Crazy guilt over morning after pill

[Arania]

Hi, I am feeling very upset after taking the morning after pill and wondered about others’ perspective.

Background is I’ve desperately wanted to be a mum for years but had lots of physical health problems then my marriage ended in my late 30s. Despite that it was hard to give up on the dream of being a mother. Started dating someone new, stupidly managed to miss a few pills on different weeks last month. I then realise there is at least a small chance I could be pregnant and I begin to panic because whilst I do desperately want to be a mother, and I’m already in my late 30s, I had begun to realise that things were going to end with the person I was dating and that he maybe wasn’t a very nice guy. But most of all I panicked because when the reality of possibly being pregnant hit, I realised I was too unwell to care for a child especially as a single mother with an insufficient time supportive ex.

As a result of this panic I think about taking the morning after pill but am concerned about doing it because I have always been quite uncomfortable with the idea of ending a conception. I am very very very pro-abortion rights for women in general as it’s an entirely personal choice and completely subjective. But had always thought this was something I personally would find it difficult to deal with. obviously the morning after pill is not an abortion but my understanding is the research around its mechanism of action is uncertain and they can’t fully rule out that it prevents implantation of an early embryo. Whilst this is not technically a pregnancy, it is postconception so I personally am not comfortable with stopping this (I realise this is a fringe view and most people would be fine with it which I understand).

Eventually I become so panicked that I just take it. After a few days I became overcome with guilt.

Obviously the chance that I was even pregnant in the first place in my late 30s with a few missed pills more than seven days prior were pretty low, Probably under 1% percent. Yet this doesn’t seem to help, I am still overcome with remorse

I am unclear if follicular rupture counts as ovulation. The drug doesn’t normally seem to have much of an affect on downstream luteal progesterone concentration either

OP have you considered counselling or CBT or such for the anxiety and guilt? As pp said you’re actively seeking material to fuel the guilt and worry. Respectfully, this isn’t the usual response to the MAP I would have thought

I don’t understand why it is so often stated that levonelle can inhibit or even delay ovulation when – as far as I can see – all that has been conclusively proven is the drug only really works before ovulation.

OK, fine. Based on this: www.ncbi.nlm.nih.gov/pmc/articles/PMC5102184/#__ffn_sectitle

Yes- IF you managed to ovulate despite being on oral contraceptives and IF you had sex on a fertile day and IF the egg you produced was of sufficient quality to produce a viable embryo and IF the sperm of the man you slept with was also of a sufficient quality to produce a viable embryo and IF your body would otherwise have sufficiently produced a suitable uterine lining to sustain the products of conception, despite you having been on the pill, and IF said products fertilised and continued to grow in such a way that they would have implanted and successfully produce an infant, then yes, taking the pill may have led to the loss of a viable embryo. It's very, very, very unlikely.

Might I offer you this:

The Sunscreen Song, by Baz Luhrman

Specifically, this line: Whatever happens, don't congratulate yourself too much, or berate yourself either. Your choices are half chance, and so are everybody else's.

I also agree with PP, consider seeking some help to deal with your anxiety.

Entirely reasonable advice that this isn’t a normal reaction to taking the MAP and to seek counselling for anxiety! It’s not, and I know it’s to do with wanting a kid but being too physically unwell. And yes I have sought counselling for this given my excess distress

Assessing the research is something I do with everything-I worked in academia for 14 years. Can be a bad thing. I was hoping to reassure myself by looking again at the precise evidence that this drug does work by inhibiting or delaying ovulation. Dr Q put it well- if there’s no decent medical evidence this thing stops implantation...then why worry.

But looking at the main papers cited.....looks to me like in most cases the LNG MAP doesn’t actually stop egg relapse and rupture. I feel like i am missing something due to lack of medical knowledge that Dr Q the gynae could possibly explain

if I get my head round this last bit it might help me stop all the research and move on!

Maybe the scientific community hasn't worked it out yet, so they've gone with the best explanation they've got?

But the statements you see on some high quality scientific pages saying -LNG works via inhibiting ovulation - they seem to be contradicted by the raw data in a few of the most cited papers....so it would be an odd best guess explanation for them to make

Because past a certain stage in the cycle, according to these papers, most women do show follicular rupture, DESPITE the fact that the data is showing the drugs stops pregnancy if taken prior to ovulation. i.e. the drug only works prior to ovulation....but not by stopping, inhibiting or even delaying ovulation. Unless they mean..........the egg is released, but it's damaged or inhibited in some way.

Unless I am being dense and there's another component to ovulation other than follicular rupture

Maybe the scientific community hasn't worked it out yet?

TLDR, if they haven't worked out how it works.............seems odd they would not just say that.

Like............if the papers show LNG mostly doesn't stop follicular rupture....then how can the method of action be inhibition of ovulation?

That's not how science works though, is it? You can support a theory with evidence or you can disprove a theory with evidence. You can explore a phenomenon and offer suggested theories that explain it. But very rarely, if ever, is something definitely proven. The theory that we go with is generally the one that currently has most evidence supporting it. The Big Bang theory isn't conclusively proven, we don't know for certain how the universe was formed. It's just the best idea we've got.

@quince2figs
Could I ask a question ? And sorry OP to jump on your post

My dr is virtually insisting I have a mirena placed at time of elcs but I’ve always had Infections after c sections-I would much rather wait till the 6 week check but I’m getting a lot of pressure I don’t think it makes a difference does it (we never do anything sexual till after 6 weeks of that makes a difference so no risk at all!)

Hey broohaha-Yes of course you’re right that that is how science works. But what I’m saying is the main papers that are cited in support of the theory that ovulation is inhibited themselves actually say that the follicles rupture in most women i.e. ovulation is NOT inhibited.

Is follicular rupture synonymous with release of an oocyte? I've read otherwise, and that in around 50% of cases, an oocyte is retained within the follicle post-rupture.

www.nature.com/articles/s41598-019-51551-9

The above study was conducted on infertile women, but it may also be the case that the use of a MAP causes said retention of the oocyte, perhaps?

*I should say, women undergoing fertility treatment rather than infertile women.

Great find Broohaha. It could explain it. Noe et al in the paper propose eg cervical mucus stopping fertilisation of the egg but they might not have factored the above in

I was hoping the kindly contraceptive specialist gynaecologist could give an opinion on follicular rupture vs actual ovulation if she returns to the thread

XS-I do know someone who runs a health org who is quite down on Mirena being put in straight after birth. I’m sure a doctor would know better. It has sometimes been said that Mirena was pushed quite a lot but that might be because it’s effective

One thing I was particularly interested in in posting on this thread with other women’s opinions on things like the morning after pill and contraception that stops implantation. It is my understanding that all hormonal contraception may well do this on occasion due to the effects on the endometrium. People seem to have different views on whether this is something that actually bothers them. I think most people don’t even know it happens. I actually didn’t.

Well, if you post the @ symbol followed immediately by the name of the poster you want to reply, it should give them a notification that you've replied to them and they may come back.

As an aside, hormonal contraceptives can cause anxiety/depression (they certainly do for me) so if you're finding anxiety a problem, maybe consider coming off them?

For most people, I don't think the prevention of implantation, if it even occurs, is something that bothers them. It's a tiny bundle of cells at that point, certainly not sentient. It looks nothing like a baby. It has no heartbeat and, according to some sources, two thirds of fertilised eggs fail to produce an infant anyway. Also, women have an estimated 20% chance of getting pregnant each cycle, I believe (for women of 40, it's more like 5%) so the odds are that there is no fertilised egg to worry about anyway.

Oh, I came off them. Goddamn things caused the problems in the first place. I haven’t used them in many years. My mood never seem to be terribly sensitive to hormones, but it is ridiculously sensitive to bastard ethics around early implantation of blastocysts in a way that doesn’t seem to bother more sensible woman

@quince2figs
It would be most kind if you would give your opinion on the question of follicular rupture versus actual ovulation

*Hadn’t used them in many years. Least you know where you are with condoms!

@BrooHaHa Yeah I think you’re right. I just wish wish wish I could see it like that and stop feeling guilty.

Yeah I think that the odds that I actually conceived, whilst on the pill, even having skipped a few, have got to be under 1%. And the odds that the morning after pill interfered with any post fertilisation event would take that figure down further! And yet my brain won’t let go of the guilt saying as long as there is any probability, there is

*As long as there is a probability this happens, there is culpability for making the decision to take the pill.

Why do you feel guilty?