8:49 am - 06/19/2010

plan b twice in one month?

Hey everyone, this is my first time posting here. I checked the tags and faq about plan b but couldn't seem to find my answer so hopefully this is ok.

In the beginning of the month, I had unprotected sex with my boyfriend and took plan b less than 12 hours afterwards. He didn't ejaculate in me, however I'm not on HBC (due to health concerns and the fact that I feel it is really not that healthy for your body). I had some spotting after (it was light, then super super heavy, then light again. it lasted 3 days) 4 days after I took it. My period is due somewhere between the 26th and the 1st (usually my cycle is a 3-4 days longer than a 28 day cycle but it varies). Last night we had protected sex, but the condom broke. We stopped way before he ejaculated. Is it safe to take plan b twice in one month? What will it do to my cycle? I've heard that it can mess up your cycle and give you spotting for 3 months, is that true? I should be ovulating right around now, so I'm relatively more concerned about an unplanned pregnancy right now than I was the first time I took it.

Thanks in advance

Ps- I know I should be more responsible aout using a more reliable birth control method than condoms, but I really am not too keen on pumping my body full of hormones that can cause horrible side effects.
prettyhowtown_ 19th-Jun-2010 02:14 pm (UTC)
You could ask in the askanurse community.

I cannot say for sure whether taking Plan B twice in one month could cause long-term side effects, but I am sure that you would feel pretty out of sorts for at least a month or so. I took Plan B once (am very sensitive to hormones, FWIW) and felt terrible for weeks... exhausted, pimply, grumpy... just not myself, and my period was very much out of wack.

You might consider getting a paragard IUD. I got one for free at a Public Health clinic as I did not have health insurance at the time and also had a very low income. It is non-hormonal and causes some side effects (cramps and heavier bleeding), but these are more manageable for me than the side effects caused by hormonal BC.
svexsal 19th-Jun-2010 02:50 pm (UTC)
I agree with this comment. Paragard is wonderful for that sort of thing and I too qualified for a free one when I went to Planned Parenthood. Check out iud_divas.
Good luck!
kort_ni 19th-Jun-2010 02:24 pm (UTC)
I can't really answer your question about taking plan B twice in one month, but wanted to point out that if you are concerned about the hormones in hbc (and pumping your body full of them), you are getting those same hormones in mega doses when you take the plan b.

You might also want to check out the fertility awareness method or iuds, if you feel that condoms alone are not a reliable enough birth control method for you.
frolicnaked 19th-Jun-2010 07:54 pm (UTC)
I'm not a salesperson for HBC but I'm not entirely sure that the hormones-being-bad-for-you is scientifically correct...

Along this line, I think one important factor to consider is that "you" covers a wide variety of people. For example, if "you" are someone with, say, hypertension, a family history of blood clots, and migraines with aura, those are all substantial contraindications. And for that person, combined hormone BC may indeed pose real health risks. On the flip side, if "you" are someone who has heavy, painful periods and who's prone to ovarian cysts, HBC can actually help make those situations more manageable for some.
misspaigeb 19th-Jun-2010 02:42 pm (UTC)
euphonism 19th-Jun-2010 05:20 pm (UTC)
archangelbeth 19th-Jun-2010 03:05 pm (UTC)
The megadose of hormones in Plan B can do just about anything -- or nothing -- to your cycle, depending on how your individual biochemistry reacts to the hormones. If you're concerned that your boyfriend might've had semen in his precum from a prior ejaculation, or might've "leaked" (rare; in my experience, it happens at a fairly high state of arousal), such that there might've been exposure to sperm, then Plan B would be a good way to hedge your bets. (Though Plan B may not stop an ovulation that is very close to completion, nor will it do much, if anything, if one has already ovulated.)

Another option would be the ASAP insertion of a copper IUD, I hear, but you'd probably have to talk to iud_divas for more data there.

Note that Perfect Use Withdrawal has an effectiveness rate in the mid to high 90s, just like Perfect Use Condoms do; it would not be beyond the pale for you to decide that this counted (assuming no prior ejaculation without urination before the next "round") and was sufficient protection.

I also note that you are not at all irresponsible to be using only condoms. My spouse and I used only condoms (with an occasional instance of only-sponge) for approximately 10 years before we deliberately ditched all contraception with the intent of conception. Now we use either only-condoms, sponges-with-crude-FAM or crude-timing, non-PIV sex, or -- far too commonly -- "oh, great, the kid's awake and needs breakfast" and "it's late and I'm exhausted." O:p Anyway, with only-condoms, I've only been pregnant once, far as I know.

Now, you may wish to consider different condoms that may be less prone to breakage, or review if they're being used correctly (sufficient lube, etc.) to reduce breakage and ensure lack of "slipping"... Or you may feel that the recent break just makes you feel uncomfortable about condoms! In which case you might want to look into the sponge, withdrawal as a researched and deliberate method, diaphragms/cervical caps, or a copper IUD, to use instead or in conjunction with condoms.

But condoms-alone doesn't make you irresponsible, honest. This is a matter of comfort with your chosen method, not "irresponsibility."
atalanta0jess 19th-Jun-2010 04:04 pm (UTC)
Yup - copper IUDs work (VERY effectively) as EC for up to five days after the intercourse, I think it is. The only catch is that I'm not sure how easy it is to find someone to do an emergency insertion. It may be possible...I don't know anyone who has tried, quite frankly. I know that the PPH where I got mine was quite insistent about having an STD test before hand, so that could be an interfering factor.
fullcollapse 19th-Jun-2010 03:10 pm (UTC)
I'm not well versed in the general safety of hbc, but I'm led to believe that on the surface, it's not all that harmful--however, it increases the risk of blood clots dramatically. For that reason alone I have and will never take it, because my mom had a blood clotting disorder that was only noticed when she became pregnant and it caused her many losses, even one full term (would have cropped up if she used hbc as well) and within 16 years, it killed her. It's also why I will take preventative measures and go on daily injections of blood thinners since there is a chance that I have the disorder as well.

I just wanted to throw that out there, on the safety of hbc, in case anyone is put off my the OP's assertion that it's unsafe, because it's very dangerous for some women. I believe it can increase the risk of clots in women with no clotting disorder, as well as create a baaad situation for those who do have one. Husband and I haven't been having sex for very long, just a couple years, and we just use condoms right now. We want children but won't actively try until this October. After our first, if I don't feel like condoms are enough, I'll only consider a non-hormonal IUD. The problems with clotting come from the surge of hormones, which is why pregnancy can "trigger" it. I'd be very opposed to Plan B for myself simply because of be afraid of what it could do to me (and we want kids, so yeah.)

I was unaware that you can get the IUD for free through some programs if you qualify. I'll have to look into that when the time comes.
atalanta0jess 19th-Jun-2010 04:02 pm (UTC)
I don't think it increases the risk of clots "dramatically" for most women, just to clarify. It increases the risk, but not hugely.

WRT getting an IUD for free, in some areas Planned parenthood has programs that offer free contraceptive health care. AFAIK, most of those programs include any type of contraception that the PPH offers, including IUDs. Its pretty sweet. :)
archangelbeth 19th-Jun-2010 05:56 pm (UTC)
"Dramatically" may be overstating the case, sort of. The increase is measurable and has things like "fivefold" in it, but this usually something like "Tiny chance multiplied fivefold to be less-tiny chance." (And pregnancy bumps up the rate comparably or more, depending on the study you look at!)

http://www.healthfinder.gov/news/newsstory.aspx?docID=630012 says: "The overall risk of venous thromboembolism is low, perhaps three for 10,000 woman-years for women in general, [...]" I believe that translates to something like, out of 10,000 women in a year, you might have 3 with blood clots. (Although my math may be off.)

Older pills double or triple that -- presumably 6 to 9 out of 10,000 woman-years -- says this article. The newest ones multiply by 4 or 5, so presumably 12-15 out of 10,000 woman-years. The safest are levonorgestrel or norgestrel.

It also says that the lower the dose, the lower the risk, and that the risk lowers the longer one is on the pill. "The risk of an event was highest in the first three months of use and lowest with pills containing levonorgestrel." (Further, POPs and IUDs don't raise the risk, the article says.)

(The article doesn't assess the risk to smokers or people with other predisposition to clots anyway.)

I believe http://www.ncbi.nlm.nih.gov/pubmed/19679613 and http://www.ncbi.nlm.nih.gov/pubmed/19679614 are a couple of the studies, in less accessible form. (Or similar ones.)

This jibes with other stuff I've researched.
http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/020683s004s006s007lbl.pdf says: "The approximate incidence of deep-vein thrombosis and pulmonary embolism in users of low dose (<50 mcg ethinyl estradiol) combination oral contraceptives [(levonorgestrel and ethinyl estradiol)] is up to 4 per 10,000 woman-years compared to 0.5-3 per 10,000 woman-years for non-users. However, the incidence is less than that associated with pregnancy (6 per 10,000 woman-years). The excess risk is highest during the first year a woman ever uses a combined oral contraceptive."

http://www.ncbi.nlm.nih.gov/pubmed/8996419 disagrees slightly with the first link, and believes that third-generation OCs (oral contraceptives) were prescribed preferentially to older women, who were more at risk for blood clots anyway. (If I'm reading that one right. I'm pretty sure I am...)

I do note that you are totally correct! HBC does measurably increase the risk of blood clots, and you in particular have a genetic history that suggests you may be predisposed to them anyway. It's just that "dramatically" is perhaps a misleading term for people who don't have the same medical history.
nickelshoe 19th-Jun-2010 10:08 pm (UTC)
As far as I know, levonorgestrel (the Plan B drug) does not increase risk of clotting. It's the estrogen in the HBC that is the issue, which Plan B doesn't have.
jaggednib 19th-Jun-2010 03:59 pm (UTC)
My husband and I are using the withdrawl method and infrequently, we'll use condoms. I don't consider this irresponsible, though. We're done having children and this is going to suffice until he goes to get his vasectomy.
Personally, I would only worry about plan B if there was 'accidental' ejaculation INSIDE my vagina...
dizzybee7 19th-Jun-2010 07:19 pm (UTC)
I used Next Choice twice in one month because I was paranoid that withdrawal didn't work. I was in the same situation as you--I took it really early in my cycle when I definitely wasn't ovulating and probably didn't need to take it, and then I really thought I did need it later on in my cycle because I would be ovulating at that time.
Both times I took it I got had a withdrawal bleed a few days later. I also skipped my period for that month month, but I wasn't pregnant. So yeah, I just had the 2 withdrawal bleeds and then no period. I think it made me really emotional but other than that nothing too bad. There was no three month spotting, just the 2 withdrawal bleeds. Of course my cycle was messed up because I did skip that month but I expected that something like that would happen.
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