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You’re reading The Checkup With Dr. Wen, a newsletter on how to navigate covid-19 and other public health challenges. <a href="https://www.washingtonpost.com/newsletters/the-checkup-with-dr-wen/?method=SURL&location=ART&auto=true&itid=lk_inline_manual_2" target=_blank>Click here to get the full newsletter in your inbox</a>, including answers to reader questions and a summary of new scientific research.

Over the past few weeks, you might have noticed something new on the shelves of your local pharmacy: The first over-the-counter birth control pill, which its manufacturer <a href="https://www.cnn.com/2024/03/04/health/opill-otc-birth-control-pill-available-in-stores/index.html" target=_blank>started shipping</a> to retailers after the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-approves-first-nonprescription-daily-oral-contraceptive" target=_blank>finally allowed it to be sold</a> in stores and online without a prescription.

This is the right decision, as I and a chorus of obstetricians and gynecologists <a href="https://www.washingtonpost.com/opinions/2023/05/15/birth-control-fda-over-the-counter/" target=_blank>have long argued</a>. More than 100 other countries have already made birth control pills available over the counter. This particular medication, known as Opill, was approved over 50 years ago, and decades of data prove that people can safely use it to prevent pregnancy.

Here’s what people considering Opill should know:

To start, it’s highly effective. When used as instructed, meaning taken at the same time every day, Opill is 98 percent effective at preventing pregnancy. After accounting for real-life behavior, it works about 93 percent of the time. These figures are <a href="https://www.cdc.gov/reproductivehealth/contraception/index.htm" target=_blank>on par</a> with other birth control pills.

Like other non-barrier methods, this pill does not protect against sexually transmitted infections. People in non-monogamous relationships should use condoms, which, when combined with the pill, further reduce the chance of pregnancy.

Those considering Opill should also know that it is a progestin-only medication. Many birth control pills contain both estrogen and progestin. These combination medicines are associated with an elevated risk of blood clots. Progestin-only pills don’t have this risk. Opill can be used by women with common chronic diseases such as high blood pressure, obesity and diabetes. And it is safe for <a href="https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2024/03/first-over-the-counter-daily-contraceptive-pill-released" target=_blank>breastfeeding women</a>.

The <a href="https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/opill-0075mg-oral-norgestrel-tablet-information#:~:text=Common%20side%20effects%20may%20include,important%20to%20seek%20medical%20advice." target=_blank>most common side effects</a> are irregular menstrual bleeding, breast tenderness, nausea and headaches. Less common side effects can include abdominal cramps, bloating, weight gain, acne and mood changes.

Some people should not take Opill. Specifically, women with breast cancer or a history of breast cancer should not use it. People taking other medications should also verify that they don’t <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/017031s035s036lbl.pdf" target=_blank>interact with Opill</a>. For instance, patients taking certain treatments for seizure disorder, tuberculosis or HIV should opt for other forms of birth control.

In my view, women without primary-care providers stand to benefit the most from Opill. It’s also helpful that manufacturers are dispensing the pill in three-month packs. A major reason that people don’t use oral contraceptives as instructed is because they simply run out of pills. That should happen less now that they can buy more pills at once and don’t have to rely on their physician to refill prescriptions.

Still, it’s critical for women to understand that Opill does not replace their annual checkup. Even people who think of themselves as young and healthy should receive regular screenings for high blood pressure, diabetes and <a href="https://www.washingtonpost.com/opinions/2024/04/04/early-onset-cancer-increasing-princess/" target="_blank">cancer.</a> These visits are also opportunities to address mental health and <a href="https://www.washingtonpost.com/opinions/2024/02/06/alcohol-young-people-women-health/" target="_blank">substance use</a>.

Birth control pills are not the only form of contraception available. People who do not wish to take a medication every day can consider long-acting reversible contraceptives, such as <a href="https://www.cdc.gov/reproductivehealth/contraception/index.htm" target="_blank">intrauterine devices</a> that can stay in the uterus for as long as 10 years. They can also consider getting a shot every three months or a small rod inserted into their arm that lasts up to five years. Other contraceptive options include a skin patch and contraceptive ring that deliver hormones, as well as barrier methods such as diaphragms, cervical caps and condoms.

Unfortunately, <a href="https://aspe.hhs.gov/reports/health-coverage-women-under-aca" target=_blank>nearly 8 million</a> reproductive-age women are uninsured. More than <a href="https://www.webmd.com/sex/birth-control/contraception-access-care-disparities-bias" target=_blank>19 million live</a> in areas designated as “contraceptive deserts,” which means they do not have the full range of birth control options available to them. Since <a href="https://health.gov/healthypeople/objectives-and-data/browse-objectives/family-planning#:~:text=Nearly%20half%20of%20pregnancies%20in,control%20and%20family%20planning%20services." target=_blank>nearly half of</a> pregnancies in the United States are unintended, and with <a href="https://www.washingtonpost.com/abortion/" target="_blank" class="contextual_link">abortion</a> care becoming more limited, it is welcome news that many women will find it less challenging to access safe birth control pills.

In the coming weeks, I plan to address another crucial issue in women’s reproductive health: menopause. What questions do you have? Please <a href="https://docs.google.com/forms/d/e/1FAIpQLSeMsJd-ZmwGWXpyQ1lMIrI31r1Nt9muJgOSFSgfMNdvSknAeg/viewform" target=_blank>send them my way</a>.

Lifelines: A Doctor’s Journey in the Fight for Public Health

When Doctors Don't Listen

California State University, Los Angeles, BS

Washington University School of Medicine, MD

University of Oxford, MSc

Leana S. Wen, a Washington Post contributing columnist who writes the newsletter The Checkup with Dr. Wen, is a professor at George Washington University's Milken Institute School of Public Health and author of the book "Lifelines: A Doctor's Journey in the Fight for Public Health." Previously, she served as Baltimore’s health commissioner.

Leana Wen

Finally, birth control pills can be purchased over the counter

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