Over-the-Counter Birth Control: Who Is It Right For? Here’s What an OBGYN Told Us
A board-certified New York City women's health doctor explains the two key factors to consider when you're researching the best birth control method for you.
About the Expert:
Elizabeth Rodgers, MD, is a board-certified obstetrics and gynecology doctor practicing in New York City since 2007. Dr. Rodgers has a special interest in adolescent gynecology, empowering young women and helping to provide them with a supportive environment to start their gynecologic care. Dr. Rodgers adds: “I am also the mom of three children.”
Following the FDA’s July 2023 approval of the new over-the-counter (OTC) contraceptive pill, many people are wondering if this pill is right for them. As a board-certified women’s health physician, I advise my patients who have this question that the two important considerations in choosing the right contraceptive option are accessibility and ease of use.
What to know about over-the-counter birth control
An over-the-counter pill is a great step forward in making contraception accessible to a large group of people, especially those without health insurance or those who are reluctant to see a medical provider.
Young people often start off with contraception they can purchase over the counter (such as condoms or the emergency contraceptive pill) because they may not feel comfortable asking their family or seeking out a health care provider on their own. The vast majority of adolescent pregnancies are unintended, and having access to effective contraception without a prescription will allow for better pregnancy prevention.
With respect to ease of use, the OTC contraceptive pill will still require people to remember to take a daily pill, which can be challenging for some patients.
The OTC birth control pill approved contains progesterone only, which makes it safe for most reproductive age people. It prevents pregnancy by thickening cervical mucous to prevent sperm transport and thinning the uterine lining. It also suppresses ovulation in some women. It is not effective as emergency contraception (such as after unprotected intercourse to prevent pregnancy) or as an abortive method, nor does it protect against sexually transmitted infections.
While the over-the-counter pill is a step forward in reproductive independence, it may not be the ideal choice for all patients. Discussion with a health care provider can help patients choose the contraceptive option that is best for them.
Who is OTC birth control right for?
When I speak with a patient about birth control, I want to understand what is happening in their life—and it is not all about sex. I want to talk about the regularity of their period, whether they suffer from acne, whether they experience severe cramping, and, ultimately, how their period impacts their quality of life. Topics like these can help a patient and me navigate what might be the best birth control options for that individual.
All contraceptive options are not created equal, and there is not a one-size-fits-all solution. A few years ago, with the help of a college-aged intern, I created a tangible box that includes samples of the various options so my patients can physically see the differences between each while we discuss the pros and cons.
For some women, the ease and accessibility of an over-the-counter birth control pill will be a great option. It has very few medical contraindications, which makes it safe for many patients. It should not be used in patients with breast cancer, unevaluated abnormal bleeding and certain liver disorders.
It should be noted that the birth control pill is 98% effective in perfect use, which requires the patient to be compliant with taking a pill each day (ideally at the same time each day). For many, remembering to take a daily pill can be a burden. Long-acting reversible contraceptives (LARCs) must be inserted by a medical provider, but do not require daily maintenance. They are available in hormonal and nonhormonal options and are effective for extended periods of time. For example, patients who wish to avoid hormones, either because they have a contraindication to the pill or just as a personal preference, may want to consider Paragard, which is an IUD that may be effective for up to 10 years.
Each patient is different, and every birth control option has pros and cons. As an obstetrician-gynecologist, I encourage patients to consider their options and have a conversation about what is best for them with their health care provider. Remember: When it comes to reproductive health, knowledge is power.
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