I recently had to change my pharmacy for two reasons. (1) Like an increasing number of big-chain drug stores in New York, the CVS in my neighborhood has put almost all of its products behind locked plastic cases and you can only get to them by ringing a bell and speaking to another human being, which is something I am usually unwilling to do in general, let alone to buy a Diet Coke, thanks, and (2) I started to get self-conscious about how much Plan B I’ve purchased there in the last year.
This isn’t because I think there’s anything shameful about using emergency contraception. Quite the opposite, in fact. In most cases in which Plan B is or may be required, I think that using it is the most responsible thing you could be doing. Unless you’re me, of course, because I’m using it the only wrong way a person can be, i.e. the exact way they/literally everyone tells you not to use it: as your primary form of birth control. I can explain, I swear.
Look, I never meant to end up this way. For a long time, I hit all the right marks as a sexually active woman solely responsible for my reproductive health (because, in case you haven’t noticed, our male sex partners are seldom expected to take on any part of that responsibility themselves and have, in fact, actively rejected the opportunities to do so that have come their way in the form of as-yet mythical male birth control). I went on the pill at 17 in anticipation of my inaugural sexual encounter with a boy who proceeded to break up with me almost immediately after said initiation to sex-having society (long story, different story). When, years later, I realized that the pill more so than the breakup was responsible for the severe depression I subsequently entered, I switched to the mini pill (hormonal birth control that only contains progestin, no estrogen). But if a pill doesn’t make you depressed, it makes your hair fall out. Meanwhile, the only long-term, non-hormonal baby-blocker on the market involves having a piece of actual metal shoved into your cervix, probably with little to nothing in the way of pain medication (a process 69 percent of Cosmo readers described as, “Pretty awful, actually.”) And while cycle-tracking via apps like the FDA-approved Natural Cycles has become an increasingly popular option among those who have ruled out pills or implants, it’s not without drawbacks of its own (like having to plan sexual activity around your fertility windows as well as data privacy concerns associated with some other period-tracking platforms).
All of which roughly translates to: For many people who may become pregnant and would rather not, there are no good birth control options, just bad ones and worse ones. (That said, hi, if you are a lawmaker with the power to continue stripping women of our reproductive rights, please don’t use this as an excuse to take this one away, thanks!)
So for the past year or two, while I’ve resigned myself to contraceptive limbo in the vague hope that maybe someone will suddenly invent a form of long-acting reversible contraception (LARC) that doesn’t cause some life-altering side-effect or other, coasting by on Plan B has kind of proven the least of the contraceptive evils, and I’ve relied on it accordingly. (Before you ask, yes, I am aware that condoms exist. But I am a mere mortal, which means that for all kinds of reasons we simply do not have time to get into right now, condoms don’t always happen, okay?)
And guess what? With the exception of some occasionally inconvenient post-coital trips to CVS, it’s literally been fine. I’m not saying I go into every sexual encounter planning to pop a morning-after pill afterwards. But also, what if I did? Would that really be so bad? And if so, why? I mean, look, I get why it’s not the best idea, logistically speaking—it’s both less effective and more expensive than most other forms of birth control. But if I’ve accepted those terms and still concluded, personally, that this is the best contraceptive option for me at the moment, is there any real reason—medically speaking—I shouldn’t use it as I see fit?
Or does the real rationale for this blanket warning against regular Plan B use have more to do, as I’ve come to suspect, with the same reason I started to feel weird about the frequency with which I’ve made these post-sex drug store runs in the first place, i.e.: the stigma that follows sexually active women for being sexually active women, particularly if we do so in a way that doesn’t fall neatly within the very narrow parameters of societally sanctioned sex-having womanhood. If we must have sex outside the patriarchal bounds of marriage and monogamy, we’re expected to uphold certain standards of cautiousness, discernment, and responsibility in those encounters in a way our male partners typically are not. We’re not supposed to be messy or unprepared or indiscriminate or indiscreet—all these things that have become synonymous with this image of rolling up to the drugstore after a presumably regrettable hookup to drop $50 on a backup plan.
So, for the sake of my own curiosity—and that of (mostly) shameless Plan B Queens like me—I went ahead and asked OB-GYNs and reproductive health experts if there’s any real reason you can’t use the morning-after pill as often as you want, or if this cautionary attitude that surrounds over-the-counter emergency contraception (EC) is just another symptom of the often arbitrary, shame-fueled ways in which society tries to police women’s sex lives and hinder our reproductive autonomy. Just! Wondering!
What Is Plan B and How Does It Work?
First of all, let’s get clear on what we’re talking about here. Plan B is one of the most commonly recognized brand names for a form of over-the-counter emergency contraception. Also known as oral levonorgestrel, it is a large dose of progesterone taken orally within 72 hours of unprotected sex, explains OB-GYN Vanessa M. Parisi, DO, Lead Physician at HerMD in Millburn, New Jersey. “It works by blocking the surge of luteinizing hormone (LH) and thereby prohibits ovulation,” she says, adding that it is more effective at preventing pregnancy the earlier it’s taken after sex. When taken within the first 24 hours, Plan B is 95 percent effective at preventing pregnancy, a stat that drops to 89 percent when taken within 72 hours.
And, just to go ahead and bust one lingering and very false morning-after-pill myth: If fertilization and implantation have already occurred, Plan B won’t do anything. Which is to say, it’s not the abortion pill and cannot harm an existing pregnancy, says Dr. Parisi.
You can find this same levonorgestrel-based drug under other brand names, including trendy newcomer Julie, as well as a number of off-brand versions that tend to retail for less than the big-name stuff (and which you can usually find me purchasing because, unless a particularly generous lover wants to spring for the full-price option—the height of romance!—I’m not shelling out an extra $20 for designer progesterone, thanks).
It is worth noting that Plan B (and its levonorgestrel-based ilk) isn’t the only form of emergency contraception. There are also by-prescription options like ELLA, which is recommended for use by consumers over a certain weight range (Plan B may be less effective for those over 165 pounds, per Planned Parenthood), or combined oral contraceptives consisting of ethinyl estradiol plus levonorgestrel, says OB-GYN Alyssa Dweck, MD, a member of the medical advisory board for sexual wellness company INTIMA. Last but not least, the copper IUD is a non-hormonal form of birth control, which, if inserted within five days of unprotected sex, can act as emergency contraception. For the purposes of this article, however, I’ll be focusing on Plan B/oral levonorgestrel.
Can You Really Take Plan B “Too Often?” (And What Happens If You Do?)
When it comes to matters of female health, particularly of the gynecological variety, it’s always worth keeping in mind that in the grand scheme of humans practicing medicine, we as a society only rather recently started giving a fuck whether women live or die. Even more recently did we decide women deserve bodily autonomy in the form of reproductive rights (and actually, in this country anyway, it seems we’re still not really sure about that! Love it here!). All of which is to say, there’s not quite as much research available on the morning-after pill—especially not-as-directed use of it—as we might like to see.
That said, based on what we *do* know (from the, oh, 30 or so years of use since this form of EC first hit drug-store shelves), Plan B can safely be taken as often as needed, even if that means taking it more than once within a given menstrual cycle, says board-certified Family Medicine Physician Erika Aragona, DO, a sexual health advisor for ASTROGLIDE.
“As far as we know, there is no point at which Plan B becomes unsafe. So theoretically, you could take it every morning with your vitamins,” says Community Sexual Health Specialist MaKayla Montoya, a Texas-based abortion expert. “In my professional experience, I’ve never seen anyone experience any sort of health risk [related to Plan B use], urgent or long term.”
While the experts note that there are possible side effects associated with Plan B, including nausea, breast tenderness, or disruptions to your menstrual cycle, these symptoms are temporary and not dangerous, though they can be annoying, says Dr. Dweck.
There’s also no evidence to suggest that frequent or repeated use of this form of EC will worsen the severity of those symptoms should you prove susceptible to them—which, according to Planned Parenthood, isn’t particularly likely anyway. Per their website, “The morning-after pill is super safe, and Plan B side effects aren’t super common. There have been no reports of serious problems out of the millions of people who’ve taken it.”
So Why Can’t You Use Plan B as Your Primary Birth Control?
Short answer: Well, you can. It’s like I always say: You’re an adult, you can do whatever you want.
But, to be clear, the three doctors I interviewed for this story all qualified their comments with more or less the same blanket statement that has always accompanied Plan B use: Even if there’s no known medical safety issue at hand with taking it more than directed, you should still avoid doing so.
Why? Because first and foremost, that’s what the package says and the rest of us have to assume that whatever decisions the powers that be make in terms of how we should or should not use the drugs they approve and market are made for a reason and who are we to go against their expertise? So fine, in case this wasn’t already abundantly clear: I am not a scientist nor a doctor nor anyone with the authority to encourage you to do something the prevailing wisdom says you shouldn’t.
With that little disclaimer out of the way, it seems the main reasons we’re cautioned against using Plan B as a regular form of birth control are not medical but logistical. “Experts recommend using Plan B sparingly and not as a primary form of contraception because it is a backup method with lower effectiveness compared to regular contraception methods like birth control pills, condoms, implants (like Nexplanon), or intrauterine devices (IUDs),” says Dr. Aragona. “It also is more expensive than other forms of birth control if emergency contraception is taken frequently.”
Don’t get me wrong, these are all perfectly good reasons to curb your Plan B dependency if you can. That said, no sex is 100 percent safe—whether you’re talking pregnancy, STIs, or kink-related risks. And personally, I’ve always been a big proponent of the idea that informed, sex-having adults have every right to weigh those risks and enact the preventative measures that work for them on their own terms.
And while, yes, there are plenty of logistically sound reasons to opt for a more reliable form of birth control, best believe that a lot of the “avoid it if you can” mentality surrounding EC is, in fact, rooted in lingering stigma, sex-negativity, and ignorance.
“I believe the title ‘emergency’ contraception is what feeds into this belief that it should only be used sparingly, although ‘emergency’ in that context means fast-acting,” says Montoya. “There is an astoundingly huge stigma around EC and people who use it, not to mention the medical misinformation that runs rampant on social media.”
This is a problem, not only because sex-negativity of any kind is harmful and disproportionately affects women, but because emergency contraception like the morning-after pill is “a revolutionary harm reduction tool and we cannot let misinformation and myths prevent people from accessing it,” says Montoya.
All of which is to say: Are there more effective birth control options out there? Yes, obviously. Does it make sense, logistically speaking, to use one of those rather than relying on Plan B? Also yes. But look, having a body—particularly one that could become pregnant—is complicated, and no birth control is without risks. Weighing those risks and choosing whatever method works for you is 100 percent your prerogative as a sex-having adult, especially in a society that delivers little to nothing in the way of support for women in terms of managing our reproductive health. And if that method of your choosing happens to be, well, a “backup method,” that’s not a personal or moral failing—nor is it really anyone else’s damn business. I’m not necessarily saying you should go out and start popping Plan B like candy, but I am saying you should go forth and pop it with pride.
