining to shed, therefore no period results. With the conventional 28-day regimen, periods occur while taking the placebo tablets, and with Seasonique, while taking the final seven pills.

“In regular birth control pills, a lot of people take the whole pack of regular pills and not take the placebo,” said Chao.

Although the method works, patients might find Seasonique is a better choice for several reasons.

“If your prescription plan pays for a monthly pill, then you are short,” she said.

In addition, she said, “Having that estrogen all the time will prevent PMS (including mood swings), migraines (and menstrual headaches) and will decrease breakthrough bleeding (bleeding between periods).”

It also helps prevent painful periods (cramps) and endometriosis (tissue which lines the uterus found growing outside the uterus), said Chao.

Even with Seasonale, more breakthrough bleeding may occur during the first month of use, said Chao.

She said two new 24-day, active pill regimens include YAZ and Loestrin 24 Fe, which averages periods of less than three days. YAZ and Loestrin 24 Fe also contain “very low-dose estrogen” and because “you’re only off the (active) pill four days,” less breakthrough bleeding occurs, said Chao.

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Serious risks associated with using oral contraceptives include blood clots, stroke and heart attack. Smokers, especially those over age 35, also face increased risks of cardiovascular problems, according to Dr. Robert Siefring, a member of the OB/GYN staff at Cooper University Hospital in Camden. The hormones in the contraceptives also can stimulate growth of uterine fibroid tumors in women who have them, he said. In addition, women who have undiagnosed genital bleeding or who have breast cancer should not take oral contraceptives, said Siefring.

Siefring, who said he does not typically prescribe the extended-regimen contraceptives, “especially the Seasonale, which has more breakthrough bleeding,” acknowledged that convenience makes them attractive options.

Another factor to consider is the cost of contraceptive pills, which “is approaching $50 per month,” he said.

“I’m putting in more progestin IUDs — they’re good for five years,” said Siefring, and their cost $300, breaks down to $60 per year.

“They are very effective and eliminate the problem of the patient forgetting to take the pill or losing the pill,” he said.

Another product, which had been available as a prescription since 1999, earned FDA approval on Aug. 24 for over-the-counter use for women 18 and older. (Prescriptions are still required for patients 17 and younger.) Plan B (by Duramed Pharmaceuticals of Cincinnati, a subsidiary of Barr Pharmaceuticals), also known as emergency contraception or “morning after” pills, consists of two tablets containing the progestin levonorgestrel, a synthetic hormone which must be taken within 72 hours of having unprotected sex.

According to information on the FDA Web site, Plan B works to prevent pregnancy by stopping the release of an egg from the ovary. It also may prevent fertilization of the egg, or prevent a fertilized egg from attaching to the womb. Plan B will not work if a fertilized egg has been implanted prior to taking the emergency pills.

“It’s not as effective as birth control,” said Chao, but, “if they do get pregnant anyhow, there’s no effect to the fetus.”

“Plan B has been a tremendous addition to our ability to treat a patient,” said Siefring. “We’ve had post-coital contraception before. It was a combination of pills, but the problem with that was that we’d have to call in scripts and it typically was associated with a lot of nausea and vomiting. You would take a significant amount of hormones,” he said.

“With Plan B, a protestin-only treatment, it doesn’t contain the estrogen. You still get some nausea, headache, abdominal pain and breast tenderness,” said Siefring.

Chao added that irregular bleeding may occur a week after taking the pills.

Yet, the over-the-counter availability of Plan B creates “less anxiety for the patient,” who may be embarrassed about calling a physician in the middle of the night to explain why she needs the emergency contraception, said Siefring.

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