Are over-the-counter birth control pills safe?

What is over-the-counter birth control?

Since gaining FDA approval last year, Opill, the first over-the-counter (OTC) birth control pill, has raised many questions and garnered a lot of attention. It is a mini-pill, meaning it is a progestin-only pill and doesn’t contain estrogen. Progesterone-only pills work by thickening cervical mucus and preventing ovulation, offering an effective and accessible method of birth control. Progestin-only pills may be considered safer than combined estrogen-progesterone for several reasons:

  • It may have fewer side effects.
  • It is safer for women who smoke, have high blood pressure, are overweight or have a history of blood clots.
  • It may be safer for breastfeeding women because progesterone will not affect your milk flow.
  • If you have a history or are at an increased risk of blood clotting, the mini-pill may be safer because it is not associated with an increased risk of developing blood clots.

With all of the available information from differing sources, you may still be wondering: “Are over-the-counter birth control pills safe?” Below, we dive into everything you need to know about the safety profile of OTC birth control pills.

 

Hormonal Birth Control Safety & Efficacy

Hormonal contraception has been a safe and effective form of birth control since the FDA approved the first hormonal birth control pill in 1960. Since then, there have been dozens of short- and long-term studies that show the efficacy and safety profile of hormonal birth control. 

Researchers and providers now have over four decades of research on the various forms of hormonal birth control, and at least 500 million women alive today have utilized contraception. It is safe, and when used correctly all of the time, fewer than 1 in 100 women will get pregnant, meaning it is 99% effective at preventing pregnancy. However, people are not perfect, so when talking about birth control and effectiveness, providers usually refer to the “typical use” rate of effectiveness. For short-term birth control like birth control pills, that is closer to 93%.

OTC birth control: What you need to know

The FDA-approved Opill is a short-term, daily hormonal birth control pill. That means you have to take it every day at the same time. It is safe and effective when used correctly and should be effective starting 48 hours after you begin taking your pill. There are still some things you should keep in mind before starting the medication.

In an interview with WFBR, Amanda Rostkowski, MD of Comprehensive Gynecology of CT, shared that due to the formulation of the minipill, you have to be very careful about taking it on time, every day. She shared, “For this particular pill, if you’re late by taking it even as little as three hours, they recommend a backup method, like condoms, for a week after.”

Other considerations include:

  • Cost: Many healthcare insurers cover the cost of prescription birth control, and they may not cover the cost of OTC drugs
  • Prior health history: If you previously had breast cancer, a history of blood clotting or used other methods of hormonal contraception with adverse effects, you should speak to your healthcare provider before starting the pill
  • Lifestyle choices: Because you have to take the minipill at the exact same time every day, it may not be the best choice for everyone, Dr. Rostkowski says. “If you are sexually active and younger, it can be hard to remember to take medication every day.”

The Progesterone only pill

Since the recently approved OTC birth control is a progesterone-only pill (POP), it’s critical to understand what that means and if there are any side effects or considerations. The POP, or mini pill, is one of two forms of hormonal birth control that contain progestin, a form of progesterone, one of the hormones that play a part in the female reproductive system. The other form of progesterone-only contraceptives is an injection. When used properly (meaning 100% of the time), progesterone-only contraceptives have a 99% effectiveness rate. Progestin-only pills are safe and effective and, for some individuals, may be a better option. Below, we discuss side effects, benefits and other considerations for progestin-only birth control.

Progesterone-only pill side effects

As with other forms of birth control, POPs have side effects. The main side effect is unpredictable spotting or breakthrough bleeding between periods. You may also have shorter periods or, less commonly, heavier periods. According to the American College of Obstetricians and Gynecologists, other side effects include headaches, nausea and breast tenderness.

Is there a risk of blood clots?

In some women, the estrogen in combination hormonal birth control can increase the risk of blood clots in the leg (deep vein thrombosis) or the lungs (pulmonary embolism). The risk is relatively low, but if you have other health or lifestyle factors like heart failure or cancer, you smoke or are currently using another form of hormonal therapy (i.e., gender-affirming care or for menopause), the risk may be more significant. In research, progesterone-only contraception was not associated with blood clots, so it may be a better option for individuals who are at a heightened risk. You should still speak with your healthcare provider prior to starting the pill if you have any of the previously mentioned risk factors. 

The progesterone-only pill and weight gain

One other often-noted side effect of hormonal contraceptives is fluctuations in weight, specifically weight gain. In research on POPs, there is limited evidence of weight gain. However, remember that everyone’s body responds to medication differently, and you may gain or lose weight. 

The progesterone-only pill and breastfeeding

The La Leche League International, one of the foremost breastfeeding advocacy groups, recommends POPs as the contraceptive of choice for those who breastfeed. In research, POPs do not impact milk production or neonatal outcomes.

Talk to an ObGyn for OTC birth control needs and more

Yes, the OTC birth control pill is safe and effective when used correctly, but Dr. Rostkowski still implores women to visit their women’s healthcare provider, “we love meeting with patients and helping them explore their options,” she shares. Beyond birth control counseling, your ObGyn works with you on STI testing, annual women’s wellness exams and even bone density testing. Women’s Health Connecticut caters to every aspect of women’s health, from your first period to menopause and beyond. Contact us to request an appointment today.