‘This is Huge’: The Promises and Challenges of New, Over-The-Counter Birth Control Pills

April 1, 2024 By Jane Kelly, jak4g@virginia.edu Jane Kelly, jak4g@virginia.edu

For the first time in history, women in the United States can purchase birth control pills over the counter without a doctor’s prescription.

Called Opill, the contraceptive can be purchased at brick-and-mortar stores and online. A month’s supply costs about $20.

The U.S. Food and Drug Administration approved the progesterone drug in July.

At the time, Dr. Patrizia Cavazzoni, director of the FDA’s Center for Drug Evaluation and Research, said in a statement that “When used as directed, daily oral contraception is safe and is expected to be more effective than currently available nonprescription contraceptive methods in preventing unintended pregnancy.”

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UVA Today turned to two experts for their takes on this new development in women’s health. Drs. Renee Ward and Megan Bray are both gynecologists at UVA Health. Ward is an associate professor of urogynecology and reconstructive pelvic surgery in the University of Virginia School of Medicine, where Bray is an associate professor of obstetrics and gynecology.

We had questions, they had answers.

Q. How much of a game-changer is the Opill?

Ward: This is huge in terms of increasing access to contraceptive care, which is incredibly important for women’s health. It’s incredibly important for women being able to have control over the destiny of what they want to do with their life. It’s a very safe pill, and the risks of that go along with a pregnancy and the period after a pregnancy are much higher than with the contraceptive pill. So, that is huge. 

There are many individuals who can’t get to a provider for multiple reasons – just more “health care deserts” in our country now than there have been in the past. There may be financial reasons, or a gap in insurance that makes it hard for someone to get in and get a prescription. So the accessibility of being able to go and get this over the counter is huge.

Q. How does the Opill work?

Bray: I think it’s important to note that progesterone has been around for a long time, since the 1970s. It works in three ways. It thickens the cervical mucus so that sperm can’t get into the uterus, it decreases motility in the tubes to help prevent egg and sperm from meeting, and it thins the lining of the uterus, so it is inhospitable for implantation to occur. 

Q. How effective is the Opill?

Ward: It is as effective as other hormonal pills that are available by prescription, with typical use. Nine out of 100 people using this pill for a year would be expected to have an unplanned pregnancy with typical use. Now, with perfect use, the success rate goes up, but it’s a harder medication to take because patients need to take it every single day. 

Q. What about teen use of the Opill?

Bray: If you skip a progesterone-only pill, then you need birth control back-up for two or three days. If you are not consistent with taking it regularly, people can become pregnant. You have to be on point with the progesterone pill. That’s one thing that bothers me about teen use.

Another is the cost. I’m not sure that teens can afford $20 a month on their own.

The big advantage is that you don’t have to go see a gynecologist in order to get a prescription.

Q. What are the side effects of the Opill?

Ward: The main side effect with this is going to be irregular vaginal bleeding. That is why many people who get prescription birth control pills choose to have one that has estrogen and progesterone in it, because the bleeding profile is more favorable. But with that comes other risks. And I think that is why the first over-the-counter formulation is the progesterone-only because it has a much lower risk profile. 

Q. How do sexually transmitted diseases fit into use of the Opill?

Bray: While the Opill is capable of preventing pregnancy, it does not prevent STDs. Consistent condom use can. We need to focus on both of those things for women.

Media Contact

Jane Kelly

University News Senior Associate Office of University Communications