OTC birth control 'a tremendous advance' in women's health, with important caveats

Key takeaways:

• Presenters at the ACP’s annual meeting discussed the newly available birth control option.
• Although it is a major step forward, it is less effective than other options, they said.

BOSTON — The new, over-the-counter birth control option is an important advancement for women without health insurance, but it may be less effective than other options, according to presenters at the ACP Internal Medicine Meeting.

Janet Pregler, MD, FACP, the Iris Cantor Chair of Women’s Health at the University of California, Las Angeles, and Carolyn Crandall, MD, MS, MACP, a clinical professor of medicine at UCLA, offered an update on women’s health at the meeting. Specifically, Crandall focused on sexual health, discussing the newly available OTC birth control pill, norgestrel 0.075 mg (Opill, HRA Pharma), in the context of the STD epidemic.

“Rising rates of sexually transmitted infections (STIs) among women are of extreme concern in the state of California,” Crandall said. “We’re really focused on increased rates of congenital syphilis — something that I can’t say I thought that I would ever see in my career.”

She presented a hypothetical patient to the audience: a healthy, cisgender woman aged 21 years, who has no health insurance and is using condoms for birth control visits for an STI check. The patient asks about the new OTC pill.

“What are you going to say to this patient?” she asked. “Opill was approved last year, it became available to buy last month, and this month, you may go back to your practice and get your first questions about this because now it's actually available.”

Crandall detailed the history of norgestrel — it was approved in the United States in 1973 and was “regularly used with a good safety profile until 2005,” when the manufacturer “just stopped making it because they weren’t making any money” — in addition to the known side effects, like nausea, irregular bleeding, breast tenderness and mood changes.

“This can be a little more difficult for folks to tolerate,” she said.

Another factor to be cautious of is the fact that Opill is “a little bit less effective, potentially, than some other things in the same class.” The pill works by effectively “confusing the sperm” so they cannot enter the fallopian tubes.

“All those things do add up to an effective contraceptive, but the issue is that if you miss pills, then you can become pregnant,” Crandall said. “Under ideal use, it works very well. The issue is, obviously, women use this in the real world.”

Crandall also noted that “not all the oral contraceptives are really created equal” when it comes to adherence and breakthrough pregnancy potential — something she said should be made clear to patients.

“Opill is super important for individuals who don't have access to health care, and this is a tremendous advance,” Crandall said. “But it's really important for us to [be mindful] when patients ask about this, about how we're counseling them.”

Additionally, Crandall stressed the importance of advising patients to continue with condom use for STI prevention when they begin the new OTC pill or any other form of birth control.

“Make that part of the counseling, because it’s not clear to many women what the effect of these other methods would be on that risk,” she said.

The key point about norgestrel, Crandall said, is that although “this is a moderately effective form of birth control,” it is “not in the highest tier.” However, it is “still a great improvement for women who did not have access to health care” and rely on other, less effective OTC methods.

“It's safe for the vast majority of reproductive age women to take,” she said. “The American College of Obstetricians and Gynecologists really made this a priority to make this available.”