text:
- Is Plan B Really Less Effective If You're Overweight?
- More Weight, Less Efficacy
- The IUD Option
- How does Plan B work, again?
- So…does Plan B have a weight limit?
- Well, should you still take Plan B if you're over 165 pounds?
- Plan B
- If Your Partner Comes In You & You're Not On Birth Control, Here's What To Do
- My boyfriend cummed in me more then once within 48 hours but Ive taken Plan B within the 48??
- What is emergency contraception?
- EC may be used if:
- How does emergency contraception work?
- How do I use emergency contraception?
- How effective is emergency contraception?
- What are the benefits of emergency contraception?
- What are the downsides or health risks of emergency contraception?
- Where can I get emergency contraception?
- Important tips
- Personal Experiences
- Resources on EC:
- Related resources from UHS:
Is Plan B Really Less Effective If You're Overweight?
Photo: Megan Madden / Refinery29 for Getty Images
Plan B, aka the morning-after pill, is meant to be there for you in those "oh shoot" moments. Whether you're saying to yourself "oh shoot, the condom broke" or "oh shoot, I forgot to take my birth control," nobody's perfect. So it's always comforting to know that emergency contraception like Plan B is an option. However, there's a not-so-comforting detail about Plan B that isn't exactly common knowledge but totally should be: Apparently, research shows that the effectiveness of Plan B may depend on your weight.
ICYDK, researchers have been exploring the link between weight and Plan B for years, but the subject is making waves now thanks to a new show on Hulu called Shrill, starring comedian Aidy Bryant. (Related: Aidy Bryant Says Her Life Changed When She Stopped Trying to Lose Weight) In the first episode of the show, Bryant's character Annie takes Plan B after having unprotected sex with a guy. One missed period and a positive pregnancy test later, Annie realizes that her Plan B dose didn't work, and she returns to the pharmacy to demand answers. The pharmacist tells her that if she weighs more than 175 pounds, Plan B is less effective.
Cue a collective jaw-drop heard round the world.
If you're wondering "how?!" and "why?!" you're not alone. But to better explain, let's backtrack for a moment. What exactly is Plan B?According to the product's website, Plan B One-Step is a form of over-the-counter emergency contraception that's meant to be used as a "backup plan" to help prevent pregnancy. You take the pill within 72 hours (though the manufacturer instructions say the sooner, the better) of having unprotected sex or experiencing birth control failure, and that's it-you're (hopefully) protected from an unplanned pregnancy.
Plan B works the way it does because of a hormone called levonorgestrel, and that's where the possible connection to weight comes into play. (Related: The 4 Biggest Misconceptions About Plan B) A handful of studies have suggested that emergency contraception that contains high doses of levonorgestrel may not be as effective for women who fall under the category of obese on the BMI scale (a BMI of 30 or higher). One such study, published in the reproductive medicine journal Contraception back in 2015, collected data from two randomized trials that included more than 1,700 women who'd taken emergency contraception with levonorgestrel. The results showed that "women for whom levonorgestrel was not effective in preventing pregnancy had a significantly higher mean body weight and BMI than women who did not become pregnant." Translation: The higher a woman's body weight and BMI, the more likely it was that emergency contraception containing levonorgestrel would fail to prevent pregnancy. Contraception also published a review of four studies on the subject in 2016, and the researchers wrote that their findings seemed to suggest a correlation between obesity and an increased risk of pregnancy after taking emergency contraception with levonorgestrel, though they noted that they felt that their evidence was "limited" and "poor to fair quality."
Since the research on the connection between weight and Plan B is pretty limited and relatively inconclusive, not to mention the storyline in Shrill was low-key terrifying, we reached out to a couple of experts to learn more.It's important to remember that emergency contraception like Plan B is, at its core, a dose of hormones, and hormones are fat-soluble, "which is exactly why some studies show that emergency contraception may be less effective in women who are overweight (body mass index 25–29.9) or obese," says Hedieh Asadi, M.D., cofounder of DeoDoc Intimate Skincare. "Body weight might influence the effectiveness of oral emergency contraception, but it is not possible to draw any accurate conclusions that there is a lesser effect-oral emergency contraception should not be withheld from women who are overweight or obese."
The FDA seems to agree with this perspective, as the agency reviewed the research back in 2016 and decided that the available evidence wasn't strong enough to warrant any changes in Plan B's safety or efficacy labeling. "The FDA continues to believe all women, regardless of how much they weigh, can use these products to prevent unintended pregnancy following unprotected sexual intercourse or contraceptive failure," the agency wrote in a consumer Q&A post back then. And yet, in 2013 in Europe, when manufacturers of an identical version of Plan B reviewed the research themselves, they came to a different conclusion and changed their labeling information to include a warning about weight limitations, reports Mother Jones. So, what's a girl to believe?!
If you're thinking that doubling up on Plan B doses might be a good "just in case" strategy, Dr. Asadi says it's probably best not to go that route. "The best advice to increase the effectiveness is taking the emergency contraception as soon as possible," she says. "The sooner you take the pill, the less the risk of becoming pregnant. No data or scientific studies exist to condone increasing the dose of the emergency contraception pill in relation to weight."
As for regular birth control, even if it contains a dose of the levonorgestrel hormone found in Plan B, there's no need to panic about its effectiveness, as "there is no risk of impaired efficacy of hormonal contraceptives in obese women," says Dr. Asadi. (Related: Study Says Birth Control Pills May Worsen Your Mood) However, she recommends women with a BMI greater than 30 use a nonhormonal IUD instead of hormonal contraceptives, as the latter may "increase the risk of thrombosis (blood clots)," she explains.
Bottom line: The relationship between weight and the effectiveness of Plan B is, at best, pretty complicated. There's no definitive answer as to whether there really are weight limitations associated with the drug, which is no doubt frustrating for anyone who wants (no, needs) to feel confident relying on the emergency contraception in those "oh shoot" moments.
This could point to a larger problem in the medical community-specifically, how health care providers address the issue of weight with their patients, says board-certified ob-gyn Heather Bartos, M.D. "Providers are likely trying to be sensitive to women who get upset when their weight is addressed (I've had patients get very upset that we even bring it up)," says Dr. Bartos. "This does point to the issue of increasing obesity in the United States and how we address this calmly, logically, and without prejudice to patients. It's part of a larger conversation about openness and honesty in the doctor's visit (on both sides of the exam table)." (Related: What People Don't Realize When They Talk About Weight and Health)
As frustrating as it is that there's no clear-cut answer about whether legitimate weight limitations really do exist for Plan B,the best thing you can do is tell your doctor that you're confused about this issue. Voice your concerns openly when you have the opportunity to do so, because any health question or concern is completely valid. If nothing else, Shrill's storyline about Plan B keeps an important conversation about emergency contraception in the forefront of your mind, and it encourages you to keep asking questions in the name of your health.
- By By Allie Strickler
If you've ever taken Plan B or another OTC emergency contraceptive pill, you've probably taken it for granted that the single-pill dose works just as well for everyone — that regardless of age, height, weight, or activity level, the pill will be 95 percent effective if taken within 24 hours of unprotected sex, and 88 percent effective if taken within 72 hours.
But a small study published over the summer in the medical journal Contraception suggests that your weight can influence the effectiveness of a single dose of levonorgestrel, the ingredient in Plan B that prevents pregnancy. In women who are clinically obese, a single pill might not raise levonorgestrel levels enough to effectively prevent pregnancy.
It was only when obese women were given 3.0 milligrams of levonorgestrel — effectively, a double dose — did their levels of levonorgestrel reach the amount proven to prevent pregnancy in women with normal BMIs.
As Refinery29 recently pointed out, this isn't the first we're hearing of Plan B's weight limit: In 2013, the makers of Plan B warned that the drug is less effective for women over 165 pounds and completely ineffective for those over 175 pounds. The very next year, the European Medical Association determined that in spite of the drug manufacturer's warnings, potential benefits of taking Plan B outweigh the risk of failure (i.e., pregnancy) for all women regardless of their weight.
In any case, the implications of residual doubt and emerging research is that clinically obese women should double up on Plan B pills to guarantee the method works as well as humanly possible. But because there isn't tons of data on the effects of double doses or side effects (and this recent study was pretty small), that's not necessarily recommended.
So what exactly are you supposed to do if your BMI is on the high side and a slip-up leaves you unprotected from pregnancy?
Related Story
Experts agree that the absolute best option for obese women is the copper IUD. With 99.9 percent effectiveness when inserted within five days of unprotected sex, it stops sperm in its tracks and prevents fertilized eggs from implanting in your uterus. Of course, getting an IUD is totally different than popping an OTC pill and moving on with your life. Because it requires a doctor for prescription and insertion, and it can prevent pregnancy for 10 to 12 years (unless you have it removed beforehand), the decision to get one is a way bigger decision to make, all under the pressure of a potential pregnancy and five-day time crunch.
But until researchers sorts out emergency contraceptive dosage, you'll want to rely on the backup plan that actually works.
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Elizabeth Narins Senior fitness and health editor Elizabeth Narins is a Brooklyn, NY-based writer and a former senior editor at Cosmopolitan.com, where she wrote about fitness, health, and more.
The "Plan B" contraceptive pill is the most affordable and convenient form of emergency contraception for women in the U.S., yet it has a remarkable failure rate in larger women.
Physicians may want to think twice before suggesting the "Plan B" pill to patients in need of emergency contraception (EC).
The results of a large European study show that the popular form of EC, levonorgestrel 1.5 mg, (Plan B pill) loses its potency in women weighing about 165 pounds and does not work at all in women weighing 175 pounds or more. Since the average weight of a woman in the U.S. is 166.2 pounds according to the U.S. Centers for Disease Control and Prevention (CDC), women have few options but to take a gamble on the only approved form of over-the-counter emergency contraception.
The study originally set out to compare the effectiveness of different types of EC. It studied the outcomes of the levonorgestrel "morning after" pill and the ulipristal acetate pill known as "Ella" in about 2,000 women. The lead author, Anna Glasier, MD, honorary professor of Obstetrics and Gynecology at the University of Edinburgh, in Scotland, and a world-renowned expert on EC, decided the data would be more practical if it could be used to identify at-risk patients.
"Somewhere between 90% to 95% of women who take emergency contraception do not appear to be at great risk of pregnancy, so if you could work out who was genuinely at risk, it might help you as a clinician," she explains.
She and her team conducted a meta-analysis and found a worrisome pattern: Levonorgestrel consistently failed in heavier women. Generally, levonorgestrel prevents about 50% of pregnancies that would have occurred without intervention, but when Glasier factored in weight, the effectiveness changed drastically. Women with a body mass index (BMI) of 25 or higher experienced decreased efficacy, and the pill stopped working entirely in obese women with a BMI of 30 or higher. In fact, obese women that took levonorgestrel were slightly more likely to become pregnant, 5.8%, than women who did not take EC at all, 5.6%. The number of obese women included in the study was small, but still statistically significant.
These findings elicited a change in the patient information packets of the European levonorgestrel EC that reflects the drug's impotence in overweight and obese women. The FDA is currently reviewing the evidence and considering a change to U.S. labels, but most women are still unaware of the drug's limited efficacy. Reports by National Public Radio state that physicians treating overweight and obese patients regularly see women who became pregnant after taking the Plan B pill.
This glaring issue was overlooked because the original research used to bring the Plan B pill to market did not focus on a representative sample of women in the U.S. and Europe. It obtained approval from the FDA based on data from the World Health Organization in which the average BMI of participants was too small to see the effects of weight. "If you look at the first study, they reported the BMI and the mean was 22 with a standard deviation of plus or minus three. So these were not, by and large, very heavy women," Glasier explains.
More Weight, Less Efficacy
Several theories exist as to why the levonorgestrel pill fails in women over a certain weight: the dilution of the steroids in a larger blood volume; hormones becoming sequestered in fat cells; or the drug might be metabolized differently in a larger person. Yet nothing is definitive. "There is a lot of evidence that certain contraceptives are less effective in heavier women, although the studies haven't really been of really good quality. None, including ours, have been designed to look specifically at the relationship between effectiveness and weight," Glasier says.
Quite possibly, a larger patient simply needs a larger dose of the drug. "It is not really surprising because if you do studies on animals you dose them on a weight basis; however many milligrams per kilogram. The only reason that we don't do that with human medication is because it would just be so horribly complicated," Glasier continues.
The only consolation to the dismal success rate of levonorgestrel is that resulting infants are not adversely affected if a patient still becomes pregnant. Glasier insists there is no evidence for concern over a baby's future health due to a mother ingesting Plan B or the Ella pill. That said, women should definitely be advised to consider other options.
Ella proved to be more effective than levonorgestrel regardless of weight and definitely performed better on overweight and obese women. Ella bested Plan B by half, with about 50% fewer pregnancies than those taking levonorgestrel. For both drugs, pregnancy risk is elevated by additional factors unrelated to a patient's weight. Women who had intercourse around the time of ovulation had a fourfold increase in the likelihood of pregnancy compared to women having sex outside the window of fertility. Those who had unprotected sex after using either pill type were also more likely to get pregnant.
The IUD Option
Due to these mitigating factors, Glasier recommends the copper intrauterine device (IUD) as a first line of defense. It offers a 95% success rate as emergency contraception, making it the most effective option by far. "The big advantage, of course, is that once it's in place you can keep it in place and it is a highly effective ongoing contraceptive until you want to get pregnant and fertility comes back to normal within a week."
Ideally, of course, women should avoid the need for EC entirely by getting a copper or Mirena IUD or a hormonal implant before an emergency arises. Glasier describes these options as "independent of compliance," meaning that patients do not need to remember to take a daily pill or follow other such instructions. But when it is too late for preventative steps, the copper IUD is the way to go.
Unfortunately, an IUD is not available from pharmacies and a lot of women do not like the idea of having a foreign object inserted into their cervix. In the U.S., it is much more expensive than taking an emergency contraception tablet. A lack of health insurance coverage could make the costs prohibitive, and the extra steps involved may deter some patients from taking action.
The Ella pill also requires a visit to a doctor and a prescription, which prohibits some women from access. Glasier still recommends this option over Plan B if a woman is not willing or able to obtain a copper IUD.
For now the most affordable and convenient form of emergency contraception for women in the U.S. is overthe-counter levonorgestrel, and it is for sale without any warning of its ineffectuality in larger women. Those who still become pregnant will have to think of a "Plan C."
— Mapes is a Washington D.C.–based freelance writer.
She wrote about diabetes social networks in the December issue.
Of course, you want every medication you take to work. But when it comes to emergency contraception, the stakes are pretty darn high. Which is why it's especially frustrating that, despite years of suggestions that Plan B may not work as well for women with higher BMIs, there's still so much we don't know about weight and emergency contraception efficacy—like what weight would be considered "risky" or how effective is "less effective?"
So it's not surprising that higher-BMI women aren't sure what the heck to do. And, considering that the average woman in the U.S. weighs 168.5 pounds, it's a question that's definitely worth answering.
When it comes to emergency contraception options, levonorgestrel is the easiest to get, but it may be the least effective in higher BMIs.
The best thing about levonorgestrel (like Plan B One-Step and its generics) is that it's available over the counter. That means you or your partner or basically anyone should be able to walk into a drugstore and get it without much hassle. It's taken as a single dose and works by delaying ovulation.
During a normal monthly menstrual cycle, the pituitary gland releases a surge of luteinizing hormone (LH), which then signals your ovaries to release an egg. This dose of levonorgestrel dampens the release of LH, thus delaying or totally preventing ovulation that month. (If you take it after LH hits its monthly peak, ovulation won't be stopped and your chances of getting pregnant won't be decreased.)
But the limited research we have so far suggests that Plan B isn't the best option for higher-BMI women. The issue first came up in a 2011 study published in Contraception, which found that women who had a BMI over 25 were more likely to become pregnant after taking emergency contraception. However, this was just a population-based study of 3,445 women, meaning that it doesn't prove that BMI was responsible for the drug's failure because there could have been many other factors involved.
But it got the ball rolling, and since then, other studies using weight in addition to BMI also found a negative correlation between weight and the effectiveness of levonorgestrel emergency contraception (such as Plan B). But others, such as this one from researchers with the World Health Organization (WHO), published in Contraception this January, suggest that BMI isn't all that much of an issue.
A review of four available studies published last December in Contraception found a similar trend. "While data are limited, the findings suggest that women with obesity have an increased risk of pregnancy after use of compared with women who have BMIs in the normal/underweight range," lead author Tara Jatlaoui, M.D., medical officer specializing in women's and reproductive health at the CDC, tells SELF. However, she cautions that the data her team was able to review were still "extremely limited."
So that's where we are: surrounded by research that suggests—but can't confirm—that the morning-after pill might not be as effective in certain weights.
The FDA still says the data available aren't conclusive enough to lead to a warning label or prescription changes. Last May, the agency announced that it had completed its review, but that the data were too limited and conflicting to warrant changing the label in the U.S. "There are currently no weight-related considerations on the Plan B One-Step (levonorgestrel) label," a spokesperson for Teva Pharmaceuticals, the makers of Plan B, confirmed to SELF.
Interestingly, the only changes in drug recommendations that came out of this research happened overseas. In 2013, the makers of the Eurpoean drug Norlevo (basically their version of Plan B), added a warning to their product that said it was less effective for women over 165 pounds and became ineffective at 175. But that decision was reversed in 2014 and the European Medicines Agency released a statement confirming that women of all weights can continue to take the medication because the "benefits are considered to outweigh the risks."
- Hulu's new show Shrill, starring Aidy Bryant, addresses Plan B and weight.
- In the show, Annie (played by Aidy), becomes pregnant after taking Plan B and is told the drug is ineffective in women over 175 pounds.
- Nothing is definitive, but research suggests that Plan B might be less effective in women over 165 or 175 pounds.
Hulu's new show Shrill features Aidy Bryant, who plays Annie, a fat woman out to take control of her life—which, btw, doesn't have anything to do with changing her weight.
(FYI: The show is based on Lindy West's memoir, Shrill: Notes from a Loud Woman. Also: Aidy recently told Cosmopolitan she's all about owning the word "fat.")
In the first episode, Annie takes the morning-after pill (a.k.a. Plan B), after a hook-up with a guy who is honestly the biggest jerk I've ever seen (he makes her exit his house through the back door when his roommates are home). But when she starts feeling weird and misses a period, Annie takes a pregnancy test and realizes she's pregnant.
This isn't supposed to happen—she took Plan B!—but when she takes it up with the pharmacist, the pharmacist bluntly asks, "Do you weigh over 175 pounds?" When Annie says yes, the pharmacist replies, "The morning-after pill is only dosed for women 175 pounds and under."
I'll spare you the rest of the story here because, spoilers (though def go watch it ASAP), but is this for real? Does the morning after pill really have a weight limit? And if so, WTF are plus-size women supposed to do about that?
How does Plan B work, again?
So, Plan B is an emergency contraceptive pill. It comes in the form of one tablet that contains 1.5 milligrams of levonorgestrel, a synthetic version of the hormone progesterone. You're supposed to take it within 72 hours (three days) after having unprotected sex, according to the Plan B website, although the sooner you take it, the better.
The pill helps stop the release of an egg from your ovary. It may also help prevent the fertilization of an egg that's already been released or by keeping a fertilized egg from implanting in your uterus (where it would then grow). But—and this is important—Plan B is not an abortion pill; again, it's an emergency contraceptive.
So…does Plan B have a weight limit?
Let's get this out of the way up front: The research on this isn't totally clear, but there's enough out there to suggest that Plan B is less effective in women who weigh more than 165 pounds (or 175 pounds, depending on what you're looking at), and the effectiveness seems to be even less the more you weigh.
One 2011 study in the journal Contraception found that women who had a BMI greater than 25 (women who were, by BMI standards, overweight) were more likely to get pregnant after taking Plan B than their counterparts with lower BMIs.
This was followed by another study published in Contraception in 2015 that had similar results. Then, a meta-analysis published in 2016 in the same journal also suggested that "women with obesity experience an increased risk of pregnancy" after taking Plan B when compared to other women.
But here comes the conflicting data: A 2017 study published again in Contraception, didn't find much of a difference in Plan B's effectiveness, regardless of a woman's BMI.
Also important: The Food and Drug Administration (FDA) doesn't specifically warn women about this on the labeling, and there doesn't seem to be anything about this on the Plan B website either.
The FDA did address the data in 2016 in a "Consumer Questions and Answers" forum, but said that it was too limited and conflicted for them to add a warning label to Plan B. Still, this something doctors (and pharmacists) are aware of—and should still bring it up to patients who inquire about Plan B.
As far as a woman's increased risk of pregnancy if she's overweight and takes Plan B—the 2015 study found that women 176 pounds or more were six percent more likely than other women to get pregnant. "That's similar to your risk of getting pregnant if you don't use birth control," says Christine Greves, MD, a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies. Basically, Dr. Greves says there isn't enough data to say that Plan B definitely will or won't work for those with a higher BMI.
Well, should you still take Plan B if you're over 165 pounds?
It's generally recommended that you go ahead and take Plan B regardless of your weight or BMI, says Jessica Shepherd, MD, a minimally-invasive gynecologist in Dallas. Still, you're probably not super comforted knowing that it might be less effective if your weight or BMI is higher.
That's why Dr. Greves recommends calling your doctor and "having a heart to heart" about your options. One good treatment option is getting the copper IUD inserted, she says. This can help keep an egg from implanting in your uterus—and serve as birth control for you in the future, Dr. Greves says. (Just keep in mind that you'll need to do this within five days after having unprotected sex for it to be helpful in this situation.)
You'll specifically want to get the copper IUD, Dr. Greves says—its effectiveness doesn't depend on your BMI or weight, while your weight-slash-BMI does matter with hormonal IUDs.
While it may be tempting to simply double up on your Plan B dosage, you definitely don't want to do this, Dr. Shepherd says. "This hasn't been studied," she says, so you can't know what the outcome would be—and you definitely don't want to chance it.
The bottom line: If you've had unprotected sex, weigh over 165 pounds, and want to take Plan B, have a conversation with your doctor, ASAP.
Korin Miller Korin Miller is a freelance writer specializing in general wellness, sexual health and relationships, and lifestyle trends, with work appearing in Men's Health, Women's Health, Self, Glamour, and more.
The condom broke. Or you missed a pill. As you learn about your options. you come across information that states Plan B doesn't work for people who weigh more than 165 pounds. That's because in 2011, some studies indicated that Plan B Emergency Contraception (containing levonorgestrel) wasn't effective for women over a certain weight. This prompted the European Medicines Agency (the FDA equivalent in Europe) to approve a label change warning women of the possible reduced efficacy. This label change then prompted the Food and Drug Administration (FDA) to conduct its own review over whether the Plan B emergency contraception available in the US needed an updated label as well.
In light of their review, today the FDA concluded that the data concerning the effectiveness of levonorgestrel (LNG) EC (the most commonly used emergency contraception) in women who weigh more than 165 pounds or have a BMI of more than 25 kg/m2 was inconclusive. This means that the FDA doesn't believe a change in the labeling is warranted at this time, but that more research is needed to better understand the relationship between weight and the effectiveness of LNG-containing EC.
The National Women's Health Network also believes that further research on the potential relationship between body weight and EC needs to remain a top priority. Without this crucial information, women are forced to play guesswork with their contraception. Women should be aware of all of their options related to contraception and pregnancy, and well-informed to make the best decision for their health care needs.
While the verdict is out on whether weight affects how well EC will work for a particular woman, we know that timing does matter; it is important to take emergency contraception as soon after unprotected sex as possible to improve efficacy. Women, and particularly women with a higher body weight, should be encouraged to use the most effective options (the copper IUD or ulipristal acetate ). If these options aren't easily accessible, or are unacceptable to an individual, no woman should be denied or discouraged from using levonorgestrel EC because of her weight. Women must have autonomy in all aspects of their health care, but especially in decisions related to their reproductive health.
To learn more about the link between emergency contraception and body weight, check out the March/April issue of The Women's Health Activist.
Plan B
Clinical Trial Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.
A double-blind, controlled clinical trial in 1,955 evaluable women compared the efficacy and safety of Plan B (one 0.75 mg tablet of levonorgestrel taken within 72 hours of unprotected intercourse, and one tablet taken 12 hours later) to the Yuzpe regimen (two tablets each containing 0.25 mg levonorgestrel and 0.05 mg ethinyl estradiol, taken within 72 hours of intercourse, and two tablets taken 12 hours later).
Table 1: Adverse Events in ≥5% of Women, by % Frequency
|Plan B
|Abdominal Pain
|Heavier Menstrual Bleeding
|Lighter Menstrual Bleeding
|Breast Tenderness
Postmarketing Experience
The following adverse reactions have been identified during post-approval use of Plan B. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Gastrointestinal Disorders
Abdominal Pain, Nausea, Vomiting
General Disorders and Administration Site Conditions
Nervous System Disorders
Dizziness, Headache
Reproductive System and Breast Disorders
Dysmenorrhea, Irregular Menstruation, Oligomenorrhea, Pelvic Pain
Read the entire FDA prescribing information for Plan B (Morning After Pill, Emergency Contraception) (Levonorgestrel)
If Your Partner Comes In You & You're Not On Birth Control, Here's What To Do
Here's the thing about the idea of safe sex: no sex is 100% safe. There is such a thing as practicing safer sex — which includes anything you do to lower your risk of infection or conception — but even if you and your partner do use a condom, accidents happen. A condom that's expired or worn incorrectly can tear or fall off, putting you at greater risk for STIs and — if you're not using another method of birth control — pregnancy. Luckily, if your partner comes in you and you're not on birth control, there are steps you can take to lower your risk of becoming pregnant.
According to Danielle M., a certified obstetric nurse, pregnancy occurs much more easily than you might think. "If someone with a penis ejaculates in or near your vagina (or even enters your vagina before ejaculation occurs — pre-cum can carry sperm from a previous ejaculation through the urethra), you are at risk for being pregnant," she explains. Even if your partner attempts the pull out method, pregnancy is possible — according to Planned Parenthood, withdrawal results in pregnancy for about one in every five people who use that as their only form of birth control.
Unsmiling woman looking out window with curtain sitting in cozy bedroom in apartment. thoughtful depressed asian lady looks worried in bed. frustrated girl at home hands cross on chin frowning think
Once unprotected sex takes place, your best defense against unwanted pregnancy is taking an emergency contraceptive. Danielle says that an emergency contraceptive (such as Plan B One-Step, which is also sold as Next Choice One Dose) can be taken up to 120 hours (or five days) after unprotected sex, though it's most effective if taken within 24 hours. Unfortunately, Plan B is not effective for everyone.
According to Julia Huff, a women's health nurse practitioner at New York University, Plan B is "much less effective in people who have a BMI over 25, which is the majority of Americans for sure." As Julia suggests, "If possible, you should reach out to your gynecologist to get a prescription for ella (ulipristal acetate), which is a morning-after pill that is believed to be effective in people up to a BMI of 35."
All morning-after pills use the same active ingredient as daily birth control pills — a hormone called levonorgestrel — but at a much higher dose, which "works by preventing the release of an egg from the ovary," according to MedlinePlus. The goal of emergency contraception is to prevent or delay ovulation, so that's why it only works if you take it before ovulation has occurred.
Worried girl hugging pillow and having depressing thoughts, lying in bed
Morning-after pills aren't the only ways to lower your risk of unwanted pregnancy and, in fact, are not even the most effective method. Both Julia and Danielle say that the the copper IUD is actually the most effective means of emergency contraception when inserted within five days of unprotected sex. As well as serving as an effective non-hormonal birth control method, the copper IUD can help prevent conception even after unprotected sex has taken place and has been shown to be 99% effective at preventing pregnancy, according to Julia.
As Jess O'Reilly, Ph.D. and host of the Drive Him Wild With Pleasure video course, previously explained to Elite Daily, "… is inserted by a medical practitioner into the uterus and the copper changes the way the sperm cells move to reduce the likelihood of their making it to the egg." Copper IUDs release copper into the uterus and fallopian tubes, "which acts as a spermicide," according to Healthline. Of course, this means that only copper IUDs, such as Paragard, are effective as emergency contraception, not hormonal IUDs.
Image Point Fr/
If you miss that five-day window period where emergency contraception can be used effectively and suspect you might be pregnant, you should visit a healthcare provider to determine this for sure. "You should also be screened for STDs and discuss future birth control options," says Danielle. Julia also suggests taking a pregnancy test two weeks after unprotected sex regardless of any bleeding you may have, as emergency contraception can contribute to irregular bleeding that is not a true period.
When it comes to STI testing, Julia says that the earliest testing should be done is "two weeks after exposure for gonorrhea and chlamydia, 10 days after exposure for syphilis, and four weeks after potential exposure for HIV." She adds, "Syphilis and HIV testing are most accurate 90 days after exposure, though can be detected before then." Therefore, you should plan to see your gynecologist to have testing done both two weeks and three months after unprotected sex, as additional medical risks develop the longer an STI is present and untreated.
Try to practice safe sex, friends, but remember: Accidents can and do happen, but if you take immediate action, you can still prevent pregnancy from happening.
My boyfriend cummed in me more then once within 48 hours but Ive taken Plan B within the 48??
For all girls who think they may be pregnant:Please Read!?
1. The pull-out method is not a method, you can still get pregnant-males secrete sperm all throughout the sex act. They cannot feel it and they certainly cant control it. Even if he doesnt see fluid when he masturbates it still occurs. Vaginal sex is much more intense than masturbation and sperm is microscopic. The majority of sperm are released during ejaculation but many are released prior and it only takes one!
2. You can get pregnant if he just rubs his area on your area, but doesnt stick it in, but chances are very small
3. You can get pregnant if you have sex in the water
4. You can get pregnant while on your period
5. You can get pregnant anytime of the month, you never know when you are actually ovulating unless you chart for years. Ovulation charts are a "guesstimate" at best-they are not very accurate.
6. Sperm do not die immediately on contact with the air
7. You can get pregnant even if you douche afterwards
8. You can get pregnant during the 1st time
9. You can get pregnant even if you havent had your period yet, you may be ovulating for the first time and dont know it yet.
10. You can get pregnant while on birth control, it only reduces the risks, the same as condoms
11. You can get pregnant standing up
12. You can get pregnant even if you take a bath or shower afterward
13. You can have your period, and still be pregnant
14. You do not have to have an orgasm to get pregnant
15. You can get pregnant at any time during your cycle,
16. You can get pregnant from pre-cum,
17. You can get pregnant in any position,
18. You cannot get pregnant from oral sex (some people think you can)
19. You can get pregnant even if you go pee right after sex!
20. You can get pregnant while breastfeeding, chances are only slightly lower when first beginning breast feeding then fertility soon returns. This was used as a method back in the dark ages before reliable birth control was widely available. It belongs in the same myth trashbasket that pulling out belongs in! These were only considered methods way back before more reliable methods became readily available, so like back when your grandmother's mother was young. Even then they had condoms, but many couldnt afford them. They are very affordable now and available in most mens bathrooms in most gas stations and convenience stores so there is NO excuse for not having one now days!
21. Birth control pills and other hormonal birth control methods are about 98-99% effective if taken 100% correctly. Condoms are about 70-80% effective when used correctly-they are more effective if you use a spermicide with them. Plan b is about 80% effective the first time you use it. If you use it again in the same month, that effectiveness rate can go down so it can become less effective the more often it is used when used close together. It is NOT meant to be a form of birth control. It is meant as EMERGENCY contraception-like a condom break-NOT so you can excuse yourself that it is ok to have unprotected sex now and use Plan b later. (I only use Plan b as example-it is the same for ANY emergency contraceptive so Next Choice and Ella included)
22. All women ovulate at different times of the month. New studies indicate women may even ovulate multiple times per month, so don't trust your cycle to be your birth control method.
23. Weed, mountain dew and coffee do not make you sterile, so don't listen to that bull either. If a man tells you he has had a vasectomy or that he is sterile ask for medical proof.
24. Anal sex will not make you pregnant although it can transfer std's, cause long term problems
25. Home pregnancy tests are not 100% accurate, false negative are much more common than false positives.
26. Kissing your boyfriend will not make you pregnant, neither will holding hands but these can lead to sex so you may want to have a condom available so you dont get caught up in the "heat of the moment"!! It is no excuse.
27. Stressing can make your period late, even if you are not pregnant.
28. The only way to know if you are pregnant for sure is to take a test. You can not find out by looking at your symptoms. This will only stress you out more! Test.
It doesn't matter what your story is, when you had your period, how many times you had sex, if he did or didnt ejaculate, cum (or nut-my favorite expression -girls, this one is just crass!), if you're on birth control, whether or not the condom broke, or anything. You always have a chance of being pregnant, and that's exactly what we're going to tell you. So before you post, test! You can test 4 days before your first missed period, better yet, a week after your period is late so don't ask us your chances of being pregnant, just test!! Depending on circumstances and your contraceptive method (or none), your chances to be pregnant are from 0.5-2% all the way to 85%.
Common things that can mess up your cycle:
1) stress
2) starting birth control
3) stopping birth control
4) switching birth control methods
5) puberty and natural hormonal changes
6) not eating enough or dieting
7) taking hormones, steroids, or other prescription drugs
8 ) illness
The Science Bit::
*sperm can live for up to 3 to 5 days inside the female body.
*an egg is viable for up to 36 hours after ovulation.
*ovulation typically occurs 14 days before, not after, your period (regardless of cycle length).
*it is rare for the luteal (post ovulation) phase to change, a longer cycle usually means you ovulate later.
*it is impossible to know exactly when you ovulate, without being a dedicated long term charter (and this is difficult to do. The most accurate chart basal temp and cervical mucus every day for years before they are accurate and even then the body can throw you a curve). Therefore it is impossible to say exactly when you are fertile. Women can change from month to month so fertility charts are a guess at best. Online "ovulation charts" are guesstimates at best-they are NOT gospel.
*pregnancy is a risk you take any time you have sex (even on hormonal birth control because that is only, at best, 98-99% effective).
*day one of the cycle is the first day of bleeding.
*therefore your window of highest fertility is from 5 days prior to ovulation until 2-3 days after
Hope this information is helpful. Please refer back whenever you think you may be pregnant!
JUST TO ADD: If you are on birth control pills and at any time you need to take antibiotics, antibiotics can reduce the effectiveness of birth control pills so you need to use back up BARRIER protection, like condoms, for the entire time you are taking the antibiotics AND for at least 7 days after you finish them. Since antibiotics reduce the effectiveness of the Pill, you CAN become pregnant when taking antibiotics while on the Pill if you do not use a barrier back up method. I say barrier method because "pulling out" or removing the penis before ejaculation is NOT effective as a method of birth control and neither is it a back up method, also, I dont recommend the use of emergency contraceptives (Plan b, Next Choice) when you are on hormonal birth control already (birth control pills, Depo-Provera, Nuva Ring, Ortho Evra are examples of hormonal birth control methods). Plan b or other emergency contraceptives are a big blast of hormones and when you are already on hormones, this becomes a hot mess of circulating hormones in your system. It is not contraindicated to use Plan b when on oral contraceptives that I know of, BUT by taking these large doses of hormones, you are opening yourself up for major side effects from these hormones. Things like sore, tender, swollen breasts, nausea, vomiting, cramping, bloating, acne, dizziness, headaches, lack of appetite or increased appetite are all side effects of large doses of hormones found in birth control. Sounds a lot like pregnancy, doesnt it? So if you are using Plan b (or other emergency contraceptive) because of a missed pill or as "back up", it is not going to save you any stress to have delayed periods (most women experience delayed periods or irregular bleeding after using Plan b or other emergency contraceptives) along with the symptoms listed above!! You will be terrified you are pregnant so do yourself a favor and use condoms for back up when needed rather than emergency contraceptives. It is always, always better to PREVENT pregnancy than trying to fix things after the fact!
Another issue comes to mind. DO NOT tell yourself at any time that it is okay to have unprotected sex because you can just take Plan b or Next Choice, or any emergency contraceptives, after-no "heat of the moment" BS-you are in control of your body and "heat of the moment" is just another way of saying "I'm just lazy about protecting myself"!! It is always, always better to PREVENT pregnancy. Prevention is MUCH more effective than taking an emergency contraceptive after the fact! Emergency contraceptives are a great tool to use in our contraceptive arsenal available to today's woman, but they should be reserved for TRUE emergency use, meaning a slipped or broken condom, a dislodged diaphragm etc. It could be used for a missed pill, but as I say above, you are better off using condoms because the added blast of hormones is going to delay your period and make you feel pregnant because of the side effects and believe me-it will shoot your anxiety levels through the roof. If you must use emergency contraceptives, keep this in mind and expect the delay in your cycle. Women will often have a bleeding episode, like a period, after about a week after taking emergency contraceptives (but not ALL women have this bleed) and the next period due is almost always delayed or bleeding may be irregular-you may spot several times or not bleed at all for a couple of months. Every woman is very different so it is hard to say what is "normal" as all of these scenarios are normal. If you take emergency contraceptives and your period is late and it has been at least a month since your unprotected sex event, you can go ahead and test for pregnancy. If you test any sooner, it is likely too soon and it will not be accurate. If it is negative, it is likely to be the hormones delaying your cycle. Wait another month, if still no period, see your gynecologist to rule out pregnancy. DO NOT use emergency contraceptives as a contraceptive. They really shouldn't be taken very often and they do NOT "cover you for a few days"-you return to fertility quickly so if you took an emergency contraceptive one day, dont expect it to protect you the next day-it doesnt work like that. A regular, reliable method of birth control such as oral contraceptives (birth control pills or the Pill), Depo-Provera, an IUD like Mirena, or an implant like Norplant or Implanon, or Nuva Ring or Ortho Evra (the Patch) are much better for your system and MUCH more effective than emergency contraceptives. More women should look into long term birth control solutions like IUD's or implants like Implanon or Norplant. These are effective for 3-5 years depending on which method you choose and they dont require you to take a daily pill or remember anything other than the time that they need to be replaced, so what could be more convenient?
Not all methods are for everybody so be sure that you research the method(s) you are interested in then go talk to your women's health care professional and ask any questions and then decide, with their help, which method will work the best for you in your individual situation. We are SO blessed in the time we live in that we have so many options available to us. There is really little excuse NOT to use some method of birth control. It is readily available in so many different places, convenience stores, grocery stores, gas stations, doctors offices, family planning clinics and depending on where you go, much of it is low cost or no cost if you are a student or low income or uninsured. NO EXCUSES!!! Protect yourself and have babies when you WANT to have babies!! It is up to YOU to take control and advocate for yourself and plan your life.
What is emergency contraception?
Emergency contraception (EC) is a method used to prevent pregnancy after unprotected vaginal sex or when your method of birth control fails. Depending on the type of emergency contraception, it may be effective up to 5 days after unprotected sex, but it is most effective within the first 12-24 hours. It is intended for emergency situations and does not protect against sexually transmitted infections (STIs).
There are three main types of EC, and this page will focus primarily on ella® and Levonorgestrel.
- 85% effective up to 120 hours after unprotected sex
- Requires a prescription
Levonorgestrel (e.g. Plan B One-Step™, Next Choice®, and other brands)
- 89% effective up to 72 hours after unprotected sex; continues to reduce risk of pregnancy up to 120 hours but with decreasing effectiveness.
- Available without prescription (over-the-counter)
ParaGuard (copper IUD)
- 99.9% effective up to 120 hours (5 days) after unprotected sex
- Requires a prescription and a visit to a health care provider for insertion
- Provides ongoing contraception for up to 10 years
- See IUDs for more information.
EC may be used if:
- You had sex without using any type of birth control method.
- Your primary birth control method failed. For example, the condom broke and your partner ejaculated into your vagina.
- You were forced to have unprotected sex. (See the U-M Sexual Assault Survivor website for resources and information)
How does emergency contraception work?
EC consists of one of the two hormones found in birth control pills — progestin. The release of this hormone into your body helps to keep your ovaries from releasing an egg and thickens your cervical mucus to prevent sperm from joining with an egg in the uterus. Progestin also thins the lining of the uterus to keep a fertilized egg from attaching to the uterus.
EC does not cause an abortion. The "morning-after pill" (ella® or Levonorgestrel) is NOT the "abortion pill" RU-486. If you are already pregnant, emergency contraception will not end your pregnancy. If you think you may be pregnant, talk to your health care provider.
How do I use emergency contraception?
Following package directions, take EC as soon as possible after unprotected sex. The sooner you start the EC, the more effective it is in preventing pregnancy. Eating a snack or drinking a glass of milk can help reduce nausea.
EC is taken as one or two doses or pills, depending on the product. Take the first pill as soon as possible and, if there is a second pill, you may take it 12 hours later, or take it at the same time the next day.
How effective is emergency contraception?
EC is most effective within the first 12-24 hours after unprotected sex. The sooner you start EC after unprotected sex, the better it will work. Depending on the brand of EC, it may be effective up for to 5 days (120 hours) after unprotected sex.
The efficacy is slightly decreased from 72–120 hours (3-5 days) after unprotected sex, but it is still recommended for use.
In terms of effectiveness, Levonorgestrel:
- Is most effective for women with a body mass index (BMI) that is less than 25. To determine if this pertains to you, you can use a BMI calculator from Mayo Clinic.
- Is most effective within 3 days (72 hours) after unprotected sex. It is less effective after 3 days.
Talk to your health care provider about which type of contraception is right for you.
What are the benefits of emergency contraception?
- EC is an effective and safe back-up birth control method to prevent pregnancy after having unprotected sex.
- EC is available at local pharmacies or health care clinics to anyone that is 17 years of age or older.
- EC does not affect your ability to get pregnant later, if desired.
What are the downsides or health risks of emergency contraception?
- EC will not provide protection from sexually transmitted infections (STIs).
- EC is not intended for regular use and is not as effective as other forms of birth control. Talk to your health care provider about other long term options that may be right for you.
You may have some negative side effects while using EC. Nausea and vomiting are the most frequent side effects. If you are worried about feeling nauseous or vomiting, you can use anti-nausea medicine about one hour before taking the pill(s). You may also want to eat a snack or drink a glass of milk before taking the pills to reduce nausea.
Other side effects may include: breast tenderness, irregular bleeding, abdominal pain, fatigue, dizziness, or headaches.
Where can I get emergency contraception?
For ParaGard copper IUD:
- Call UHS 734-764-8320, select option 2, and request "emergency contraception IUD"
- Learn more about IUDs
By prescription (ella): Call UHS 734-764-8320, select option 2, and request "ella emergency contraception." You can also get it in advance (you don't have to wait for an emergency to get it).
Without prescription (Levonorgestrel): You can buy it at pharmacies, including the UHS Pharmacy, and other stores that sell medication. It can be purchased by both males and females of any age. There is no limit on the quantity that can be purchased at one time.
If you are under 17 years old, you need a prescription to get EC.
Important tips
- Take EC as soon as possible! The sooner you start the EC after unprotected sex, the more effective it is.
- If you do not regularly use another form of birth control, you can keep some EC at home in case of an emergency. This will allow you to take it as soon as possible after unprotected sex.
- EC is a good backup birth control option. After you use the morning-after pill, talk with your health care provider to find the best type of birth control for you to use on a regular basis.
- If you vomit within two hours after taking EC pills, call your health care provider.
- After you take EC, it is normal for your next period to be different than usual. Your period may come earlier, be lighter or heavier, or you may have spotting throughout the month.
- If you do not have a period in the next month after taking EC, take a pregnancy test and talk with your health care provider.
Personal Experiences
I had broken up with a long-term boyfriend and decided to take a break from birth control pills, thinking I wouldn't be sexually active until I had found someone new. On New Year's Eve, I was still off the pill and I had unprotected sex with one of my friends.While it wasn't necessarily a negative sexual experience, I got nervous that I could become pregnant. I went to the pharmacy and picked up Plan B Emergency Contraception and while it was a little pricey, it was easy and well worth it! I recommend it for anyone who runs into a similar emergency.
I have taken Plan B in emergency situations only, 3 times over the past five years. Each time after I took it, I was exhausted and had an upset stomach for 3 days. The last time I took Plan B, my period came early. I thought it was strange, but the directions said it could happen. I have never gotten pregnant.
Resources on EC:
- For questions, call for Nurse Advice.
- Emergency Contraception website from the Office of Population Research at Princeton University and the Association of Reproductive Health Professionals
- Planned Parenthood Emergency Contraception
Related resources from UHS:
- Contraception
- Pregnancy Testing
- STI Assessment
- HIV Antibody Testing
- Resources for Sexual Health
According to a 2013 study conducted by the CDC, the average American woman between the ages of 20 and 39 weighs 166 pounds. For African-American women, the average is slightly higher at 186 pounds. Odds are you that would be hard pressed to find a woman in America who doesn't know that between the ages of 20 and 39 — if she's sexually active — it is possible she could become pregnant. All of this information in itself is harmless but for one detail that remains curiously absent: If you weigh more than 176 pounds and find yourself in a situation where your birth control fails, then chances are the morning-after pill might not work for you.
A 2011 study in the journal Contraceptive, recommends that women who have a body mass index (BMI) of more than 25 should not rely on levonorgestrel or a "normal" dose of Plan B, as an effective emergency contraceptive. While the weight limits for these pills have been the topic of debate for several years, this important disclaimer is still nowhere to be found on any box of Plan B. Indeed, when a European manufacturer of a pill similar to Plan B announced that it would begin labeling its boxes with information regarding its effectiveness, it was asked by the European Medicines Agency to remove the warning from its packaging, citing that the available research was not conclusive enough to warrant concern. Since Plan B was approved by the FDA in 1999 — when the average weight for women was closer to 160 pounds — no adjustments have been made to the drug to fit the changes.
"The average woman in America spends five years trying to get pregnant and 30 years trying not to," explained Cecile Richards, President of Planned Parenthood in an interview with The New York Times. Although Plan B manufacturers insist that there are no weight limits, researchers have suggested that women weighing more than 176 pounds should consider taking two of the recommended doses to help ensure effectiveness. With the current cost of Plan B running at close to $50, that would mean women who lie outside the weight range could count on spending more that $100 on emergency contraception. Sadly, because statistics in this country tell us that there is a correlation between obesity and poverty, that would put the morning-after pill out of reach for many.
Although Plan B is not recommended to be used as a substitute for regular birth control, helping to lower the odds of unwanted pregnancy is one time when stepping on the scale now and then could really help.
Read the full story at Fusion.
Could dandelions hold the secret to a new form of birth control?
As birth control method for men nears approval, major pharmaceuticals keep their distance
Forget PMS, study finds birth control pills might be the reason you feel bad all month
Update (11/25/13): An FDA spokeswoman tells Mother Jones the agency is evaluating whether to require US emergency contraceptive pill makers to change their labels.
The European manufacturer of an emergency contraceptive pill identical to Plan B, also known as the morning-after pill, will warn women that the drug is completely ineffective for women who weigh more than 176 pounds and begins to lose effectiveness in women who weigh more than 165 pounds. HRA Pharma, the French manufacturer of the European drug, Norlevo, is changing its packaging information to reflect the weight limits. European pharmaceutical regulators approved the change on November 10, but it has not been previously reported.
This development has implications for American women. Some of the most popular emergency contraceptive pills sold over the counter in the United States—including the one-pill drugs Plan B One-Step, Next Choice One Dose, and My Way, and a number of generic two-pill emergency contraceptives—have a dosage and chemical makeup identical to the European drug. Weight data from the Centers for Disease Control and Prevention (CDC) suggests that, at 166 pounds, the average American woman is too heavy to use these pills effectively.
These pills, which use a compound called levonorgestrel to prevent pregnancies, are the most effective morning-after pills available without a prescription. Other pills sold in the United States require a prescription, are less effective at preventing pregnancy, or cause side effects such as nausea or vomiting. Plan B One-Step, which retails for $50, is the only emergency contraceptive drug in the United States available to women of all ages without a prescription.
Emergency contraception advocates reacted to the news about Norlevo with dismay. "There's a whole swath of American women for whom are not effective," says James Trussell, a professor of public affairs at Princeton and a senior fellow with the Guttmacher Institute, a think tank for reproductive health issues.
Data for the years 2007 to 2010 show the average weight of American women 20 years and older is 166.2 pounds—greater than the weight at which emergency contraceptive pills that use levonorgestrel begin to lose their effectiveness. The average weight of non-Hispanic black women aged 20 to 39 is 186 pounds, well above the weight at which these pills are completely ineffective. A CDC survey published in February found that 5.8 million American women used emergency contraceptive pills from 2006 to 2010.
HRA Pharma began investigating the need to change Norlevo's label after Anna Glasier, a professor of obstetrics and gynecology at the University of Edinburgh, published research in 2011 showing emergency contraceptive pills that use levonorgestrel are prone to fail in women with a higher body mass index. In an email, Karina Gajek, a spokeswoman for HRA Pharma, says that by December 2012, the company had reviewed clinical data on its own and requested permission from a European Union governing body to update its product information.
New leaflets warning women about the weight limits will appear in every box of Norlevo sold in Europe in the first half of 2014. The new packaging slip will read, in part: "Studies suggest that Norlevo is less effective in women weighing or more and not effective in women weighing or more" and that Norlevo "is not recommended…if you weigh or more."
But American manufacturers do not currently advise American customers of weight limits for levonorgestrel-based emergency contraceptives.
Because the Food and Drug Administration prohibits generic drug manufacturers from changing product information unless the brand name manufacturer makes a change, companies that manufacture generic versions of Plan B One-Step cannot update their packaging information unless Teva Pharmaceutical Industries, the exclusive manufacturer of Plan B One-Step, acts first. (The FDA has proposed a rule change that would allow generic manufacturers to update drug information independently.) A spokeswoman for Teva declined to comment for this article.
It is not clear whether drugmakers can formulate an effective levonorgestrel pill for women who weigh more than 165 pounds. "A dose increase of levonorgestrel is not proven to be a solution for this problem," notes Gajek, the HRA Pharma spokeswoman. "However, women with higher weight are advised to discuss alternative emergency contraceptive options with their physician: IUD or alternative oral emergency contraceptive." In the United States, IUD insertion can cost anywhere from $500 to $900.
According to a database of emergency contraceptive pills maintained by Princeton, HRA Pharma sells Norlevo throughout most European countries, parts of China, parts of the Middle East, many Francophone African countries, Australia, Taiwan, and South Korea. Norlevo was also recently approved for sale in India. Gajek says that changes to Norlevo's labels will be "procedure and country-dependent" and adds that the company has no timetable for changing its product labels in non-European countries.
A spokesman for Gavis, which manufactures the Plan B One-Step generic called My Way, declined to comment for this story. Actavis, which makes Next Choice One Dose, did not reply to requests for comment.


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Funding Announced for Nova Scotia Harbors
The Government of Canada will be investing $42 million in small craft harbor improvement and transfer projects across Nova Scotia over the next three years.
The announcement was made by Scott Brison, President of the Treasury Board and Member of Parliament for Kings─Hants, on behalf of Jonathan Wilkinson, Minister of Fisheries, Oceans and the Canadian Coast Guard, last Friday, August 17.
Coastal communities across Canada are supported by small craft harbors that provide the commercial fishing industry with safe and accessible facilities.
With approximately 44,000 Canadians employed in this sector, the Government of Canada is making investments to renew its network of small craft harbors and work with municipalities and other stakeholders where investments and divestitures can enhance local communities.
The investment, covering repairs to 27 small craft harbors across the province, will include:
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The Government of Canada is investing $250 million over two years to renew its network of small craft harbors. This is in addition to $100 million that will be invested in 2018-19 for repairs, maintenance, construction, and dredging at core commercial fishing harbors across Canada.


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Hezbollah leader Hassan Nasrallah mad one of his long, meandering, threatening speeches about how powerful Hezbollah is and how weak Israel is on the 11th anniversary of the end of the Second Lebanon War.
He obliquely threatened to shoot rockets at Israel's Dimona nuclear reactor, as he bragged that Israel closed down the ammonia tanks in Haifa after a previous threat.
As usual, the brave leader issued his speech by video instead of in front of his fans, out of fear that a Hezbollah spy for Israel would assassinate him.
But one point he made that I didn't see in the English reports that is worth mentioning.
Last month, President Trump met with Lebanese prime minister Hariri where he praised Lebanon's role in the fight against terror. Trump said, "The Prime Minister and I have just concluded an extensive conversation about the challenges and opportunities facing Lebanon and its neighbors. Lebanon is on the front lines in the fight against ISIS, Al Qaeda, and Hizballah. "
Nasrallah said, "The words of Trump that his country and Lebanon are partners in the war on terror reflects his political ignorance because Hezbollah is a partner of the [Lebanese] government."
In this case, Nasrallah is correct. To claim that Lebanon is fighting against Hezbollah is indeed ignorant – the Lebanese army ignores and even sometimes partners with the more powerful Hezbollah in the south.
Hezbollah is part of Lebanon's government and has complete military control over a significant part of the country, with not a word of dissent from the Lebanese government. Nasrallah has veto power over any Lebanese government initiative.
Trump's words indeed were naive. the Lebanese government as it stands now is part of the problem, not the solution.
We have lots of ideas, but we need more resources to be even more effective. Please donate today to help get the message out and to help defend Israel.


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One of Yggdrasil's lucky players won $5.197,198 million on its progressive jackpot slot Empire Fortune.
Up and emerging software developer Yggdrasil Gaming has been hitting plenty of headlines lately as this relatively young company continues to send shockwaves through the industry.
Yggdrasil Gaming has promoted a selection of highly-rewarding and amusing slot games powered by their revolutionising iSENSE platform, which comes with impressive in-game feature tool set BOOST, as well as with the social sharing tool kit BRAG.
Yggdrasil's games have changed the lives of many players of the recent years and this last case is a worthy example.
The fortunate player, from Norway, was playing at Betsson's NorgesAutomaten gaming site on July 4 on his mobile device, when he hit a life-changing 49 million Norwegian Kroner which is approximately $5.2 million. The winner has been a NorgesAutomaten player for nine years and he decided not to publicly disclose his identity.
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This massive pay-out is the jackpot pool's record and surpasses the previous $3.3 million paid out in December 2016. At the same time, this is the biggest single amount won by any player at NorgesAutomaten.
Alexis Wicen, Managing Director of NorgesAutomaten, said: "We are always looking to have the best games and biggest jackpots on our site and it's always a pleasure to see one of our loyal players win such a huge amount"
Speaking of the record win for Yggdrasil Gaming, Fredrik Elmqvist, their CEO commented:
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Kyle and Ken Fields were looking for a way to honor their father and preserve the pharmacy business he spent years building.
The brothers had heard complaints from businesses and universities in southwestern Ohio about rising prescription drug costs, so they began laying a foundation for Appro Rx — their version of a pharmacy benefit management company.
One by one, their audits found that businesses were unknowingly paying 20 to 30 percent markups — $200,000 or $600,000 more than actual cost per year — for medications.
A common finding in the audits was that the charges were coming from the country's largest pharmacy benefit managers: CVS Caremark, Optum Rx and Express Script. Pharmacy benefit managers are middlemen in the prescription-drug pipeline between manufacturers and pharmacies, and they were established with the goal of managing costs for insurers and consumers.
The Fields brothers thought that landing the pharmacy benefit manager contracts would be easy.
Then the president of a private university in southwestern Ohio called to say that his existing PBM had made a donation to the school for the exact amount the Fields' audit found they were overpaying for drugs.
A month later, a grocery store chain called to say that a representative from his current PBM cut a $212,000 check on the spot to cover the discrepancy found in the Fields' audit.
Shortcomings in federal or state regulation of pharmacy benefit managers, coupled with the secrecy around how prices are set for prescription drugs, have public agencies and private businesses fighting for transparency so they can unravel how pharmacy benefit managers work.
Pharmacists at Ohio State University's Wexner Medical Center agree with the Fields brothers that the same things are happening in the private sector, and, in fact, to almost anyone who has a health care plan.
Rising costs
A nationally recognized industry survey by the Henry J. Kaiser Family Foundation reported that the price tag for family health care coverage has increased from $13,000 in 2008 to $20,000 this year.
Prescription-drug spending has been the fastest growing sector of health care costs over the past several years, according to the Centers for Medicare and Medicaid Services.
"In the private sector, it's even worse because there is little scrutiny," Kyle Fields said. "People just don't know what the cost of the drugs are, and that goes for business owners."
He said one of the biggest problems in the private sector is that employers aren't aware that when they selected a health care provider for employees, they also are selecting the health care company's pharmacy benefit manager.
Health care companies such as Centene and UnitedHealthcare are owned by the same companies that own the PBMs Envolve and OptumRx, respectively. CVS Caremark is in the final stages of purchasing Aetna, pending federal approval.
Pharmacy benefit managers demand a rebate from manufacturers in exchange for including their drugs in health care plans so they are pre-approved for patients. That list of approved drugs is called a formulary.
Manufacturers factor those rebates into the price of their drugs, which adds to the cost for consumers.
The Dispatch contacted six of the 10 major pharmaceutical companies in the country. All six pointed fingers at PBMs for rising drug costs but would not provide data showing how.
At the same time, the largest pharmacy benefit managers point fingers back at drug manufacturers. CVS Caremark has refused numerous requests from The Dispatch for proof.
Despite all of the finger-pointing, the two groups seem united by one key factor: The quest for higher profits.
"We don't hate PBMs; they are our customers and we want to work with them," said Christine Waller, spokeswoman for pharmaceutical giant Mylan, earlier this year.
Dropping PBMs
Frustrated by the setup, Scott Knoer, head of 18 Cleveland Clinic pharmacies, did what he thought was fair for the group's employees and their dependents: He tossed PBMs out of their health care plan.
That allowed Knoer and his staff to take back control of the approved drug list and end the secrecy.
"We determine what the most cost-effective medication is, which is not the cheapest," Knoer said. "We are not placing things on a formulary to get a rebate and maximize profits."
Taking control of the formulary has saved Cleveland Clinic $33.6 million per year, he said.
Knoer noted that his group has an advantage because, as a pharmacy, it can more easily see which drugs are most cost effective.
A complicating factor in the private sector, Knoer acknowledges, is that businesses don't have the resources to manage their own formularies.
"There's a lack for awareness by business owners and the employees they have doing this," he said. "Usually, there is someone in human resources that runs the employee health plans and they are not physicians or even really know what a PBM is."
"PBM buster" companies like Appro Rx said business owners can start by asking for numbers and seeing what they are being charged per claim.
The range should be $2 to $4 per claim, depending on the medication. Anything above that, Fields and Knoer agree, deserves more questioning by business owners.
"It blows your mind how twisted this system is," Fields said. "Just asking for transparency is a start."


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