Welcome back; it’s Doctor Rich. So I was watching an early episode of The Walking Dead, and a potentially sensitive medical topic (that of abortion) came up. That wasn’t what concerned me. What concerned me was the topic of emergency contraception and abortion and how many patients don’t know what the difference between those things are. So we’re going to watch Lori Glenn and Rick “duke it out” — and then we’ll talk about the purpose, function, use, and misuse of emergency contraception.
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Glenn [to Lori, who’s nervously holding a bottle of pills]:
Morning-after pills. Do they even work?
I don’t even know if I want to…
I… uhhh… got these too — just in case.
Lori [reading the label on a medicine bottle]:
Prenatal vitamins. That’s a hell of a choice.
So morning-after pill or prenatal vitamins…
[Lori takes a handful of morning-after pills, goes to a field, and begins to vomit. Rick finds the bottle of morning-after pills and goes to find Lori.]
So she’s taking a bunch of morning-after pills. I wouldn’t imagine that within seconds she would become nauseous — this is probably a regret phenomena and inducing vomiting here.
Spoiler alert: Taking a morning-after pill will in no way affect an established pregnancy.
So Rick finds the morning-after pill and puts two and two together. And now for the confrontation…
Something you need to tell me?
We can’t leave. I’m pregnant.
Rick [Holding up the empty pill bottle]:
So what do we learn?
We learned that most people don’t know what a morning-after pill is. So the morning-after pill essentially is just progesterone and levonorgestrel, okay? It is specifically formulated as one pill, FDA-approved to be taken within 72 hours of unprotected intercourse. As long as it’s taken within that time frame, it will inhibit (or has an 80-some-odd percent chance of inhibiting) ovulation.
What does that mean? That means that every month in the first half of the cycle, the woman will start to produce an egg. In the middle of the cycle, that egg will ovulate — or it will leave the ovary and enter the fallopian tube. If sex has occurred, the sperm will then fertilize the egg, and the egg will go and implant inside the uterus. So emergency contraception only works to prevent the egg from ever coming out of the ovary to begin with.
It does not cause abortions in any circumstances. It doesn’t inhibit fertilization. It doesn’t inhibit implantation.
So if ovulation already occurred, it just won’t help as the morning-after pill. It just won’t help prevent the pregnancy that’s already occurred. So the only mechanism of action is to prevent ovulation from happening.
Now, long before there was a Plan B® or a prepackaged morning-after pill, there was the ability to take any combination birth control pill. If you add up a number of pills — we’ll call it four pills that total a hundred micrograms of estrogen and 0.5 milligrams of progesterone — and you take that, and then you repeat that dose 24 hours later, that is also highly effective at inhibiting ovulation. Does not cause an abortion, does not affect a pregnancy that’s already established.
Also, IUDs (copper IUDs and progesterone IUDs) can also be used as emergency contraception, meaning that if you’ve had unprotected sex and you place an IUD within that 72-hour timeframe, it can inhibit ovulation. It’ll also prevent implantation of a fertilized egg, but doesn’t disrupt a fertilized egg that’s already been established.
Now, if there was a circumstance where she wanted to have an abortion after already having fertilization, implantation, and the gestation of the pregnancy began to grow (which looks like to be in the first trimester, the very beginning part of the pregnancy) in the zombie apocalypse, they would look for a medicine called misoprostol, which causes uterine contractions. It can force an established pregnancy to be disrupted, and you can pass the pregnancy. Again, mifepristone is not available in the United States — that’s another medication that’s used for that. And of course, surgical abortion (which I think Herschel’s a veterinarian, but I don’t know if he’d be able to perform that). Thank God they didn’t wade into those waters.
But those are the options for terminating an established pregnancy, which none of those things were entertained in this episode. They used the wrong medicine to try to disrupt an established pregnancy — because emergency contraception doesn’t do that. Thanks for joining us for this zombie apocalypse episode of the Doctor Rich Channel! If you get caught in a zombie apocalypse, make sure you hit that subscribe button for more lifesaving information.