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How Bad Is It to Take Plan B As Birth Control?

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There aren't a lot of stats on how many women take Plan B—emergency contraception described by the company as a "backup plan" to prevent pregnancy—as a form of birth control, but when I heard a friend mention that she took Plan B upwards of fifty times as a BC replacement, I started to wonder: How bad is it to use Plan B as your Plan A? (BTW, don't fall for these three birth control myths.)

Sure, spending $50 at the drug store everytime you have sex isn't ideal. But hey, it's easily accessible without an Rx, and better than the alternative—an unplanned pregnancy—so the logic goes. (I informally polled a dozen or so friends and coworkers ages 23 to 30, and there was a clear pattern: Everyone had either taken the emergency pill multiple times themselves or knew someone who had. I'd even heard of some relying on it more or less as their only form of birth control, taking it multiple times per month, when on a hiatus from taking the Pill.)

Yet despite its frequent use, there is a striking lack of information about using Plan B regularly. In a group chat amongst friends, no one knew what was considered "too many times" to take Plan B in one year, or if taking it repeatedly was considered "safe" or "healthy." So here's the deal, friends.

The Health Lowdown

"There aren't health risks to taking Plan B as much as you need," says Lauren Streicher, M.D., clinical associate professor of obstetrics and gynecology at Northwestern Univeristy's Feinbeg School of Medicine. Medically speaking, there isn't any danger, since it doesn't contain estrogen, the hormone that can potentially up your risk of blood clots, Streicher explains. Plan B contains only a progestin—a synthetic version of the naturally-occurring hormone progesterone found in some birth control pills—which is responsible strictly for preventing pregnancy.

"It's not necessarily bad to use as a regular form of birth control because it is simply a higher dose of a regular progestin-only birth control pill," gynecologist Diana Hoppe, M.D. confirms. And according to clinical management guidelines for OB/GYNs from the American Congress of Obstetricians and Gynecologists (ACOG), "oral emergency contraception may be used more than once, even within the same menstrual cycle."

To ease any potential worries about the ability to get pregnant later on in life, as with any other progestin birth control, there's no reason to think that using it would have any effect on fertility, Streicher explains.

Still, there's not a lot of data on the safety of emergency contraception pills if used frequently over a long period of time (no studies have been done, considering the obvious limitations), and the ACOG guidelines do note that continued use of emergency contraception like Plan B exposes you to higher total levels of hormones than from ongoing use of your standard birth control pill. While there may not be any clear harm from that, there are still some unknowns, so it's not a great idea to give yourself more of hormones than necessary, says gynecologist Alyssa Dweck, M.D., assistant clincical professor at Mount Sinai School of Medicine.

There are other downsides too. "Irregular bleeding is the biggest complaint I get from people who use this over and over," Dweck says. Plus, if you take it repeatedly, it may take some time for your menstrual cycle to get back to normal, she says. Nausea is yet another not-so-fun side effect from the higher dose of progestin.

Preventing Pregnancy

But what about the whole reason you're taking the morning-after pill in the first place—you know, the whole preventing pregnancy part? Well, as the company states, it's simply less effective than other birth control methods. Compared to the birth control pill or IUD that are around 98 or 99 percent effective, respectively, Plan B prevents pregnancy about 75 percent of the time, if no other birth control was used, says Dweck. (Of course this number varies wildly depending on a number of factors including how old you are, where you are in your cycle, and if you took it as a back up after missing one birth control pill, she explains.)

Plan B doesn't become less effective each time you take it, but, "thinking about it statistically, if you keep using it over and over and over again, you're going to eventually be one of those 25 percent who takes Plan B and still gets pregnant," Dweck says. "The bottom line is, the more you use it the more chances you're taking that it may fail."

The Consensus

While the docs all agree there's no clear health danger from taking Plan B even as often as a couple times per month, it's definitely not recommended by anyone as a replacement for regular birth control.

Not to mention, practically speaking it's pretty ridiculous too. "If someone is having sex even just three to four times a month, you're still talking about a couple hundred dollars a month," Streicher says. (And many birth control pills are now free under the Affordable Care Act!)

One of the biggest concerns for docs? If you're relying solely on an emergency contraceptive, that likely means you aren't seeing a primary care doctor or OB/GYN, or don't have a trusting relationship with them, says Hoppe. Whether you go to a family doctor, local clinic, or Planned Parenthood, regular check-ups are a crucial time to talk about other things besides contraception, like how to prevent STDs and maintaining optimal vaginal health, she says. Your doc can also chat with you about the best form of birth control there is. So while Plan B is good in a pinch, you should talk to your doc about healthier (and cheaper!) ways to practice safe sex.

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