Sunday, August 19, 2007

Over-the-Counter Birth Control Pills

If birth control pills were available over-the-counter (OTC) would you buy them? And, more importantly, should you?

Judging from the results of a study of over 1,000 women, buying the Pill OTC would likely be safe, especially for younger women....

Women in many countries can buy birth control pills over-the-counter(OTC). Not so in the US. Here a prescription (meaning a doctor's visit to screen for contraindications to Pill use) is required.

Even with the screening requirement, approximately 6% of COC [combination oral contraceptive] users in the US are contraindicated for use.

So researchers wanted to see how well women could self-screen for contraindications to Pill use. The women were given a checklist and asked to determine if they had any of the Level 3 or 4 contraindications to Pill according to the WHO Medical Eligibility Criteria. The results:

The sensitivity of the checklist to detect true contraindications was 83.2% (95% CI 79.5–86.3%) and specificity 88.9% (86.4–91.0%). 6.7% (5.3–8.0%) of women incorrectly thought they were not contraindicated when they truly were, largely due to unrecognized hypertension of >140/90 mm Hg. Using a cut-off of 160/100 mm Hg (WHO Category 4 contraindication), 2.6% (1.7–3.5%) incorrectly thought they were not contraindicated. In regression analysis, younger women, more educated women and Spanish-speakers were significantly more likely to correctly self-screen (p<.05).

The study concludes:

The percentage of women who incorrectly self-identified as not contraindicated (6.7%) is similar to the proportion of actual pill users in the US who are contraindicated for use (6%). Over-the-counter provision of COCs would likely be safe, especially for younger women and if independent blood pressure screening were encouraged.

So, what do you think; if you could purchase the Pill OTC, would you?

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At 4:39 PM, Blogger #1 Dinosaur said...

Yes and yes. Absolutely: OCs ought to be available OTC.

That would even solve the EC problem (take 5 pills now and repeat in 12 hours.)

At 6:35 PM, Blogger ema said...

Dr. #1 Dinosaur,

I couldn't agree with you more!

At 9:46 PM, Blogger Bardiac said...

So, why aren't they OTC?

(Yes, I'd get them otc, for sure.)

At 10:52 PM, Blogger ema said...


Heh, can you say "torters"?

Seriously now, I think it's a combination of 1) not wanting to give up all the power that comes with regulating access to birth control, on the part of the government, and 2) an unwillingness to make OTC availability an issue for fear of risking profits (frivolous liability claims from torters, loss of political favors) on the part of pharma.

It's a shame, really, but well in line with the prevailing "women of repro age are not to be trusted with making their own health decisions, no matter what" (political and legal) climate.

And just to add some salt to the wound, did you know that in a lot of countries IUDs are OTC? You still need to have it inserted/removed by a doctor, but the rest is up to you, the patient. Imagine that!

At 4:45 AM, Anonymous Anonymous said...

Absolutely....more freedom for having to go when the pharmacy says i can go, no more "what can i do if i lose a pack?" no insurance nightmares. i think teen pregnancy and unwanted pregnany would drop if it were easier for women to get OC

At 4:19 AM, Anonymous Anonymous said...

If the started selling the pill OTC, I'd be first in line!
I never ever get the chance to go to the docter for a prescription!

At 10:42 PM, Anonymous Anonymous said...

I've been taking birth control pills for over 20 years, I've been married for over 10 years, and I've just moved back from the Caribbean where birth control pills are OTC.

I spent over $100 to get a physical to maintain my pills. It is disheartening to watch the money stream in the US associated with access to such a basic medicine.

I picked up 3 months perscription today, but I'll have to wait until my PAP results come back to get the other 10. My father (age 70 this year) laughed at me because he can get Viagra over the internet without a doctor visit - did I mention they deliver them to the front door.

After all these years what makes potential reaction to birth control any more risky than all of the sinus medications we've made OTC in the past 10 years.

If anyone knows how I can help become an activist in this area, please post a reply to let me know - I'm very frustrated.

At 9:31 PM, Anonymous Anonymous said...


At 10:32 PM, Anonymous Anonymous said...

Well, men can buy condoms to protect themselves, why can't women buy birth control.
When women get raped, they have nothing protecting them. Giving them the ability to protect themselves beforehand is genius.
Also, of course the birth control pill messes with hormones, but so do some cholesterol medication.
And to say that women who smoke shouldn't take birth control, and that they might take it if its OTC is stupid, because MOST OTC pills arent supposed to be taken if you smoke, yet they are still out there.

At 6:39 PM, Anonymous Anonymous said...

I would deffinatly get it OTC if I could im in a posision where i wish i had gotten it

At 12:18 PM, Anonymous Anonymous said...

Yes yes yes!! I have wondered for DECADES why it isn't already over the counter.

At 4:24 AM, Blogger Jacey said...

Having it be over the counter would be so much nicer, for people who dont want to have to deal with the doctors and pharmacists, and also for younger women who may not have anyone the can go to and dont necessarily feel comfortable going to get a prescription alone.
I know i would definitely buy it otc

At 5:57 PM, Anonymous Anonymous said...

Nothing would please me more than to have BC over the counter. I did a google search for "Why isn't birth control over the counter?" What a waste of a doctor's visit! I think I am perfectly capable of making birth control decisions and I deserve to. If they are so concerned about that 6%, surely they could write a clause that all women must get a doctor's approval the first time they use B.C. Think of it as a "license," like a hunter safety course, or a driver's license. Do you have to go back every single year and retest? No! You do it once. Why not do it once for birth control?

At 3:55 PM, Blogger thedrymock said...

Very late comment, and apparently I'm in the minority, but I think without some kind of mandatory screening and advice process, the pill should NOT be sold OTC. Nearly two years ago, I took a pill (Yaz) for five weeks, and I am still suffering the severe hormonal depression it threw me into, along with a number of other symptoms. Yes, this happened even while I was getting the advice of a doctor. My concern is that both doctors and regular people alike consider anything sold OTC to be automatically less dangerous than a prescription. I think despite this study, a lot of women are not going to take contraindications seriously, because it's OTC, so how bad could it be?

And as for situations like mine, although I realize my situation is much more severe than any depression most women experience on the pill, I do think (from talking to other women about my situation and hearing about their experiences) that mild to moderate depression on the pill is probably much more common than doctors or women realize. (For example, one woman I talked to said she took the same pill I had problems with, Yasmin/Yaz, and her husband told her she had gotten really "bitchy," so she stopped it. Sounds like undiagnosed depression to me.) I don't know of any other OTC drug that has the possible side-effect of depression (at any level), as all birth control pills do. All it takes is a woman or girl not reading the booklet carefully for them to not even realize that the reason they feel bad all the time is their birth control pills. And no, I was not informed about all the possible side-effects by my doctor, either (which is the reason that several years ago I was on Yasmin and depressed for two years without realizing the connection). We should be requiring that doctors do *more* to warn their patients about severe side-effects, not less.

At 4:00 PM, Blogger thedrymock said...

Also, under the current healthcare system, if a woman who doesn't have a regular gynecologist has problems with a pill she bought OTC, in order to get help, she's probably going to have to wait a long time to see a doctor she doesn't know and may not be comfortable with. It's just not worth the risk.

At 7:19 PM, Blogger ema said...


Just as a general discussion point about side effects, depression in particular, I would be cautious in ascribing too much to the use of Yaz/Yasmin for two reason. Short duration of use and DRS, the progestin hormone in Yaz. [Easing PMDD is one indication for use.]

As to OTC availability, I think you bring up two interesting points--change in public perception and access in case of problems.

It would be interesting to look at data from countries where the Pill has been available OTC and see what effect, if any, OTC availability has had on public perception and f/u care.

At 5:07 PM, Blogger Jojo said...

Yes!!! I would buy OTC pills b/c it's expensive to see a Dr. Especially IF you don't have insurance or Medicaid and i don't. Going to an Clinic takes all day and it also costs time and money... Back in Jamaica Birth controls are sold over the counter and I have not heard anyone dying or have complications from it. IDK why they can't do the same here. It's very upsetting. Something has to be done about this, soon...

At 6:45 AM, Anonymous Stephanie said...

I wish that the pill could be over the counter.

I have been using it for 12 years now and every year I have to go back and take that very embarrassing "Physical".

It would be nice if they did something like... you had to get the doctors approval, but then you're okay for 5 years or so.

I know they are concerned because it has the possibility to cause cancer...but really...Every year? I don't have an extra 300$ a year Just for a doctor to tell me I can use something I've been using for 12 years!

Yasmine/Yaz has recently been taken off the market because of many different problems people were having with it. Not all pills are like that though. If you switched pills and were still experiencing the same problems, I would reconsider your view.

At 6:49 AM, Anonymous Elizabeth (Aust) said...

Stephanie, you don't need an embarrassing physical at all - they have nothing to do with the safe use of the Pill - your doctors use the Pill to coerce women into completely unnecessary and potentially harmful exams and to force you into elective cancer screening. Your informed consent is actually required, legally and ethically, before a Dr does a pap test - all screening tests carry risk to your healthy body. Of all the screening tests, you are least likely to benefit from pap tests and most likely to be harmed (to some degree) by a false positive and unnecessary and potentially harmful biopsies and treatment.
It's a rare cancer and an unreliable test - a bad combination.
In the States, 95% of women are referred at some stage to cover a 0.65% lifetime risk of cervical cancer! (One third to one half of the small number of women who get cc have had a recent normal pap test or a series of them, called false negatives) Only around 0.45% at most benefit from pap tests.

If you're under 30 - then you're accepting risk for no benefit - "No country in the world has reported a decline in the incidence of or the mortality from cervical cancer in women under 30, irrespective of cervical screening. Many countries do not perform cervical screening on women under 30". (Taken from "Cervical screening" in "Australian Doctor" 2006 by Assoc Prof Margaret Davy, Director, Gyn-oncology, Royal Adelaide Hospital and Dr Shorne. (on line) BUT, 1 in 3 pap tests in women under 25 will be "abnormal" - false positives caused by the pap test picking up normal changes in the maturing cervix or transient and harmless HPV infections.

Finland has the lowest rates of cc in the world and sends the fewest women for colposcopy/biopsies - they offer 5 to 7 tests IN TOTAL - 5 yearly from age 30. Even so that still sends 35%-55% of women for colp/biopsies at some stage, but that's the best you'll do with this unreliable test.
We have a choice about cancer screening - it is our decision.

The only clinical requirements for the Pill are your medical history and a blood pressure test.
See: "Women after birth control get unneeded pelvic exams" in the WSJ - also comments by Dr Robert Hatcher from the "Managing Contraception" site - google his name and routine pelvic and birth control and it should appear...
Also see, "Questioning the value of the routine pelvic exam" on line and comments by Dr Carolyn Westhoff.

Our doctors do NOT recommend routine pelvic, recto-vaginal, rectal (or intimate inspections - I've heard some of your doctors do that!!!) or routine breast exams. They are all of poor clinical value in symptom-free women and expose you to risk - more unnecessary procedures - biopsies, ultrasounds, procedures and even surgery.

If your Dr refuses you the Pill without these exams, you should produce these articles and make it clear you know your rights - and that you'll be taking your concerns further. Make a formal complaint if necessary - it is outrageous that you should be routinely coerced and harmed by your doctors! This is a try-on, doctors know these exams are unnecessary and harmful and that cancer screening should be your decision.
You have huge numbers of unnecessary biopsies, LEEP, cone biopsies, breast biopsies and hysterectomies - protect your body from harm and make informed decisions about your health care - look at your risk profile, the risks and benefits of testing (you won't get that information from your doctors) before agreeing to cancer screening or preventative checks.
See: Articles by Dr Richard DeMay, US Pathologist, Dr Angela Raffle, UK screening expert and Prof Michael Baum (on mammograms) at Dr Joel Sherman's medical privacy forum under womens' privacy concerns, Parts 1 to 6 - in the side bar, you'll find links to these articles.


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