Opill offers effective, convenient birth control

Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith.

The first over-the-counter birth control pill (the Opill) received FDA (Food and Drug Administration) approval, and its maker expects it to be on store shelves in early 2024.

What's important to know about this pill compared with other birth control methods?

For answers, I'm turning to Dr. Maureen Burke. She's the chief of general obstetrics and gynecology at Upstate.

Welcome to "The Informed Patient," Dr. Burke.

Maureen Burke, MD: Thank you for having me, Amber.

Host Amber Smith: Over-the-counter means women won't need a prescription from a medical provider in order to get this birth control pill. How significant is this?

Maureen Burke, MD: This is a very big deal. Hormonal birth control is much more reliable for pregnancy prevention than barrier methods that have historically been available without a prescription. Things like condoms or spermicides and needing a doctor's appointment to get a prescription can actually be a big barrier to getting hormonal contraception.

So, being able to get it without a prescription is going to be a game changer for some women.

Host Amber Smith: Do you have any medical concerns about this being available without a doctor's visit?

Maureen Burke, MD: Absolutely no. This is a progesterone-only pill. And this is a medication that is incredibly safe for almost everybody.

Host Amber Smith: What does it mean -- "progestin only"? (Progestin is a synthetic form of progesterone.)

Maureen Burke, MD: There are two types of hormonal birth control, some that have just a single hormone, progesterone, and some that have a combination of two hormones, progesterone and estrogen. Progesterone is really the one that has the biggest impact on preventing ovulation, which is the way birth control pills protect against pregnancy.

Estrogen can be used in combination to help sort of regulate hormones in the body, but it's not necessary for pregnancy prevention.

Host Amber Smith: So, what type of woman would benefit from the combination with the progestin and estrogen versus progestin only?

Maureen Burke, MD: One of the most important things to know about a progestin-only pill, like the Opill, is that it needs to be taken at very close to the same time every single day and is less effective if a dose is missed. Adding estrogen into a contraceptive pill increases its efficacy, which means that it's not quite such a big deal if a woman forgets one day of her pill, or if she takes a pill in the morning one day, and then the next day realizes at 3 p.m. that she hasn't taken it yet and takes it at that time.

So, it provides a little bit more reliability, but other than that, there's not a big difference in terms of progestin-only versus the combined pill.

Host Amber Smith: But nevertheless, the birth control pills are not effective if you don't take them every day, roughly regularly. Are there concerns about these over-the-counter pills being misused?

Like, I'm wondering if someone takes more than one of them, or takes the whole pack at once, what could happen?

Maureen Burke, MD: Really very little in terms of risks to the patient. Progesterone can have some GI (gastrointestinal, or digestive) side effects when taken in large quantities, so someone who takes more than one pill a day or multiple doses in a day might feel nauseous or vomit or have diarrhea, but there's not any significant risks to the body from taking too much progesterone at once.

Host Amber Smith: What if someone who is pregnant takes birth control pills?

Maureen Burke, MD: It does not impact the pregnancy, actually, so progesterone levels increase in the body at the beginning of pregnancy, and having a little bit of extra progesterone on board from a progesterone-only pill does not make a difference or put the pregnancy at risk.

Host Amber Smith: What happens if a man takes these pills?

Maureen Burke, MD: Nothing, it's not going to reduce their sperm count or prevent pregnancy from their side, but it's also not going to have any long-term impacts on their health.

Host Amber Smith: Does having had one or more births versus not having had children make a difference in whether a woman can take Opill?

Maureen Burke, MD: No, it doesn't matter whether a person has been pregnant before or not in terms of how the Opill works.

And one thing that's really important for people to know is that using the Opill or any type of hormonal contraception is not going to impact a patient's ability to get pregnant in the future.

Host Amber Smith: How long after a birth can a woman start taking the Opill?

Maureen Burke, MD: Any progesterone-only contraception can be started almost immediately after delivery, so it's very common for us to discharge a patient from the hospital with a prescription for a progesterone-only contraceptive. And if somebody doesn't get discharged with a prescription, it's certainly something they could pick up and start taking at any time.

Host Amber Smith: So, are there any side effects for a woman to look out for if she starts taking the progestin-only Opill?

Maureen Burke, MD: Not really. This is a very low dose of progesterone, so the women are not going to feel many side effects. Sometimes people will feel nauseous or have a little bit of GI discomfort when they first start taking a pill, but that's generally a side effect that goes away once they've kind of adjusted to the dose.

Host Amber Smith: How soon after you start taking the birth control pills are they effective?

Maureen Burke, MD: That's a really good question and something that it's important for people to realize -- that the progesterone-only pills are not effective right away. It takes seven days of continuous use before we can reliably use it as a contraceptive.

Host Amber Smith: That seems important, because I'm imagining that drugstores will put these on the shelves near the condoms. And the labeling must be pretty clear that you've got to take it for at least seven days for it to be effective, right?

Maureen Burke, MD: Yeah, I think that this is going to take some information and advocacy on the part of reproductive health providers to make sure that people who are picking up these pills off the shelf know that they need to take it for seven days. And I imagine that that will be pretty obvious on the packaging as well.

Host Amber Smith: Are there any women who should not take this medication?

Maureen Burke, MD: Really there are very few contraindications to using a progesterone medication.

People who have active breast cancer or a personal history of breast cancer, it may not be safe to use progesterone. People who have significant liver disease, the pills are going to be less effective. And then there some people who are taking seizure medications where the seizure medication may interact with the progesterone and make the progesterone less effective.

But that's a very small group of people.

Host Amber Smith: So, if these are being picked up in pharmacies, in drugstores, can the people who are buying them get questions answered by the pharmacist there?

Maureen Burke, MD: Yes, anytime somebody is picking up an over-the-counter medication, they can go ask a pharmacist a question about how to use it.

Host Amber Smith: Is the effectiveness expected to be the same for women using this product of any age, whether it's young teens or closer to menopause, is it going to have the same effectiveness?

Maureen Burke, MD: Yes, the effectiveness of progesterone-only contraception doesn't change based on age.

It is important to realize that the pill is only effective as the reliability of its use. So, a person who is missing doses isn't going to have the same effectiveness as a person who's remembering to take the pill every day. But that's really the only thing that changes how effective it is.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.

I'm talking with Dr. Maureen Burke. She's the chief of general obstetrics and gynecology at Upstate. And we're talking about contraceptives and the new over-the-counter birth control pill for women that was recently approved.

The first birth control pills were approved 60 years ago. Can you tell us in general how things have changed over the years with contraception?

Maureen Burke, MD: Yes, it was really revolutionary when the first birth control pill was put on the market.

It was the time women really had autonomy over their bodies, in terms of deciding whether sexual intercourse could potentially result in pregnancy or not. The two components of the birth control pill -- estrogen, progesterone -- are still the same, but the dosing and the exact way that those hormones are made in the pills has changed over time.

One of the things that's changed is that we've come to understand that the effective dose is a lot lower than what was in the original formulation of the pill. So, some people may have parents or grandparents who remember significant side effects from a birth control pill. Some people may really have in mind that it's risky for people who have high blood pressure.

That's really the estrogen component of contraception that has some of those risks, and the risk is much less today than it was 60 years ago because the doses are lower. But also, those aren't concerns for people who are taking progesterone-only pills, which weren't an option in the past.

That's a more recent development, the progesterone-only pills.

Host Amber Smith: Well, let's talk about how the pill compares to other forms of birth control. It's considered the most effective method. Is that right?

Maureen Burke, MD: Well, when we talk about forms of birth control, we kind of divide it into two categories, hormonal and non-hormonal.

And generally, when we think about non-hormonal, we're talking about things like condoms, spermicides, tracking one's menstrual periods and trying to avoid sex during the fertile window of the month. And those types of decisions to prevent pregnancy are significantly less effective than hormonal birth control.

But hormonal birth control actually comes in many, many different forms. There are pills, there are patches, there are flexible rings that a person can put inside their vagina. And then there are forms of hormonal birth control that can last longer in the body. So, there's an injection that lasts three months, there are implants that can go in the arm and last four to five years, there are devices that can be placed in the uterus called IUDs, which can last anywhere from five up to 12 years, depending on the device. And the longer-acting forms of hormonal birth control are actually more effective than things like pills.

So, a pill, if used correctly, is probably about 90% effective. But the longer-acting hormonal contraceptives, the implant and the IUD, are really closer to 99-plus% effective. And we actually consider those longer-acting forms to be as effective as permanent sterilization or tying the tubes.

So the pill is definitely more reliable than condoms or spermicides, but there are still other forms of birth control that are even more reliable than a pill.

Host Amber Smith: It sounds like there are a lot of options these days, and maybe that helps you get things more specific to each individual for what their needs and desires are.

Maureen Burke, MD: Yeah, that's exactly right, Amber. Having so many options available really allows each individual to make the choice that feels right to them.

Some people really appreciate the convenience of a pill. They appreciate that if they know that they're not going to be having sex for a prolonged period of time, they can stop taking the pill if they want to, whereas some people feel like the convenience of something that's longer acting and sort of lives in their body for a few years is a lot more convenient because they don't have to think about whether they're on the contraceptive or not when they're thinking about whether they're ready to have sex, so it really just depends on what's most convenient for the person as an individual.

Host Amber Smith: Which is the most popular method with young women?

Maureen Burke, MD: A lot of young women are still opting for short-acting options, like the pill.

And I think that this will be a very popular option for teens and young adults who may be in a phase of life where they're just starting to make decisions about sexual activity and may appreciate the convenience of being able to pick something up at the pharmacy without having to make an appointment.

However, long-acting forms of contraception are becoming more popular with younger people who realize that it can be a lot more convenient to have something on board all the time for pregnancy prevention.

Host Amber Smith: Which works best for women who've already had children?

Maureen Burke, MD: It really doesn't matter. It's still whatever works best is the one that an individual finds most convenient for their body and their lifestyle.

Host Amber Smith: Do any protect against sexually transmitted diseases?

Maureen Burke, MD: Hormonal birth control does not protect against sexually transmitted infections, so anybody who is at risk of a sexually transmitted infection, because they have multiple partners, or maybe they're having sex with somebody who they know has other partners, or they're just not sure whether their partner has other partners, should still be using condoms to prevent STIs.

Host Amber Smith: So, when someone comes to you and is considering a birth control method, what sorts of things do you tell them to think about and consider?

Maureen Burke, MD: Well, I kind of give them all the options just like I laid out with you, Amber, and see what their initial thoughts are about what they think would be most convenient to their lifestyle.

And then we have kind of a conversation from there. I answer questions about what their concerns might be about potential side effects or drawbacks to having something in their body for a longer period of time. And we just have a conversation to work out together what's best for them as an individual.

Host Amber Smith: If you recommend a progestin-only birth control method, and the patient wants that, is there a benefit to getting a prescription from you versus going to the pharmacy and getting the new Opill?

Maureen Burke, MD: We're talking about a progesterone-only pill. There's probably not a difference in terms of what can be obtained over the counter versus with a prescription.

Host Amber Smith: Dr. Burke, thank you so much for making time for this interview.

Maureen Burke, MD: Thank you for having me, Amber. I'm really excited about the Opill.

Host Amber Smith: My guest has been Dr. Maureen Burke. She's the chief of general obstetrics and gynecology at Upstate.

"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.

Find our archive of previous episodes at upstate.edu/informed.

This is your host, Amber Smith, thanking you for listening.