Curious about taking Opill, the new OTC birth control pill? An expert answers our questions

Opill, the first-ever over-the-counter birth control pill, made waves when the FDA first approved it for distribution back in July 2023. And for good reason: By removing the barrier of needing to have an appointment or get a prescription from a healthcare provider, the availability of Opill will improve contraceptive access for millions. A three-month supply is priced at $49.99, and is already on shelves in retailers like CVS and Walgreens and available online.

Opill is considered to be highly effective and very safe to take. Norgestrel, the active ingredient in Opill, was first approved for prescription use by the FDA in 1973, more than 50 years ago, and it has decades of research and use behind it. As a “mini pill”, meaning that it only contains progestin (a synthetic form of progesterone), not a combination of progestin and estradiol (a synthetic form of estrogen), Opill has been shown to be 93% effective in preventing pregnancy with typical use, making it the most effective method of birth control available over the counter, surpassing condoms, spermicides and other nonprescription methods.

Opill may be a good option to add to your birth control arsenal if you’re looking to prevent pregnancy. Experts say it should be especially helpful for teens and young adults and others who, due to time, cost or other hurdles, haven’t been able to get a prescription method of birth control in the past. But here’s what to know about taking Opill before you make the switch. 

I talked to Sophia Yen, MD, MPH, the co-founder and Chief Medical Officer of Pandia Health, the only women-founded and women-led online hormonal health clinic, providing birth control, menopause and acne prescriptions and telehealth services. Here’s what she had to say.

What to know about taking Opill

Q. How does Opill work to prevent pregnancy?

“Opill works by thickening the cervical mucus, preventing the sperm from getting to the egg, and thinning the lining of the endometrium so that if the egg/sperm connect, then they cannot stick to the uterus,” says Dr. Yen. “Sometimes, it blocks ovulation but that is NOT consistent nor the main mechanisms of its action.”

Q. Are there any factors that might affect the effectiveness of Opill? 

“With typical use, a progesterone-only pill has a 7% to 9% failure rate,” Dr. Yen explains. Note that “typical use” differs from “perfect use” in that the “typical use” rate accounts for the fact that humans don’t always use birth control perfectly and may miss doses or make other mistakes in its use. Essentially, this means 7 to 9 people out of 100 using it in a year will get pregnant, versus 85 out of 100 people not using birth control a year will get pregnant, Dr. Yen states. With perfect use, Opill is considered to be 98% effective. 

Q. What should people know before taking Opill? 

Because Opill must be taken at the same time every day to be effective, even missing a dose by 3 hours can count as having missed a pill, and you may need to use backup contraception for the next 2 days to prevent pregnancy. Dr. Yen suggests asking yourself the following questions when you’re considering using Opill for the long-term: Are you able to take the medication each day at the same time? If you are late in taking it by three hours, do you have some emergency contraception around, such as Plan B? Are you OK with using backup methods of contraception?

Q. Who should not take Opill? 

There are several contraindications for taking Opill, Dr. Yen says. “Women who have or have had breast cancer should not take Opill, nor should women who have had a blood clot in the lung (pulmonary embolism) or leg (deep vein thrombosis) in the last three months. Opill should not be taken by women with very severe liver disease (hepatitis) or liver cancer.” But because it’s progesterone-only, people who are smokers, have high blood pressure, and those who generally cannot take estrogen can consider taking Opill, Dr. Yen adds. 

Q. What are the potential side effects associated with Opill? 

Side effects that are more common with progesterone-only pills are: irregular bleeding, acne, depression, emotional changes, breast tenderness and breast enlargement, Dr. Yen notes. “The problem with progesterone-only pills [except drospirenone] is that they can have unpredictable bleeding. Thirty percent of people taking the mini pill have no bleeds, while another 30% will have spotting, and 30% continue with regular monthly bleeds.” 

Q. Can Opill be used long-term?

“Yes, it can be used long term,” says Dr. Yen. “There are no effects on fertility after you stop it—just like with the regular pill, patch, ring, hormonal IUD, and birth control implants.”

Q. What advice would you give to someone considering Opill as their primary method of contraception, especially if they have never used hormonal birth control before?

“The American College of Obstetricians and Gynecologists (ACOG) has said that birth control pills (with estrogen and progesterone and without estrogen) are safe and should be available over-the-counter, but if you have access to a prescriber, then go that route,” she recommends. “Opill is the best over-the-counter option, but by working with a provider, you can have access to more than 40 birth control options to find the one that suits you best.”

Dr. Yen explains that Pandia Health offers a virtual visit with a doctor who can prescribe all the available birth control pills, patches, rings for only $30 once a year with unlimited follow-ups with a physician. But if you prefer an OTC option like Opill, make sure you have some emergency contraception around, she suggests. “And then make sure you know about the time window—three hours late and you are NOT covered for pregnancy. It might be longer, but the research isn’t there yet,” she explains.