The FDA announced yesterday that it has approved for the first time a daily birth control pill to be sold over the counter. That’s a big change; Once the drug, called Opill, is on the market—which could be as soon as 2024—Americans will be able to buy hormonal contraceptives every day without a prescription. That’s history, but hidden beneath it are some firsts: In the coming months, Americans will be able to take more medicine for their heavy periods, cramps, headaches, and migraines; will have access to treatment for endometriosis and polycystic ovary syndrome; and they will be able to buy medicines that will reduce the symptoms of menstruation. All in one pill, made with progestin.
FDA approval only covers Opill is used as a contraceptive, but doctors have been prescribing pills containing progestin for contraceptive needs for many years. For the most part, the action works best when the pill contains both progestin and estrogen. Adding a second hormone to the mix makes all the benefits of progestin effective, and helps eliminate acne. It also leaves a lot of room for flexibility in timing: Progestin-only pills—sometimes called minipills—have a very short half-life in the body, so if you don’t take them within the same three-hour window every day, they’re not very reliable at preventing pregnancy, he says. Anne-Marie Amies Oelschlager, chief of pediatrics and adolescent gynecology at Seattle Children’s. (Some women are prescribed progestin-only pills because they are more sensitive to the other risks associated with estrogen.)
As a result, progestin-only pills are far from the best solution, experts told me. “While I think it could be used off-label, I would be skeptical if someone could find a combination birth control pill,” Erin Fleurant, a family planning consultant at Northwestern Medicine, told me. . And if progestin alone was the right choice, then an IUD, implant, or injection would be the best way to deliver the drug.
Although progestin alone is often not a doctor’s first choice — “I don’t prescribe drugs,” Veronica Ades, a clinical psychologist at NYU Langone Health, told me — the drug. he can have meaningful benefits when taken alone. Amies Oelschlager told me that he prescribes me to reduce the menstrual cycle of patients, especially if they are experiencing pain or heavy bleeding. Even low-dose pills (such as Opill) can be useful in period- and perimenopause-related management migraine headacheand mood swings from premenstrual syndrome or premenstrual dysphoric disorder.
Progestin pills can also be used for treatment endometrial hyperplasia, an abnormal thickening of the uterus (called the endometrium) that can become cancerous. Likewise endometriosisa problem that can affect up to 11 percent American women whose endometrial tissue grows outside the uterus. Patients with PCOS produce more male sex hormones and, Ades said, often have more estrogen in their bodies than progesterone (a common progestin analog). Progestin pills can help maintain good health.
Currently, patients have few options for relief from any of these symptoms without the help of a doctor. Until Opill hits the market, the best non-drug way to treat PCOS is diet and exercise, Amies Oelschlager told me. For heavy periods, the best option that patients can buy over the counter is an NSAID such as ibuprofen. “In terms of a daily hormonal drug, this is a first in the United States,” he said.
Perhaps the best conditions for using Opill without a prescription would be to stop it. If someone experiences unexplained bleeding or period pain but doesn’t get an appointment or see a doctor for a few weeks, they can buy progestin-only pills during that time. Opill can also be a plan to help patients who are already taking birth control pills but can’t go to the doctor for a refill, or can’t get their medication from a pharmacy. .
However, Ades cautioned that even using the alternative method may not be wise for endometriosis patients, whose medication changes can disrupt hormonal balance and “cause a lot of problems.” Fleurant warned that some of the symptoms that progestin pills can help alleviate may also be related to more serious conditions that require a different medication regimen. “Let’s say someone was 45 years old and had irregular bleeding and had a lot of other risk factors for ovarian cancer. I wouldn’t want her to take the pill and think it’s going to cure everything,” she said. Instead, she should be seen by a doctor.
For many women who need birth control, single hormone pills like Opill are not the most reliable option; but starting next year, it could be even better. The same trade-off, between effectiveness and availability, also affects other progestin functions.