Emergency Contraception or Emergency Abortion

A recent article published by Contemporary OBGYN presented an update on Emergency Contraception. The authors mentioned the need for accurate information about emergency contraception pills anticipating legal changes in reproductive health after Roe and Wade reversal. Following the high court’s decision pharmacies have reported an increase of up to 3000% in the sales of emergency contraception.

The FDA has approved two types of oral emergency contraception pills: levonorgestrel 1.5 mg (Plan B One-Step or generic equivalents) and ulipristal acetate 30 mg as a single dose (Ella). We will focus here on the mechanism of action of Plan B.

The principal mechanism of action of Levonorgestrel (a synthetic progestin ) is believed to be the inhibition of ovulation. The Contemporary OBGYN article mentioned that Levonorgestrel “does not harm or disrupt an existing pregnancy” but later affirms that “The drug may also alter the endometrium to inhibit implantation“.

In order to understand what is an existing pregnancy, we need to review what is needed for a new human being to enter into existence. Fertilization (the union of the ovum and sperm to form a zygote) normally occurs in the fallopian tube after ovulation. The new human being (blastocyst) moves from the fallopian tube to the uterus where it implants 5-7 days after conception. A receptive endometrium provides the embryo with the opportunity to attach and develop in the woman’s womb. Research has demonstrated that Levonorgestrel given in high doses caused obvious alteration of the endometrium (loss of ciliated cells, and pinopodes disappeared). Another study found that Levonorgestrel altered endometrial glycodelin-A levels, which could affect implantation. A drug or device that alters the endometrium will disrupt the implantation and cause an early abortion. Following this logic Levonorgestrel can harm and disrupt an existing pregnancy by inhibiting implantation. 

In summary labeling Plan B as emergency contraception, or non-abortifacient drug is not accurate information. Emergency Contraception Plan B is available for purchase without any restrictions due to age, gender, or insurance status. It is imperative that accurate information is given, and people receive fully informed consent about the probable abortifacient mechanism of action of emergency contraception pills.




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