What to know about over-the-counter oral contraceptives

Opill, the first oral contraceptive to be approved for over-the-counter use, is now available in the United States. The FDA approved the pill in July 2023 and, as of this past April, it can now be bought online and on pharmacy shelves.

This offers one more option for women who want to prevent pregnancy but may not have access to a healthcare provider. According to the FDA, about half of the 6.1 million pregnancies in the U.S. are unintended.

There are pros and cons to Opill, according to OB/GYN Holly Zheng, MD, at Cape Cod Obstetrics & Gynecology in Falmouth.

“I think it’s a good thing for people who don’t have access to an OB/GYN or a primary care that they can see readily,” she said. “So, if there are issues with access where they can’t get in for an appointment, it’s a good option. If they are uninsured, it’s a good option.

“The thing I worry about is people potentially not going in to see their provider and that they may be missing out on their annual screenings.”

At annual visits, patients get pap smears to screen for cervical cancer and have breast exams to screen for breast cancer. They can also talk to their physician about other screenings that may be appropriate for them, she said.

Opill is a progestin-only contraceptive pill, as opposed to a pill that contains both estrogen and progestin. Progestin is the synthetic version of progesterone, a naturally occurring hormone in the body. Progestin-only pills have been around for decades and Opill is slightly different but works the same way as the others, Dr. Zheng said.

Progestin-only pills are also good for patients who can’t take pills containing estrogen. Dr. Zheng said those patients include:

• Patients with a history of migraines with an aura
• Patients with hypertension
• Patients who currently smoke tobacco who are over the age of 35
• Patients with a history of blood clots
• Patient who are currently breastfeeding

Effectiveness

Contraceptive pills with or without estrogen are both 99 percent effective with perfect use, which means women take the pill at the same time every day, Dr. Zheng said. But she pointed out that most people don’t take the pill at the same time every day, which reduces its effectiveness to between 91 and 93 percent. And with progestin-only pills, patients need to be even more vigilant.

“We’re traditionally taught that the pill containing estrogen is slightly more effective,” she said. “With the progesterone-only pill, we always tell people if you miss your dose by more than three hours, you need to immediately take your dose but use backup contraception for at least 48 hours. I always tell people with the progesterone-only pills it is a set-your-alarm, take-at-the-same-time-every-day pill.”

Not for Everyone

Progestin-only pills aren’t for everyone. Certain patients should check with their doctor to make sure it is the right contraceptive choice, Dr. Zheng said. Those patients include:

• Patients with liver disorders
• Patients who are on medications for seizure disorders
• Patients who are on medications for HIV
• Patients who are on certain antibiotics, especially for tuberculosis
• Patients who take medications for a mood disorder like bi-polar disorder
• Patients with a history of stroke
• Patient with a history of heart disease
• Patient who have had bariatric surgery, as birth control pills may be less effective
• Patients with a history of lupus

Patients with a history of breast cancer should not take either oral contraceptive, said Dr. Zheng.

“Some medications make the birth control pill less effective, so they really should contact their doctor before they pick it up,” she said. “People should also know it’s not an emergency contraceptive, so it shouldn’t be used for that.”

When deciding what type of birth control pill is best, it’s a good idea to know the pros and cons of estrogen-containing pills versus progestin-alone pills, according to Dr. Zheng. They are:

• Estrogen-containing pills are more likely to regulate your cycle. Progestin pills are known for causing irregular bleeding. While a lot of women still have a regular cycle, some women have no periods and others have break-through bleeding or spotting.
• Estrogen-containing pills are slightly more effective
• Estrogen-containing pills can help with acne, whereas progestin-only pills can worsen the condition.

The other thing to consider is the cost. The manufacturer of Opill has suggested a retail price of $19.99 for a one-month supply and $49.99 for a three-month supply. Depending on your health insurance plan, prescription birth control might be free.

The Massachusetts ACCESS law requires that any health insurance plan that is subject to Massachusetts laws must provide free birth control. That includes anyone who is insured by Mass Health or who purchases their insurance on the MA Health Connector. Those who are insured through their employer should talk to their employee benefits administrator or human resources person to see if prescription birth control is free.

Like all medications, progestin-only birth control pills can have side effects. According to Dr. Zheng, the possible side effects include:

• Acne
• Nausea
• Headaches
• Mood changes
• Cramping
• Irregular bleeding patterns

“The other thing people should know is regardless of what birth control method they choose, Opill and all of the other birth control pills do not prevent STDs, so if there are concerns about the risks of STDs, they should still use condoms,” she said.