‘I think it is a wonderful advance’: Birth control pills now without prescription

March 05, 2024
Box that's green and blue with the word Opill on it. Three foil packages of pills are fanned out beside it.
Opill, the new over-the-counter birth control pill, should be on store shelves this month. Image courtesy of opill.com

Birth control pills that don’t require a prescription are headed to stores across the country, and an OB-GYN doctor at MUSC Health calls that a wonderful advance. “Research has shown that women are really interested in having easier access to birth control pills, and it meets the safety criteria for medicine to be available over the counter. So, my reaction is extremely positive, and I'm glad it's going to be hitting the shelves,” said Angela Dempsey, M.D.

“Studies show that almost half of people who have sought a prescription for birth control have said they weren't able to get it because of barriers like no insurance coverage, lack of transportation to even get to a doctor's office or  being able to get time away from work or school in order to get to an office at a time that an appointment is available just to get the prescription. Being able to get birth control pills without a prescription for those people will be a real game-changer.”

Progesterone pills

The pills, brand name Opill, are similar to some of the pills women get with a prescription. “I think it's helpful to point out that the two types of birth control pills that have been available for close to 50 years are progesterone-only pills, and then combined pills that contain both estrogen and progesterone. The over-the-counter pill is a progesterone-only pill but contains the same type of progesterone that is in the prescription pills that have been available for a really long time.”

Dempsey, an OB-GYN professor in the College of Medicine at the Medical University of South Carolina, explained what progesterone does to prevent pregnancy. “Progesterone is a hormone that is normally found in the human body and has a lot of functions on the reproductive system. It is one of the hormones that can be made synthetically and is found in birth control pills,” she said. 

“And the role that it plays in a birth control pill is that it prevents people from ovulating, or releasing an egg every month, in many cycles. And it also thickens the cervical mucus, which makes it impossible for sperm to penetrate.”

Cost and considerations

The pills will sell for about $20 a month. Dempsey said this is nothing new for much of the world. “Birth control pills are already available over the counter in over 100 countries.”

She had four key areas for women to keep in mind as they consider the first OTC birth control pills. “First, it's important to take it around the same time every day. If you do miss a dose, check on their website or call your provider to get instructions about how to catch up,” Dempsey said.

“Second, the most common side effect with any progesterone-only birth control pill, including the one that's going to be available over the counter, is irregular bleeding. That's not a sign that it's not working or that it's dangerous. It's just an effect of the progesterone hormone. But if people are trying the over-the-counter pill and have the side effect of irregular bleeding, that might be another time to just check in with their provider to see what tweaks they can make to make that better."

Third, birth control pills don’t protect against cervical cancer or infections. “And so it's still gonna be important to see your provider to make sure that you stay up to date and keep yourself as healthy as possible with all the other preventive care in addition to birth control that you might need.”

Fourth, people with certain medical conditions need to check with a doctor before taking the new pills. “There are not very many, but if you have had breast cancer, if you take seizure medication, talk to your provider about whether the pill is still safe and effective for you,” Dempsey said. “But the vast majority of people are going to be great candidates, and it works equally well as the birth control pills that you can get by prescription for preventing pregnancy.”

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