What is Opill® birth control?

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 the 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 that you can 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® and how does it work?

Opill® is the first daily birth control pill approved by the FDA for over-the-counter (OTC) use. It’s a progestin-only pill (also called a POP or minipill), meaning it contains no estrogen, unlike many combination pills.

How does it work? Opill® prevents pregnancy primarily by thickening cervical mucus to block sperm and thinning the uterine lining to reduce the chance of implantation. It may also stop ovulation, but that’s not its main mechanism.

But does Opill® stop your period? 

Not necessarily. For some, it will, but many users will continue to have periods while on Opill®, and some might also experience changes like lighter or irregular bleeding.

Because Opill® is a progestin-only pill, it requires consistent daily timing—ideally the same time every day—for maximum effectiveness. Missing your usual window by even a few hours can reduce its pregnancy prevention power. (Combination pills also benefit from consistent timing but are less sensitive to small delays.)

So, how effective is Opill®? 

Opill® can be highly effective when used correctly, but its success depends on taking it consistently and on time. Here’s a quick breakdown of how effective Opill® is with different levels of use:

• Perfect use: Taking one tablet at the same time every day without missing any doses—up to 98% effective at preventing pregnancy. This means fewer than 2 out of 100 people would become pregnant in a year.
• Typical use: Accounting for occasional missed or late doses—about 91% effective.

Because Opill® is a progestin-only pill, missing a dose or taking it more than three hours later than your usual time can increase the risk of pregnancy.

While Opill® may reduce or even stop your periods for some users, its effectiveness at preventing pregnancy does not depend on whether your period stops.

Certain medications, including some used to treat migraines and seizures, can also reduce how well Opill® works. This makes it important to discuss your health history and any medications you’re taking with your provider or pharmacist before starting.

Are there any side effects to taking Opill®?

Like any medication, Opill® can cause side effects, though many people tolerate it well. Here’s what you might experience:

Common side effects:

• Headache
• Nausea
• Dizziness
• Breast tenderness
• Acne
• Gastrointestinal issues such as abdominal pain, cramps, or bloating
• Changes in appetite (either an increase or a decrease)

These side effects are usually more noticeable in the first few weeks or months and tend to subside as your body adjusts.

Menstrual changes:

• Spotting or breakthrough bleeding
• Irregular periods
• Complete absence of periods in some users (about one-third stop getting their period altogether)

If you already have irregular periods or abnormal uterine bleeding, Opill® may not be the best fit for you.

Important: If you become pregnant while taking Opill®, there is a slightly increased risk of ectopic pregnancy—a rare but serious condition where a fertilized egg implants outside the uterus, usually in a fallopian tube. If you experience pregnancy symptoms or lower abdominal pain while using Opill®, please contact a healthcare provider right away.

Who should or shouldn’t use Opill®?

Opill® and other progestin-only pills don’t contain estrogen, which can make them a safer and more comfortable choice for many people who can’t or prefer not to take combination pills. Because they avoid estrogen, progestin-only pills like Opill® may be better suited for those with certain health conditions or who experience strong side effects with estrogen-containing birth control.

Opill® may be a good option if you:

• Smoke and are over age 35
• Are breastfeeding or chestfeeding, since it won’t affect your milk supply
• Have recently given birth, even if you don’t plan to breastfeed (if you are not breastfeeding, combination pills may be an option starting three  weeks postpartum)
• Have an increased risk for blood clots, high blood pressure, or other cardiovascular concerns
• Experience strong side effects from estrogen or worry about those side effects
• Have a history of headaches or migraines, especially migraines with aura, since estrogen can sometimes worsen these symptoms

Who should avoid Opill®?

• Anyone who is pregnant or suspects pregnancy
• Those with a history of serious blood clots, stroke, or certain hormone-sensitive cancers
• People with unexplained vaginal bleeding or severe liver disease
• Anyone allergic to ingredients in Opill®

Before starting Opill® or any birth control method, it’s important to talk with a healthcare provider who can review your health history and help you choose the birth control option that’s safest and best for your lifestyle.

Where is Opill® sold?

Opill® is now available over the counter—no prescription needed. You can find it at major drugstores, grocery stores, convenience stores, and most big-name retailers across the country. It’s also widely available online, so if you prefer the convenience of shopping from home, you’re covered.

You can purchase Opill® online through Nurx.  If you’re not sure Opill® is right for you, you can request support from a  licensed provider who is  available to answer questions and help you explore birth control options.

How much does Opill® cost?

The cost of Opill® can vary depending on where you buy it, but here’s what to know: Over-the-counter products like Opill® aren’t always covered by insurance, though some plans may still cover it in full.

If you’re buying over-the-counter through Nurx, you can get a 3-month supply of Opill® for $49.99 without insurance. If prescribed Opill® following your consultation with a Nurx provider, your insurance may fully cover the cost, depending on your plan. 

Do I have to be 18 to get Opill®?

The good news for Opill® is that there aren’t any age restrictions. This means you won’t need a parent or guardian to help you buy it over-the-counter without a prescription.

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 recommend using a back-up birth control method, like condoms, any time you have sex.

Does Opill® have placebo pills or period weeks?

All Opill® pills are active pills—there are no placebo weeks—so you can start with any pill in the pack, and this means you won’t have a regular, predictable withdrawal bleed (which is a “period” on birth control). 

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®?

The following drugs can reduce the effectiveness of progestin-only pills like 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
• Drugs including modafinil, bosentan, and St. John’s Wort

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®. Avoid using Opill® and other progestin-containing birth control pills within five days of using ulipristal acetate.

Some risks and benefits of Opill®

Like any medication, Opill® comes with both potential benefits and risks. Because it’s a progestin-only birth control pill, it may be a better fit for people who can’t take estrogen. Here’s a quick overview to help you understand what to expect:

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 and results may vary.

The risks may sound scary. But everyone’s body reacts differently.  That’s why it’s important to have a trusted provider whom you can speak to about all your options.

Taking charge of your birth control choice

Whether you’re exploring birth control for the first time or switching methods, understanding how an option like Opill® works helps you make empowered, informed decisions. Everybody is different, and what works well for one person may not be the right fit for someone else.

The good news? You don’t have to figure it out alone. At Nurx, we make it easy to get expert guidance and access the birth control method that’s right for you—no in-person appointments needed. Our licensed providers are here to review your health history, answer your questions, and make sure you feel confident in your choice.

Ready to explore your 50+ birth control options? Get started with Nurx today.

If you are ready to get started with Opill®, you can buy it now without a prescription.

Frequently Asked Questions (FAQ): 

Does Opill® stop your period?

For some people, yes—Opill® can stop your period altogether. About one-third of users stop having regular periods while taking it, while others may experience irregular bleeding or occasional spotting. These changes are common with progestin-only pills and aren’t usually a cause for concern.

Does the Opill® protect against STIs?

No, Opill® and other hormonal contraceptives don’t protect against sexually transmitted infections (STIs). To prevent STIs, it’s best to practice safe 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.

As listed above, certain medications can also reduce the effectiveness of Opill®. 

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.  Any perceived weight gain could be caused by fluid retention or other lifestyle factors besides the use of the pills themselves.

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

Medical services not offered in every state. Prescription medicine only if clinically appropriate, based on completion of  required consultation. Individual results may vary.  

Medication price not guaranteed. If seeking insurance coverage for the medication, full consultation with a medical provider is required.  Not all insurance plans accepted. Coverage based on applicable insurance terms. Additional costs apply, See Nurx.com for details.

All medications should be used as directed.

Ella® (Ulipristal Acetate tablet, 30mg), Rx only, is an emergency contraceptive used to prevent pregnancy up to five days (120 hours) after unprotected sex. Ella® may cause side effects, including headache, nausea, and stomach pain. 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.