Q: I heard Plan B is not as effective when you are overweight, and I weigh 190lbs. I went to my pharmacy to get Ella instead, but I didn’t see any on the shelf, so I took Plan B anyway. If I can’t find Ella, should I be taking a higher dose of Plan B?
For any readers who are unaware, Plan B and Ella are emergency contraceptive pills, sometimes referred to as the “morning-after pill.” They are taken to help prevent pregnancy after unprotected intercourse or when another form of contraception has failed such as a condom breaking or forgetting to take birth control pills. These medications do not cause abortions.
They work mainly by preventing or delaying the ovary from releasing an egg. If no egg is available for fertilization, then pregnancy does not occur. How well they work is dependent on how much time has passed since intercourse and where you are in your menstrual cycle. Both are more effective the sooner you take them.
There are key differences between these medications that one should be aware of, including how much time can pass after intercourse for the dose to be effective, how often you can take them, how you access them and at what body weight their effectiveness potentially decreases.
Plan B’s medicinal ingredient is levonorgestrel and it is also available under several generic drug brands. It is most effective if taken within 3 days (72 hours) post-intercourse and can be used multiple times per menstrual cycle. After taking it, you can immediately resume your regular dose of hormonal birth control. Plan B is available without a prescription. Depending on the pharmacy, it may be kept behind the pharmacy counter or out in the self-selection area close to the pharmacy where the pharmacist is easily accessible for consultation.
Ella’s medicinal ingredient is ulipristal acetate and it is available as a brand-name product only. Some studies have shown it to be more effective than Plan B at preventing pregnancy and can be taken up to five days (120 hours) post intercourse. It should only be used once per menstrual cycle and only protects against one episode of unprotected intercourse. Hormonal birth control must be put on hold for one week after taking Ella, as using both together can interfere with how each one works. Ella is available by prescription only, which is why you didn’t see it on the shelf with Plan B.
There is no official body weight limitation for using Plan B or Ella, but some studies have suggested that Plan B may be less effective if you weigh more than 165 lbs (or have a BMI >30) and that Ella may be less effective if you weigh more than 195 lbs (or have a BMI >35). By how much the effectiveness is decreased, we don’t know. The link between body weight and effectiveness is not supported by all studies and your weight should not stop you from choosing to take the medication.
So, you did the right thing by taking what you had access to at the time which was Plan B, and a single dose is all you required. A study did look at the effectiveness of Plan B at higher doses for people with a higher BMI and it resulted in no increased benefit. If you do require emergency contraception again you can speak to your pharmacist about getting a prescription for Ella.
Many people are unaware that emergency contraception is one of over 30 common ailments New Brunswick pharmacists are trained to do assessments for and can write prescriptions for if appropriate. Unfortunately, the government only publicly funds 12 of these common ailments and emergency contraception is not one of them.
This poses a potential barrier for some people to be able to access emergency contraception in a timely manner because, as you read above, the most important thing about the efficacy of these medications is how quickly you take them.
Some examples of other non-publicly funded ailments pharmacists can prescribe for include canker sores, fungal skin infections, hemorrhoids, menstrual pain, smoking cessation and pinworms. If you feel these assessments should be covered under Medicare or would like to see pharmacists assess and prescribe for other ailments within their scope of practice such as strep throat, reach out to your local MLA and let your voice be heard.
Erin Thompson (BSc, BScPharm) is a graduate of Dalhousie University and a community pharmacist practicing at Shoppers Drug Mart in Quispamsis N.B. Her opinions expressed in this column are published for educational and informational purposes only, and are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment.