Ask Dr. Hallberg: Plan B contraceptives explained

The Department of Health and Human Services announced Monday that health insurers must pay for a full range of women's health care services.

Included in that mandate is the cost of contraceptives, including conventional birth control pills and the medication known as Plan B, which is sometimes referred to as the "morning after pill." The move has not been without some controversy.

Dr. Jon Hallberg, in an interview with MPR's Tom Crann, discussed how the medication known as "Plan B" works. Hallberg is a physician in family medicine at the University of Minnesota and director of the Mill City Clinic.

Tom Crann: What is this medication that is referred to, at least by brand name in one case, as Plan B?

Dr. Jon Hallberg: Plan B is a single pill that contains progesterone only, which is one of two hormones that we use for oral contraceptive pills, and it's meant to be strictly an emergency form of contraception.

Crann: So when we talk about birth control pills or oral contraceptives, what are we talking about generally? I know there are a lot of brand names and availabilities for you to prescribe, right?

Hallberg: Yes, it's actually mind boggling, and as a family physician, I simply don't have my finger on the pulse of all the different brands. ... At its most simple, all hormonal forms of birth control basically work the same way. Their main goal is to stop an egg from leaving the ovary. So if it can't do that, it essentially cannot become fertilized. That's the first thing.

The second thing is to make it very difficult, if not impossible, for that egg to travel through the fallopian tube, and likewise makes it very difficult for sperm to come the other direction, so it really can't cause fertilization.

And then finally there's the possibility that hormonal contraceptives make it difficult for a fertilized egg to implant or attach to the uterine lining, the womb. So that's not known for sure. That's almost sort of like a third step in that process.

Crann: How is this Plan B medication different from more conventional birth control pills or oral contraceptives?

Hallberg: On the one hand it's not any different. The ingredient, levonorgestrel, is a progesterone. It's in other forms of oral contraceptives. So first of all, the ingredient itself isn't different. It works exactly the way birth control pills do.

The one thing that's different is that it's a single pill, and it's meant to be a form of emergency or backup contraception, not meant to be a daily or primary form.

Crann: I imagine some people who have religious objections to the very idea of oral contraception would have the same objections to this.

Hallberg: Absolutely. This medication should not be seen as a separate category, and I think that in many people's minds, it is, it's like RU-486. And it's not that. So if people object to oral contraceptive pills, broadly, then they would also oppose this, but if you are OK with those, then there's no reason to think that this is any different.

Crann: If a woman is pregnant, does this pill work?

Hallberg: Not at all. This does not cause an abortion. I think that's where a lot of the controversy comes from, is that people are under the impression that this somehow stops that from happening -- that if someone's already pregnant, it stops the pregnancy -- and that's simply not true.

Crann: And there is a medication that used to be known as RU-486 that's out there, but this is not that.

Hallberg: Yes. I don't know why that is, but in the lay press and in people's minds, the two are constantly intertwined, and it's unfortunate that's the case. But they are completely different in the way that they work.

(Editor's note: RU-486, known by its generic name Mifepristone, is a drug that can induce an abortion if taken within the first six weeks of pregnancy.)

Crann: How is Plan B, as it's known, available now?

Hallberg: Some states have it available over the counter. Some places if you're under 17, you have to get a prescription. Some states have it scheduled, anywhere from a Schedule II, which would be like Percocet, all the way down to a Schedule V, which is much more liberal. So it really depends on the state that you're in.

Crann: But that differs a bit from conventional birth control pills in the way it's prescribed and available?

Hallberg: That's right. Oral contraceptive pills basically contain either estrogen or progesterone or a little bit of both. And the reason that they're more controlled is that there are interactions. If women smoke, for example, we really want to be careful about prescribing estrogen because that can promote things like blood clots in their legs.

Crann: Now what if a patient comes in to you and says, "I'm really not worried about this because there's always Plan B out there," what is your advice for them?

Hallberg: That happens, and I think it's important to remember that this medication is called Plan B for a reason. There should be a Plan A. There should be very good thought put into how does a woman not want to be pregnant, if that's the case.

And this is meant to be emergency contraception. I think that sometimes it does become a little too casual, and people just think, "Well, I've always got that."

And it's important to know, too, that with Plan B, if eight women would've gotten pregnant, it'll prevent seven of them from getting pregnant. But that is not nearly as good as oral contraceptive pills taken regularly. I mean you're looking at mid-90 percent coverage there. So it's simply not as reliable.

(Interview edited and transcribed by MPR reporter Madeleine Baran)

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