A look at Over-the-counter hormonal contraception in the USA

The FDA recently approved the use of Opill (norgestrel), a progestin-only contraception, as an over-the-counter (OTC) oral birth control available in the United States starting in 2024.  Tapti Panda, MD, FACOG, a board-certified obstetrics and gynecology physician at Crystal Run Healthcare, explains how access to contraception is vital to healthy family planning, and why an OTC birth control option may be a game-changer for women across the country.

“In a national survey shared by the NCBI, it was reported that one-third of women who attempted to receive prescription contraception faced access barriers[1],” remarked Dr. Panda. “Between having difficulties getting their prescriptions refilled, a lack of insurance, to even overbooked clinics or required pre-screening difficulties, it’s a no-brainer that we need nonprescription contraception as a way to decrease barriers to birth control.”

Opill is a progestin-only (norgestrel) oral contraceptive meant to be taken daily. It acts through thickening cervical mucus, making it difficult for sperm to reach the egg or ovum, and may also suppress ovulation. Like prescription oral contraception, it is reported to be 99% effective against pregnancy when taken as intended. It is not an effective protectant against STIs and cannot be used as an emergency contraception.

“People may also be able to take Opill to manage menstrual regulation or pain,” said Dr. Panda, “but it may not be suited for everyone looking for menstrual regulation. If you have a primary care provider or OB/GYN that you see, make sure you talk to them before using Opill as a regulator for your period or period pain. If you are experiencing severe side effects, make sure to stop taking it immediately and consult with your doctor about the next steps in your family planning journey.”

As with all medications, there are people who are advised against taking this over-the-counter contraceptive. Those already pregnant, suspect they are pregnant, have a personal or family history of breast cancer, or already using prescription contraception or other medication should all see their doctor before taking Opill.

“Most women are capable of self-screening to determine if they would be good candidates to use hormonal contraception,” Dr. Tapti mentioned. “The main concern here is to ensure over-the-counter contraceptives are universally available throughout the United States.”

The American College of Obstetrics and Gynecology has long supported the availability of OTC or non-prescription related hormonal contraception across all age groups without the need for annual or clinic visits or STI (sexually transmitted infections) screening.[2] With the approval of over-the-counter oral birth control, those without consistent access to prescription contraception now have more than condoms, Plan B 1-step, or spermicides to rely on. 

Family planning is an intimate and very personal journey, but it is not without its difficulties. Six million pregnancies happen in the United States every year, and 45% of them are unplanned.[3] Of those 2.7 million unplanned pregnancies, almost 500,000 were unwanted, and overwhelmingly occurred due to lack of access to contraception and compounded by financial difficulties.[4]

“This is a victory for women as the option to control planning for fertility will be easily available in the near future,” remarked Dr. Panda. “Cost barriers and pharmaceutical access will still exist, but this provides another option for safe family planning for Americans who are experiencing trouble accessing prescription birth control methods.”

Tapti Panda, MD, is a board-certified obstetrician and gynecologist. She earned her medical degree from Rajah Muthiah Medical College and completed her residency and internship in obstetrics and gynecology at Bronx Lebanon Hospital Center, Bronx, New York. Her clinical interests include gynecology, reproductive endocrine, and pediatric gynecology. Dr. Panda provides care to patients in Warwick and Rock Hill, New York.