I stand educated on Plan B and why it might be safe for OTC use.

By the way, I have to say I never heard about the horrible side-effects of Plan B before (not that has anything to do with it being OTC).

My own experience with Plan B type medication - once was enough to remind me that condoms or other forms of BC MUST ALWAYS be used. The side effects are very unpleasant (and I am a woman with mild to moderate menstrual symptoms anyway.)

Let's start with the nausea, which can knock you off your feet for the better part of two days. Then we'll get to the cramps, which feel roughly like someone has reached inside of your lower belly with a long needle and is poking your delicate insides repeatedly. Then, since you are nauseous and your tummy is hurting, you have the general flu-like symptoms of sleepyness and disorientation. All in all you are out of work or school or whatever you participate in for at least a day - physical pain is a good deterrent to repeat incidents.

The idea of a young woman trying Plan B once and then again engaging in sex that would require her to use it again in the same MONTH even is beyond the pale. Unless the young woman in question has a high tolerance for pain, she will learn from this experience.

And I am sorry Mr. Esser as you may be a very responsible and caring person, but YOU are not the one who has to worry about a pregnancy and YOU are not the one who has to suffer the long term effects of such a decision (legal and moral responsibility do not always coincide with reality). Nor are you the one who has to endure the side-effects of Plan B. Your questions are valid, but your real intent is clear. It would as difficult for you to understand this pain as it would be for most women to understand why it hurts you guys so much when your testicles are kicked really hard.

I am a women's health nurse practitioner who dispenses all types of contraception.

The reason that Plan B is not only suitable for over-the-counter use, but in fact more suitable for OTC use than the regular birth control pill, is that it contains progesterone only, and the regular birth control pill contains estrogen and progesterone.

Estrogen is the culprit in the serious health concerns with the pill like stroke or venous thromboembolism, which are very rare, but must be considered, especially for women who have other risk factors, like high blood pressure, smoking status, or a family history of stroke at a relatively young age (suggestive of a genetic mutation like Factor V Leiden). Progesterone (especially with daily use) is implicated in many nuisance side effects (vigorously documented in the letters section of Broadsheet) but no life-threatening ones, so OTC use is safe for Plan B.

(There is a progesterone-only pill for use when breastfeeding, but it is not as effective as the combined estrogen-progesterone pill and is rarely used outside of a breastfeeding context, since lactational amenorrhea provides some supplemental protection. For women with contraindications to estrogen, we would recommend the much more effective and easier to use Mirena or Paragard IUD or the Depo-Provera injection, which of course have their own issues I won't go into here.)

Although anyone can have a unique side effect to any medication, estrogen is also the culprit in nausea in the vast majority of cases. Having dispensed Plan B hundreds of times, and having dispensed the old-school morning-after pill which was combined estrogen-progesterone pills in various regimens, I suspect that most of the posters here are recalling friends' experiences with the old regimen (or with Preven, the estrogen-progesterone emergency contraception packaged for EC us, which was available until probably 2004 in my area). The nausea on the old regimen was really major and pretty much universal. I can't recall hearing about it from even one person with documented Plan B use.

Also, Plan B does not work by bringing on a period. In fact, depending on what point in a woman's cycle she takes it, she may find her period delayed by several days, since menses happens when the level of estrogen and progesterone in your body drops below an endometrium-supporting threshold level. So this piece of misinformation can create lots of unnecessary worry for women. Plan B works by preventing ovulation (if you haven't ovulated yet) and/or by thickening your cervical mucus to make it less passable and hospitable to sperm, i.e., the same way the regular birth control works, minus the third aspect of thinning the endometrial lining (since it is not taken daily).

And Katha, I'm a huge fan, but I can't support your unqualified recommendation of the Today sponge. The sponge, like the diaphragm and the cervical cap, has perfect-use effectiveness of around 88%-92%, which is really not that high, and those methods are considerably less effective for women who have had babies (little-known and very major fact). For them perfect-use effectiveness is more like 80-85%, which really doesn't cut it for most women. I'd recommend using a condom with it, and since the condom is more effective, it defeats the purpose of using the sponge. Additionally, one is then exposed to the irritation and increased risk of STDs (from microabrasions in the mucous membranes) that come with nonoxynol-9, and the difficulty of perfect use with something that is more conspicuous to carry around and moment-breaking to insert than a condom. That said, the sponge is better than nothing.

As far as the cost of these methods--in fact, for many people, prescription use is less expensive than OTC use. This is a common phenomenon, coming up a lot with allergy medications, since then the client is paying the entire cost instead of the insurer picking up at least part of it. In fact, we often write prescriptions for condoms for this reason. However, I practice in California, where most uninsured women qualify for the state-funded family-planning program, which covers all of these methods. Here a woman can receive Plan B from us at no cost to her, but will pay $40 for OTC use. The benefit of OTC is that then she can access it sooner and thus increase its likelihood of effectiveness (say, if she needs it Friday night and we don't open until Monday morning).

Lastly, the harm-reduction model of health care is too big a topic to address here, but I would suggest that shaming a woman for repeated use of Plan B is not only bad health care, since if she needs Plan B she needs Plan B, but also totally ineffective in getting her on a Plan A method of birth control, which is dependent on trustworthy therapeutic communication. If I have to give a thirteen-year-old Plan B six times, but I keep her coming in the door to get more information and education each time, I am way more likely to get her on a method like the Pill than if I give her a trip the second (or fifth) time and she never comes in again. So I'm disappointed in the short-sighted "regular-use" conversation happening here. Also, this conversation is unique to Plan B. Would you deny a regular headache sufferer pain medication until she displayed avoidance of stress and computer screens and got an optometry exam? Or insulin to a type-II diabetic until he lost an amount of weight that met your arbitrary standards?