What you need to know about over-the-counter birth control and emergency contraception, from how they work to where to buy them
The reproductive health landscape in the U.S. keeps shifting, particularly since Roe v. Wade was overturned in 2022. Access to medications such as birth control and emergency contraception is also changing, with over-the-counter (OTC) options now available for both. But not everyone knows what options exist, how they work or where to find them. Here's what you need to know about OTC products for birth control and emergency contraception, according to experts.
What you need to know about over-the-counter birth control
OTC birth control pills are a newer option for people in the U.S. In July 2023, the Food and Drug Administration (FDA) approved Opill as a nonprescription oral birth control pill. Opill is now available for sale in stores and online.
Which brands are available OTC?
Right now, Opill is the only OTC birth control pill option available in the U.S. However, Cadence OTC is working on an over-the-counter combination birth control pill called Zena, which contains both estrogen and progestin — it's just not FDA-approved.
How does it work?
Opill contains the hormone norgestrel and belongs to the class of medications known as progestins, according to the FDA. "It works primarily by thickening the cervical mucus and also creating the endometrial lining to be very thin, which cannot capacitate a pregnancy," women's health expert and ob-gyn Dr. Jessica Shepherd tells Yahoo Life.
To use Opill, you take the medication by mouth every day at the same time with no breaks between monthly packs. If you miss a pill or have a delay of more than three hours from your usual time in taking it, the FDA recommends using a backup birth control method such as condoms.
How effective is it? Is it safe to use?
With perfect use, Opill is 98% effective at preventing pregnancy — meaning, only 2 in 100 women will become pregnant while using Opill if they follow the directions perfectly. (That lines up with the effectiveness of most birth control pills.) But the effectiveness of Opill is lower with typical, real-life use, which includes forgetting a pill or taking it at different times. With typical use, Opill is 91% effective, according to Harvard Health.
This medication is "extremely safe," women's health expert Dr. Jennifer Wider, co-host of the Open Wider podcast, tells Yahoo Life. "Progestin-only pills have well-established records."
However, the FDA warns against using Opill if you have or ever had breast cancer, you're already pregnant or think you might be pregnant, you're using another form of birth control or if you are male. People taking prescription medication for seizures, tuberculosis, HIV/AIDS or pulmonary hypertension, or those who are taking a supplement containing St. John’s wort should talk to a doctor before using Opill, according to the FDA. The medication may also interact with the emergency contraceptive ulipristal acetate (brand name Ella).
Overall, though, "Opill is well-studied with more than 50 years of safety data," Dr. Anitra Beasley, associate professor of obstetrics and gynecology at Baylor College of Medicine, tells Yahoo Life.
Why it's important
Before July 2023, people who wanted to have birth control needed to visit a health care provider or reproductive health clinic for a prescription before having it filled. Now, getting birth control is as simple as picking it up at a store or ordering it online.
"OTC methods eliminate many barriers to contraceptive access and allow folks to get safe and effective methods of contraception," Beasley says. "This is especially important for communities that experience barriers to care, such as Black and brown communities, young folks, those without insurance and those living in rural areas."
Data from KFF, a health policy research organization, released in September 2023 found that more than a third of oral contraceptive users have missed taking their birth control because they weren't able to get their next supply. That will likely change, Shepherd says. "Over-the-counter access to birth control allows for pregnancy prevention to be paramount," she adds.
What you need to know about over-the-counter emergency contraception
While the OTC birth control pill market is limited, there are several options for emergency contraception — and the field is growing. Cadence OTC announced on March 19 that its emergency contraception will be available at convenience stores across the country, making them the first company to offer OTC emergency contraception at these types of stores.
Which brands are available OTC?
Several OTC emergency contraceptive pills are available. Those include Plan B One-Step, Take Action, My Way, Option 2, Preventeza, AfterPill, My Choice, Aftera, EContra and Morning After Pill.
How does it work?
OTC emergency contraception pills in the U.S. contain levonorgestrel, which is in a class of medications called progestins (which are a synthetic form of the hormone progesterone). "Progesterone in high doses inhibits the triggering mechanism that causes an egg to be released from the ovary," Dr. Nap Hosang, co-founder of Cadence OTC, tells Yahoo Life. "Once released, an egg is eligible for fertilization for about a day, if active sperm are available to penetrate the egg."
If the egg is already released, these pills won't work, Hosang explains. "That's why taking it as soon as possible after unprotected intercourse is crucial," he says.
Levonorgestrel is a tablet taken by mouth, and it's designed to be used as soon as possible within 72 hours of having unprotected sex, according to MedlinePlus.
How effective is it? Is it safe to use?
Levonorgestrel emergency contraception has an efficiency rate of 89% if it's used correctly within 72 hours after unprotected intercourse. That means 11 out of 100 people who use it after unprotected sex will still become pregnant.
The medication is considered safe to use. "It does not interfere with an existing pregnancy in any way, if there is one," Hosang says, adding that it also "does not interfere with your future ability to conceive." However, according to MedlinePlus, there are potential side effects to using OTC emergency contraception, including:
heavier or lighter-than-usual menstrual bleeding
spotting or bleeding between menstrual periods
nausea
vomiting
diarrhea
tiredness
headache
dizziness
breast pain or tenderness
Why it's important
With strict rules around abortion, including bans in some states, doctors say that increased access to emergency contraception is crucial for women. There are a lot of options for people for emergency contraception, and doctors say that's a great thing. "It is important to have choices like this for patients who are not on birth control or have had sexual intercourse and no protection and need a pregnancy prevention," Shepherd says.
Side effects can also vary by medication and, if a person has side effects with one OTC emergency contraception pill, that person may do better with another, Wider says. "So more options are better," she says.
