Next Time Your Birth Control Refill Is Delayed, OTC Opill Can Be a Stopgap
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Key Takeaways
The FDA approved the sale of an oral birth control pill over-the-counter for the first time.
It is safe and effective to switch to the Opill from another birth control method at any time.
Easy access to the progestin-only contraceptive could help people to stay protected against unwanted pregnancy, even if they have problems accessing their prescription contraception, experts said.
Nearly one in three adult women who have ever tried to get a birth control prescription or refill an existing prescription report challenges getting their medication. Thursday’s FDA approval of the first over-the-counter birth control pill is about to make that process much easier.
Even if someone has reliable access to a health provider, they may face challenges in getting a prescription renewed or filled in a timely manner, or with traveling to a pharmacy to pick it up. A delay in accessing birth control pills has repercussions not only for pregnancy prevention, but also a person’s menstrual cycle.
The over-the-counter drug, called Opill, could act as a sort of stopgap for people that are having temporary issues with accessing their prescription birth control, said Anne-Marie Amies Oelschlager, MD, professor of obstetrics and gynecology at the University of Washington.
Opill isn’t a new drug. It contains a progestin called norgestrel, which has been used for 50 years as a prescription medication in the U.S. Now, it will be made available in grocery stores, convenience stores, drug stores, and online.
“People can have confidence in this in this method; it’s going to be a big step up from the prior over-the-counter methods. It’s more effective than condoms, it’s more effective than emergency contraception, and it is a very safe medication,” Amies Oelschlager, who serves as a committee member for the American College of Obstetricians and Gynecologists, said.
Related: FDA Approves Over-the-Counter Birth Control Pill for the First Time
How to Use the Opill When Your Prescription Birth Control Runs Out
Some oral contraceptives contain a combination of the hormones estrogen and progestin. Progestin-only tablets, like Opill, are sometimes called the “minipill.” Most combination pills have 21 or 24 days of active hormone pill and then some placebo pills.
The progestin-only pills typically have the active hormone pill every day, and each day contains the same dosage. That means a user can start taking the pills from any place in the pack, regardless of whether it aligns with the week of the cycle they’re on.
“You can pick up the progestin-only pill—the Opill—and start that immediately, and then continue that until you can pick up your new prescription,” Amies Oelschlager said.
It also means you can temporarily use Opill if you’re traveling and forgot to pack your birth control.
When switching from an estrogen-containing pill to Opill, start the Opill the day after taking an active pill, not an inactive pill. People switching from another brand of progestin-only birth control can start at any time, according to the FDA label.
Related: How to Start Birth Control Pills
People should also use a nonhormonal backup method of birth control, like condoms, every time they have sex for the first 48 hours after starting Opill, the FDA said. By comparison, most combination oral birth controls recommend using a backup method for a week after starting the medication.
“When I counsel patients about all the birth control options, I let them know that they’re always interchangeable,” Yasaman Ahmadieh, DO, MPH, an adolescent medicine physician in Los Angeles and a fellow with Physicians for Reproductive Health, told Verywell. “When changing from one method to another method, we do recommend a second method to prevent pregnancy. For example, you can use condoms in the first week that you change to another method.”
Things to Consider When Switching To or From Opill
Opill is a low-dose medication compared to most combination oral contraceptives. That means it doesn’t carry the same risk of complications, like blood clots and stroke, that an estrogen-containing pill has, Amies Oelschlager said.
The downside, she said, is that it’s more time-sensitive than the combination pill. To be effective, the Opill must be taken every day within the same three-hour window, even during periods of bleeding.
Whenever someone takes the pill three or more hours late, they should use an additional nonhormonal birth control method for the next 48 hours, according to the drug label.
Even when someone taking the pill as instructed, they should consider using a condom, internal condom, or dental dam in addition, Amies Oelschlager said.
“Taking a birth control pill does decrease the risk of pregnancy, but it doesn’t decrease the risk of sexually transmitted infections,” she said. “I would still recommend using barrier methods and getting tested for sexually transmitted infections.”
When switching between birth control methods or types, a person may experience some irregular bleeding. It’s normal to experience breakthrough bleeding for a few days, Ahmadieh said. If there’s enough blood to soak through a tampon every hour, she recommends seeking medical attention.
A person might experience side effects like breast tenderness, moodiness, and headache. Those usually resolve within a few days to a few weeks.
Related: The Pros and Cons of the Birth Control Pill
How to Get Opill
The Opill should be available in major retail stores across the U.S. and online in early 2024, Frédérique Welgryn, Global Vice President for Women’s Health at Perrigo, the company that makes Opill, said on a press call.
Perrigo has yet to share how expensive the Opill will be and if it will be covered by insurance. Over-the-counter medications are not typically covered by insurance. But Welgryn said the company is working to get Opill listed with private insurers and Medicare so that if that rule is lifted, the drug will get coverage soon after.
Opill Will Improve Access for People Lacking Prescriptions, Too
For people who don’t have reliable access to a health provider, obtaining a prescription can be challenging. For those who don’t have insurance, the cost of a doctor’s visit and the cost of the medication itself can be prohibitive.
Even when a person does have insurance and a primary health provider, they may face other logistical hurdles to getting a birth control prescription on time for their next cycle. They may have to take time off work to visit their provider to have a prescription written or renewed. Then it takes time to travel to a pharmacy to pick up the prescription, or to figure out a back-up plan if the prescription can’t be filled.
“When we’re talking about lack of access to reproductive health providers, it typically impacts people living in rural settings. It also affects people who have lower socioeconomic status, adolescents, and people of color disproportionately,” Amies Oelschlager said.
In a study involving Black, Asian American, Indigenous, Latinx, Native Hawaiian and Pacific Islander people in the U.S., 45% of participants reported facing at least one challenge to accessing birth control in the past year.
At a May meeting of advisors to the FDA, panelists raised concerns over whether customers would be able to accurately understand and follow the instructions on the Opill label without the help of a health provider. Ahmadieh, who cares for children and adolescents, said the research shows youth can be trusted to understand medication instructions.
“I’m very excited that my patients who are below 18 can confidentially access a birth control pill over the counter and there’s no need to depend on their physician or parents or their guardians,” Ahmadieh said. “I trust all of my patients based on the decisions they make about their health.”
What This Means For You
There are few potential side effects or risk of complications associated with the use of Opill. People who have or had progestin-sensitive cancer should speak with a health provider about whether Opill is safe.
