Over-the-Counter Birth Control Pill: What to Know (2024)

New options for birth control don’t come along very often. But now we have something to celebrate: the first over-the-counter (OTC) daily birth control pill in the history of the United States.

Oral contraceptives have been available without a prescription in other countries for many years. Now that the same is true in the U.S., birth control pills are more accessible than ever.

This is exciting news for all people looking for a safe, effective way to prevent pregnancy. Here’s what you should know about the OTC norgestrel 0.075-mg tablet, sold under the brand name Opill.

What’s new about Opill?

First, the medication itself isn’t new. Norgestrel was approved by the U.S. Food and Drug Administration (FDA) back in 1973. People have been using this medication to prevent pregnancy for decades.

What is new is that you no longer need a doctor’s prescription to get norgestrel. You should be able to find Opill in drug stores, grocery stores, and convenience stores. You can also order Opill online.

Who might want to take Opill?

The fact that Opill is available without a prescription is a big deal because it removes many barriers to hormonal birth control. For example, Opill can be a good option if you

• want or need privacy when it comes to birth control

• are having problems getting health insurance

• experience a delay in refilling your prescription birth control pills

  See Also

  Options for Over-the-Counter Birth ControlOral Contraceptive Pills (OCP): What You Should KnowOver-the-Counter Oral Contraceptive Pills | KFFBirth control methods | Office on Women's Health

• need birth control while you are waiting for an appointment with your doctor

• don’t have the time or means right now to visit a doctor for a prescription

• are a teen who is uncomfortable talking with your parent or guardian about birth control

These are just a few of the situations where someone might want to take Opill. With an OTC option, limited access to health care doesn’t have to mean limited access to birth control.

How does Opill work?

Some birth control pills combine the hormones progestin and estrogen. Opill is different in that it contain only progestin.

Each pill has the same dose of progestin, so you get a steady amount of the hormone throughout the month. Progestin helps prevent pregnancy by thickening the mucus in your cervix, which makes it difficult for sperm to enter the uterus and travel up to an egg. Progestin also may reduce or stop ovulation.

Side effects include headache, nausea, breast tenderness, and irregular vaginal bleeding. Symptoms should improve the longer you take the progestin-only pill. If they don’t, you can discuss other birth control options with your ob-gyn.

How do I take Opill?

Opill is taken once a day by mouth. Taking the pill within the same 3-hour window each day is important to get the most benefit. You can set a daily alarm on your smartphone or another device to help you remember.

Once you start using Opill, it will take 2 days for the progestin to reach full effect. Avoid vaginal sex or use a back-up birth control method during this time.

If you miss a dose, take it as soon as you remember. Again, you’ll need to use another form of birth control for the next 2 days. As with any medication, it is important to read and follow the directions carefully.

What are the benefits of using Opill?

Progestin-only pills like Opill are more likely to prevent pregnancy than other over-the-counter methods of birth control. With what we call “perfect use,” about 2 in 100 women get pregnant during the first year of using norgestrel. But most people aren’t perfect when it comes to taking medication, so the chance of getting pregnant is usually higher for what we call “typical use.” It’s important to take the pill at same time every day to decrease your risk of an unintended pregnancy.

While Opill is only approved for birth control, it may offer other health benefits too. Progestin-only pills can make your periods lighter and less painful. Opill may also improve the symptoms of premenstrual syndrome.

Norgestrel has a very good safety record that’s based on decades of use. Some people prefer progestin-only pills over estrogen–progestin pills because they don’t increase your risk of high blood pressure, migraines, or blood clots. Progestin-only pills are also safe to use right after childbirth, even if you are breastfeeding.

What else should I know about using Opill?

Opill is more effective at preventing pregnancy than some other birth control methods, but using condoms and Opill together can decrease the risk of pregnancy even more. If you want more assurance or have trouble remembering to take a pill every day, the birth control implant or IUD may be a better fit.

Progestin-only pills may not be a good choice if you have certain medical conditions. You should not take Opill if you have ever had breast cancer. If you have other chronic medical conditions, like cirrhosis, ask your doctor about what methods may be the safest for you.

Certain prescription medications may lower the effectiveness of the progestin-only pill, and vice versa. Ask your doctor before trying Opill if you take medication for seizures, tuberculosis, HIV/AIDS, or pulmonary hypertension.

Norgestrel should not be taken as emergency contraception and cannot be used for abortion. And like all birth control pills, Opill won’t protect you against sexually transmitted infections (STIs) such as HIV, chlamydia, gonorrhea, or syphilis. To prevent STIs, you will need to use a barrier method like a condom.

Last but not least, taking Opill doesn’t replace your relationship with your ob-gyn. Annual ob-gyn visits are an important part of health care. These appointments are a chance to talk about health and cancer screenings, sexual health and birth control, menstrual period concerns, and any health questions you may have. If you start taking Opill, be sure to tell your ob-gyn at your next visit.

What remains to be seen?

Because OTC access to a daily birth control pill is new in the U.S., some details are still unknown. For example, we don’t know yet whether health insurers will be required to cover Opill.

We also don’t know where Opill will be kept in stores. Will it be right there on the shelves, alongside tampons and aspirin? Or will you find it behind the counter, like with some cold and cough medications? You still won’t need a prescription if Opill is stocked behind the counter, but you will need to ask the pharmacist for it. Rules like these may vary by state, by retailer, or by individual store. Also, pricing may vary from store to store.

Final thoughts

Safety, effectiveness, convenience, privacy—there are many reasons why someone might choose the OTC birth control pill. As an ob-gyn, I’m glad millions more people now have the freedom to make this choice.