There are more than 50 brands of birth control pills on the market and all require a prescription (some even require a pelvic exam), but changed in early 2024 when Opill, the first FDA approved oral contraceptive, became as easy to obtain as Tylenol or an antihistamine. 

Opill will be available for purchase over-the-counter (OTC) and online. While its cost and whether insurance will cover it is still uncertain, millions of Americans will gain immediate access to a birth control option that can potentially save them time and money on doctor visits. 

Of course, safety and effectiveness sit top-of-mind when any medication hits the shelves. So, let’s dive deeper and discuss what you need to keep in mind with over the counter birth control.

Reducing barriers to reproductive health care

Historically, many women were not able to receive hormonal birth control without a pelvic exam, but things are changing. Having access to contraception without a visit to the doctor or a prescription is not only game-changing, but necessary for so many women.  Medicine has made incredible advances overall, but access to reproductive health hasn’t kept the same pace.

In a study published in JAMA Open Network, roughly 45 percent of women experienced at least one barrier to reproductive health care services in 2021, which is up 10 percent from 2017. [1] The United States lags behind the rest of the world in access to birth control. In fact, OTC birth control pills are already on the market in more than 100 other countries. [2]

Opill’s emergence onto the OTC market removes many barriers, such as age (Opill will be available to teenagers), proximity to a doctor or pharmacy, taking time off work, and likely, cost. After all, OTC medications are typically not covered by insurance, so the cost will need to be relatively low. 

All about Opill

Opill is a daily progestin-only contraceptive that is said to be 93 percent effective in preventing pregnancy. This is about the same level of effectiveness as prescription oral contraceptives. 

Because it only uses the hormone progestin, it works by thickening cervical mucus—to stop sperm from reaching the egg—and disrupting ovarian activity. This is in contrast to contraceptives that contain both progestin and estrogen, which stop the ovaries from releasing an egg. [4]

Opill must be taken at the same time each day. Even missing a dose by three or more hours will significantly reduce its effectiveness. That’s why it’s recommended that if a dose is missed, a secondary backup method, such as a condom, should be used for the next two days. 

You might consider setting an alarm on your phone so you remember to take it every day at the same time, or pairing you taking it with another activity you do at the same time every day, such as brushing your teeth. 

While Opill will be new as an over-the-counter option, the contraceptive itself has been around for 50 years. It was first approved for prescription use in 1973, but it wasn’t until the Supreme Court overturned Roe v. Wade that the FDA approved it for over the counter use. [3]

When to see a doctor

Opill is generally safe and well-tolerated, but some women may experience side effects, such as:

• Irregular vaginal bleeding
• Breast tenderness
• Nausea
• Cramps/bloating 
• Headaches
• Mood changes

These often resolve on their own, but women are encouraged to speak with their doctor if they do not. Opill is not recommended if you have a history of breast cancer.  

Keep in mind that just because OTC birth control will be easy to obtain—and your choices will likely grow in variety—there are still times when it’s important to speak with your healthcare professional before starting the pill. These include if you experience: undiagnosed abnormal uterine bleeding; bleeding that lasts for a long time; and repeated bleeding after sex

Once on Opill, it’s also important to reach out to your doctor if you experience a new onset of pelvic pain, two missed periods, or think you could be pregnant. If you become pregnant, stop taking Opill. 

Remember, Opill will not protect against sexually transmitted infections (STIs). Nor will it be as effective if you’re taking certain medications or supplements. For example, some antibiotics reduce the effectiveness of hormonal birth control. [5]

Finding the right birth control

Finding the right kind of birth control for you can be a “trial and error” process. Many women don’t realize this and give up on finding a better birth control option for them when the first attempt brings on intolerable side effects that don’t go away. 

Many experts recommend sticking with the same form of birth control for three months before switching to a new type. However, if side effects greatly impact your quality of life, speak with your healthcare professional before the three-month mark. You may need to switch to a new method of birth control that’s better suited for your body.   

Additional benefits of hormonal birth control

While many headlines capture Opill’s use for preventing unintended pregnancy, there’s more to it. Opill may also function as an option to relieve symptoms related to fibroids, menopause and endometriosis. For some people, a progestin-only pill can reduce inflammation and pelvic pain, create lighter and shorter periods, and help decrease cramping, bloating, and nausea. 

If you consider going on Opill to reduce menopause or endometriosis symptoms, we highly recommend you speak with your healthcare professional before just purchasing the pills. That’s because a pill with both progestin and estrogen may be a better option for you. Or, if progestin-only is in fact right for you, your doctor may think it’s better to deliver it in a different form, such as through an IUD, implant, or injection. 

The takeaway about Opill is this: it’s relatively effective and safe. Soon, it will be convenient, too. Seek guidance from a healthcare professional if you’re trying Opill for the first time and experiencing side effects, or if you’re trying it as a way to relieve endometriosis or menstrual symptoms. 

Prescription or not, your reproductive health is in your hands.