woman looks at package of birth control pills

A New Birth Control Pill is Available Over the Counter. Who Is It For?

An OB/GYN explains the FDA-approved oral contraception that will be available without a prescription

The FDA just approved an oral contraceptive medication called Opill for over-the-counter sale. Opill is a progestin-only pill, generically known as norgestrel, that has been available by prescription for nearly 50 years. Non-prescription availability, expected in 2024, will give millions more people access to safe, effective oral contraception.

“Increasing access to birth control is vital for all women and a huge step forward for women’s reproductive rights,” says Columbia OB/GYN Ryalynn Morgan Carter, MD. “Many women have significant barriers to access, including proximity to health care, child care during health care visits, insurance coverage, and prescription coverage. Making birth control readily available eliminates many of these barriers and empowers women to take further control of their fertility.” And, she says, “Opill is appropriate for virtually everyone.”

We asked Carter to provide more details about the new birth control pill and who can use it.

Who can use Opill?

There are two types of oral contraceptives: one type contains the hormones estrogen and progestin (“combination” pills); the other type contains only progestin.

The FDA-approved OTC pill, Opill, contains only progestin. Progestin-only pills are commonly used by people who cannot take estrogen, including those who are breastfeeding.

Opill is a great option, though statistically, progestin-only pills are a little less effective than other birth control methods, such as implants, intrauterine devices (IUDs), and pills that also contain estrogen. To increase efficacy, it will be important to be vigilant about taking it at the same time every day because the effect wears off over the 24-hour day. Taking it at the same time every day also creates a habit and makes it easier to remember.

Do you have concerns about people using Opill?

No. Women can safely determine on their own if progestin-only birth control is right for them and can adhere to usage directions.

Who should not take Opill?

Opill is good for almost everyone. If you have concerns, that’s okay; speak to a health care provider, including your pharmacist.

Speak to your doctor f you are taking another hormonal birth control product—oral contraceptive pills, patches, or implants; vaginal rings; IUDs; or other medications—or you have or had breast cancer or a history of blood clotting.  

Are Opill side effects different from other oral contraceptives?

No. Like other birth control pills, common side effects are headaches, dizziness, nausea, increased appetite, abdominal pain, cramps, bloating, and abnormal breakthrough bleeding.

Should someone currently taking norgestrel switch to Opill?

It depends on availability and cost. If your insurance covers prescription birth control, you may not want to switch.  

NOTE: If you switch from a combination pill to Opill or other progestin-only pill you may have some breakthrough bleeding as your body readjusts to the new medication. 

What is the one thing everyone needs to know about Opill?

Unless you’re doing something to prevent pregnancy, you’re trying to get pregnant. About 45% of pregnancies are unintended. Birth control pills like Opill are an easy way to prevent pregnancy. They provide consistent contraception, can make periods easier, and help people stay in control of their fertility.  


Ryalynn Morgan Carter, MD, is an obstetrician-gynecologist and assistant professor of OB/GYN at Columbia University Vagelos College of Physicians and Surgeons. She sees patients in Washington Heights and Orangeburg, New York.