What is Opill®?

Opill®: The First OTC Daily Contraceptive

Whether you’ve been on birth control for years or you’re thinking about it for the first time, you’re probably wondering what the deal is with this over-the-counter option. And that’s totally fair — because an over-the-counter birth control is completely new to the United States. Beyond the fact you’ll be able to purchase it over-the-counter, it’s also slightly different than the average pill since it’s progestin-only. So let’s chat through what that actually means and how to know if it’s right for you.

What is Opill®?

As we mentioned, Opill® is the first daily birth control pill to be approved by the FDA for over-the-counter use. And it’s a progestin-only pill, also known as a POP or minipill, which means that unlike many other birth control pills, it doesn’t contain any estrogen.

What does that actually mean? Well one of the biggest differences between combo pills and progestin-only pills is that you need to take it around the same time every day. Otherwise, it’s less effective at preventing pregnancy.

(As a reminder, you should also try to take a combination pill at the same time every day, but it is less sensitive.)

So How Effective is Opill®? Should I Be Worried About Its Sensitivity?

With perfect use—which includes taking one tablet at the same time every day without any breaks between monthly packs—Opill® is up to 98% effective at preventing pregnancy. This means that if a hundred people took it exactly as prescribed, two or fewer of them would become pregnant. With typical use, Opill® is still about 91% effective. But missing even a single dose or taking it more than three hours later than the normally scheduled time can increase the risk of becoming pregnant while taking Opill®.

Certain medications, including some used to treat migraines and seizures, make Opill® less effective at preventing pregnancy.

This is why it’s still important to discuss your choices with your current provider or a pharmacist.

Are there any side effects to taking Opill®?

The most common side effects associated with Opill® are breakthrough bleeding and spotting, as well as acne, headache, dizziness, breast tenderness, gastrointestinal issues (nausea, abdominal pain, cramps, bloating), and changes (increase or decrease) in appetite.

You may experience more of these side effects in the first few weeks or months as you’re adjusting to a new birth control.

If you already have irregular menstrual periods or abnormal uterine bleeding, Opill® may not be right for you. Nearly a third of people who take Opill® stop getting their period all together, while nearly half experience unexpected bleeding or spotting.

If you get pregnant while taking Opill®, you may be more likely to experience an ectopic pregnancy. While rare, this is a dangerous condition in which a fertilized egg implants itself outside the uterus — usually in one of the fallopian tubes. If you become pregnant or experience lower abdominal pain while taking Opill®, speak to a healthcare provider.

Are there any other reasons to not take Opill?

People who have or have ever had breast cancer should not use Opill®, and those who have a family history of breast cancer should discuss the benefits and risks of Opill® or other progestin-only pills with their healthcare provider. Similarly, anyone with other forms of cancer should talk to a healthcare provider before using Opill®.

How is Opill® different from other birth control pills?

Ordinary combination birth control pills contain the hormones estrogen and progesterone. They work by preventing the ovaries from releasing an egg (ovulating) each month. They also make cervical mucus thicker, preventing sperm from reaching an egg. And they thin the lining of the uterus, so it’s harder for a fertilized egg to implant in its walls.

Unlike combination pills, progestin-only pills like Opill® work primarily by thickening the cervical mucus and thinning the uterine lining. They can also stop ovulation, but they’re not as consistent about it as combination pills: they only do so in about half the people who use them.

Because Opill® and other progestin-only pills don’t contain estrogen, they may be a better choice than other types of birth control for people with certain contraindications or who experience severe side effects with combination pills.

Opill® may be a good choice for:

• People who smoke and are over age 35
• People who are breastfeeding or chestfeeding, since it won’t affect the amount of milk you produce
• People who have recently given birth, even if they don’t plan to breastfeed, since combination pills can be unsafe for the first six weeks after birth
• People with certain health problems, like a history of or increased risk of blood clots, as well as people with high blood pressure or other cardiovascular issues
• People who tend to experience strong side effects from or who worry about the side effects of taking estrogen
• People with a history of headaches or migraines, as combination-only pills may be more likely to trigger or exacerbate them

Where is Opill® Sold?

Because Opill® was approved by the FDA for over-the-counter sale in July 2023, it will be available at drugstores, grocery stores, convenience stores, and really most other major retailers nationwide. And the good news is that you’ll also be able to buy it online from places like Nurx so you won’t even have to leave your house.

How Much Will it Cost?

As far as price goes, it’ll probably vary depending on where you’re looking. What’s good to remember about over-the-counter products is that insurance plans aren’t required to cover it.

Do I Have to Be 18?

The good news for Opill® (and many other birth control pills) is that there aren’t any age restrictions. This means you won’t need a parent or guardian to help you buy it.

How soon does Opill® start to work?

Opill® starts working around 48 hours after you take your first dose. You can start taking it on any day of your cycle. For the first 48 hours you take Opill®, we do recommend using a back-up birth control method, like condoms, any time you have sex..

What about placebo weeks like my other pills?

Here’s something different for you to know. All Opill® pills are active pills — there are no placebo weeks — so you can start with any pill in the pack.

What should I do if I miss a pill?

If you miss a pill, first determine how long it’s been since you took your last dose. If you’re less than three hours late, just take your next pill as soon as you remember. If you’re more than three hours late, take one pill as soon as you remember, and then take your next pill at the usual time — even if that means taking two pills in one day. Make sure to use backup birth control every time you have sex for the next 48 hours.

If you miss two or more pills, take your next pill as soon as you remember. Then go back to your usual schedule, but use a barrier method for the next 48 hours.

(And if you’re a current Nurx patient and have questions, don’t hesitate to reach out to your provider here.)

Should I avoid certain medications while taking Opill®?

Hepatic enzyme-inducing seizure medications like phenytoin and carbamazepine, barbiturates like butalbital and phenobarbital, certain antibiotics like rifampin and rifabutin, certain HIV drugs like fosamprenavir and efavirenz, as well as other drugs including modafinil, bosentan, and St. John’s Wort can reduce the effectiveness of progestin-only pills like Opill®.

Taking any of these medications together with Opill® can increase your chances of getting pregnant. If you’ve taken any of these medications in the last 28 days, you should use a non-hormonal backup birth control method, along with Opill®.

Some of these drugs may also increase the risk of breakthrough bleeding (spotting) while taking Opill®.

Progestin-only pills like Opill® can also interact with the emergency contraceptive ulipristal acetate, sold under the brand name Ella® and others, reducing the effectiveness of both. Avoid using Opill® and other progestin-containing birth control pills within five days of using ulipristal acetate.

Here are Risks and Benefits of Opill®

Risks:

• Breakthrough bleeding or spotting
• Ectopic pregnancy
• Ovarian cysts
• Alterations to menstrual patterns
• Liver disease

Benefits:

• Unlike other birth control pills, you can get it without a prescription
• It may be safer if you have certain medical conditions or contraindications
• It may have fewer side effects and be less invasive than other birth control options
• It can reduce the risk of pregnancy by up to 98%, with perfect use

**Individual experiences/results may vary**

These risks may sound scary. But they also may not impact you. That’s why it’s important to have a trusted provider who you can speak to about your all your options.

So, that was a LOT of information to read through. But it’s important to know it all because your body matters and anytime you start a new medication, you should understand the ins and outs of it. But to sum it in case you’re skimming, not that you ever would:

FAQs:

Does the Opill® protect against STDs?

No, Opill® and other hormonal contraceptives don’t protect against STDs. To prevent STDs, it’s best to practice safer sex, including regular testing, the use of barrier methods, and medications and vaccinations where relevant.

What could lower Opill’s® effectiveness?

Inconsistent use (or human error) is one of the main reasons Opill® can be less effective than expected. This is because it needs to be taken at about the same time every day. To make Opill® as effective as possible, try setting a daily alarm on your phone or using a medication reminder app. Taking Opill® consistently and correctly is one of the best ways to avoid an accidental pregnancy.

Many medications can also reduce the effectiveness of Opill®. These include certain hepatic enzyme-inducing seizure medications like phenytoin and carbamazepine, barbiturates like butalbital and phenobarbital, certain antibiotics like rifampin and rifabutin, certain HIV drugs like fosamprenavir and efavirenz, as well as other drugs including modafinil, bosentan, and St. John’s Wort.

When taken together with ulipristal acetate (the emergency contraceptive also known as Ella®), both Opill® and ulipristal acetate are less effective. These two drugs should generally not be used within five days of one another.

Does Opill® make you gain weight?

Most studies seem to demonstrate that modern birth control pills don’t actually cause weight gain. However, many oral contraceptive users self-report small amounts of weight gain when taking the pills. This perceived weight gain could be caused by fluid retention or other lifestyle factors besides the use of the pills themselves.

The information provided here is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided here for specific medical advice. If you have any questions or concerns, please talk to your provider.

Opill®, norgestrel 0.075 mg tablets, a contraceptive intended to prevent pregnancy, may cause side effects including changes in menstrual periods (bleeding). If you would like to learn more about Opill®, please see prescribing information here. You are encouraged to report negative side effects to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH /default.htm or call 1-800-FDA-1088.

ella® (ulipristal acetate tablet 30mg), Rx only, is indicated for the prevention of pregnancy following unprotected intercourse or a known or suspected contraceptive failure. ella® may cause side effects, including headache, abdominal pain, nausea, dysmenorrhea (painful cramps), fatigue, and dizziness. If you would like to learn more about ella®, please see the full prescription information here. You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch: HTTPS://WWW.FDA.GOV/SAFETY/MEDWATCH /default.htm or call 1-800-FDA-1088.