Summary
The approval of Opill for non-prescription use to prevent pregnancy is a landmark event for the U.S., and could have a significant impact on individuals experiencing barriers to obtaining contraception, such as those who live in poverty, those who cannot take off from work or school to attend physician appointments, and adolescents. The availability of a non-prescription, progestin-only oral contraceptive pill could significantly reduce unintended pregnancies in the U.S., thereby mitigating the negative medical and socioeconomic impacts associated with unintended pregnancy. It could also increase bodily autonomy for women which is a hot topic in recent years.
When it comes to birth control pills, there’s more than meets the eye. Sure, they may come in different shapes, sizes, and colors, but that’s just the tip of the iceberg. The world of birth control pills is diverse and fascinating, with variations that go beyond their appearance. In this article, we’ll take a closer look at the different types of birth control pills, diving into their unique hormone compositions, delivery systems, and special features. Aside from all the glory given to the OPill for being the first ever over the counter birth control, we look at what makes it so special that it can be over the counter and what doctors like me think about once the dust settles.
Opill is hitting stores near you and gaining a comprehensive understanding of all the details is crucial for everyone.
Why it matters?
Birth control pills matter for a multitude of reasons.
👉🏾Birth control provides individuals with the ability to plan their families, manage their reproductive health, and pursue personal and professional goals.
👉🏾Approximately 150 million people worldwide rely on birth control for various reasons.
👉🏾Birth control pills play a vital role in promoting reproductive autonomy and gender equality. Let’s call it reproductive equality.
👉🏾Half of all pregnancies in the US are unintended, emphasizing the need for more accessible contraception. Among adolescents, 72% of pregnancies among 15-17-year-olds are unintended.
👉🏾It doesn’t end with an unintended pregnancy. Other consequences include lack of preconception care, increased risk of poor maternal and fetal outcomes, preterm birth, maternal depression, substance use, poor maternal-infant bonding, decreased breastfeeding rates, child neglect and abuse, infant death, and relationship stress.
👉🏾Prescription contraception exists, but obtaining it can pose challenges for some individuals; ACCESS is a problem. The current process for most people to obtain birth control starts with making an appointment, getting to and from the clinic, getting the prescription, picking it up from a pharmacy, waiting until their next period, taking the pill, and then repeating this entire process every year, and let’s not forget about those people who live in “medical deserts” where there are no clinics and providers.
The Benefits of Birth Control Pills Can’t be Understated
Contraception
First and foremost, birth control pills offer a reliable method of contraception. By taking these pills consistently, individuals can take control of their reproductive choices and plan when they want to start or expand their families. This freedom allows women to pursue education, career opportunities, and personal goals without the immediate pressure of parenthood. In turn, this empowers women to shape their lives on their terms, contributing to gender equality and women’s empowerment.
Period Control
Beyond preventing pregnancy, birth control pills offer a range of additional benefits. Many individuals who experience heavy or painful periods find relief through hormonal contraception. Birth control pills can help regulate menstrual cycles, reduce menstrual cramps, and alleviate symptoms of premenstrual syndrome (PMS). Some formulations even provide skin-clearing benefits, helping individuals manage acne.
Treating Health Conditions
Aside from their traditional purpose, birth control pills play a crucial role in managing certain health conditions. For individuals with polycystic ovary syndrome (PCOS), hormonal birth control can help regulate hormone levels, improve menstrual regularity, and reduce the risk of complications. Similarly, women with endometriosis often find relief from symptoms such as pelvic pain and heavy bleeding by using birth control pills.
Cancer Prevention
Even though most women are not thinking about cancer, birth control pills decrease the rate of uterine and ovarian cancer. The longer you take them, the more protective they are towards cancer rates.
The Control in Birth Control
Birth control pills give individuals greater control over their sexual and reproductive health. This control empowers individuals to engage in sexual relationships on their terms and make informed decisions about their bodies and futures. Let’s call this “sexual equity” or “reproductive equity”. With the introduction of birth control pills over 70 years ago, women can be equal partners in “reproductive equity”.
The benefits are endless. But, as we all know, everything comes with some risk, albeit a very small amount of risk. Birth control pills are not without their limitations and considerations. Each person’s body may respond differently to various formulations, and it may take some trial and error to find the most suitable option. Additionally, birth control pills do not protect against sexually transmitted infections (STIs). In such cases, combining condom use with birth control pills is recommended for STI protection ( yes, this is a PSA).
Birth control pills have a global reach, with millions of women around the world relying on them as a form of contraception. 151 million women worldwide use the pill. In the US, over 65% of women using some form of birth control use pills. There are over 100 countries that serve birth control pills over the counter. Why this all matters is such a huge topic, but the bottom line is access and control of one’s reproductive outcomes. Unintended pregnancies is a number we can quantify so we share maps. There are so many other reasons that we can’t put a number to.
The Different Types of Pill
Understanding the make-up of birth control pills allows you to understand how OPill works. Birth control pills, the patch, and the vaginal ring are all the same thing except they are delivered into your body differently. There is a combination of estrogen and progestin. The mini-pill has progesterone only. OPill falls into the progesterone only family. Understanding their mechanism of action helps people make informed decisions and manage potential side effects.
What pills are made of
Birth control pills come in different hormone compositions, each serving a specific purpose in preventing pregnancy. There are two different types: combination pills and progesterone-only pills.
Combination pills use estrogen and progesterone. Progesterone-only pills use only progesterone. The following is a list of the different variations that are on the market today. Don’t make your head spin. Just know there are very few estrogen options and a ton of progesterone options.
The way I was taught is that estrogen and progesterone are steroids. When they hit the body, the are rapidly turned into the same the thing no matter their composition. That’s why I have a tough time with bioidenticals – they are the same thing as synthetic hormones listed below because once they hit the stomach, your body changes them into the same active ingredient. That will be another article for another day.
- Estrogen component: Estradiol, Ethinylestradiol, or Estetrol
- First-generation progestin: Norethindrone acetate, Ethynodiol diacetate, Lynestrenol, Norethynodrel
- Second generation progestin: Levonorgestrel,dl-Norgestrel
- Third generation progestin: Norgestimate, Gestodene, Desogestrel
- Unclassified progestin: Drospirenone, Cyproterone acetate
- Credit NIH
Combination Pills: These pills are a dynamic duo, combining two hormones – estrogen and progestin. The specific types and doses of these hormones can vary across different brands and formulations. Estrogen plays a crucial role in preventing ovulation and regulating the menstrual cycle. It also helps to maintain the stability of the uterine lining. Progestin, on the other hand, thickens cervical mucus, making it more difficult for sperm to reach the egg and create an environment in the uterus that is less receptive to implantation.
Progesterone-only Pills (Mini-pills or POP): As the name implies, these pills contain only progestin, without any estrogen. Progesterone-only pills offer an alternative for individuals who cannot tolerate estrogen or have specific medical considerations. Progestin works by thickening cervical mucus, inhibiting the movement of sperm, and thinning the lining of the uterus to prevent implantation.
Delivery Systems
The pill is taken orally on a daily basis. Most pills have active hormones for about 21-24 days. The rest of the pack contains placebo pills, or sugar pills is an easier way to remember them.
The Patch: The birth control patch is a small adhesive patch that is applied directly to the skin. It contains hormones, typically a combination of estrogen and progestin, which are absorbed through the skin and into the bloodstream. The patch is usually worn on the lower abdomen, buttocks, upper outer arm, or upper torso. It is replaced once a week for three weeks, and during the fourth week, no patch is worn to allow for menstruation. This continuous hormonal delivery provides effective contraception throughout the menstrual cycle.
The Vaginal Ring: The vaginal ring, also known as the contraceptive ring, is a flexible, small ring that is inserted into the vagina. It contains both estrogen and progestin hormones. The ring continuously releases a low dose of hormones, which are absorbed through the vaginal lining into the bloodstream. The ring is typically left in place for three weeks, and then removed for a one-week break to allow for menstruation. After the one-week break, a new ring is inserted to start the next cycle.
Both the patch and the vaginal ring offer convenient alternatives to oral birth control pills. They offer continuous hormone delivery, eliminating the need for daily pill-taking. However, it’s important to note that these methods still require proper usage and adherence to the recommended schedule to ensure their effectiveness.
Dosage
Monophasic Pills: Monophasic birth control pills have a consistent hormone dosage throughout the entire pill pack. Each active pill contains the same amount of hormones, typically a combination of estrogen and progestin or progestin-only. With monophasic pills, individuals experience a steady level of hormones throughout their menstrual cycle, which can help maintain cycle regularity and provide consistent contraceptive effectiveness.
Biphasic Pills: Biphasic birth control pills are designed with two distinct phases, where the hormone dosage changes once during the pill pack. In these pills, the first phase typically has a lower dose of estrogen and progestin, followed by a second phase with a higher dose of these hormones. The purpose of this two-phase approach is to mimic the natural hormonal fluctuations of the menstrual cycle more closely.
Triphasic Pills: Triphasic birth control pills take the concept of varying hormone dosages a step further. These pills have three distinct phases within the pill pack, with each phase containing different amounts of estrogen and progestin. The hormone dosages in triphasic pills change throughout the cycle, aiming to replicate the natural hormonal changes more accurately than monophasic or biphasic pills.
The main goal of using varying hormone dosages in biphasic and triphasic pills is to provide a more nuanced hormonal profile, potentially leading to improved cycle control, reduced side effects, and enhanced contraceptive effectiveness. However, it’s important to note that the clinical evidence supporting these advantages is not definitive, and individual responses may vary.
Choosing between monophasic, biphasic, or triphasic pills often depends on an individual’s specific needs, preferences, and any underlying medical conditions.
I personally like monophasics because it maintains the same level of hormone throughout the cycle. I also like the lowest dose possible because why not use less hormones if you get the same outcome as higher dose ones.
Dr. Reetu Syal
Finally, OPill
Progesterone only birth control has been around for many years. In fact, when birth control was just beginning about 80 years ago, progesterone was in the first formulations as an injection. It started when doctors were trying to figure out the hormonal cycles as it relates to fertility and getting women pregnant. The first formulations of fertility drugs had only progesterone extracted from yams. While doing those injections, though, the doctors realized that women who used progesterone injections actually didn’t ovulate. They didn’t release an egg, and therefore they didn’t get pregnant. POOF! Birth control is born. The point is that progesterone-only concoctions have been around since the beginning of birth control: Progesterone is the original. Estrogen stumbled into the picture later.
Opill is made of Norgestrel which has been around a long time. It thickens cervical mucus and suppresses ovulation. No egg = no pregnancy. Sperm hate when the cervical mucus is uninviting and therefore get stopped well before they enter the uterus. No sperm = no pregnancy.
OPill has to be taken every day at the same time. There is never a pill-free week because there are no sugar pills. Every day is the same dose (monophasic).
In the documented study, of the 955 women enrolled, 6 got pregnant while on the trial. That is 0.6% failure rate. This is for women who used it perfectly, never missed a pill or if they missed for 3 hours, they used back-up birth control like condoms. That’s pretty damn good. Nothing in this world is 100% for birth control except abstinence.
From the package insert:
- Opill Tablets should be taken at the same time every day, including throughout all bleeding episodes.
- Use a nonhormonal back-up method of contraception (such as condoms or spermicides) for the next 48 hours whenever Opill Tablets are taken 3 or more hours late, or if you have vomiting or diarrhea within 4 hours after taking the pill.
- Use of Opill Tablets may be associated with changes in your normal menstrual bleeding pattern. However, women who miss two periods (or have missed a single period but have missed doses of Opill) or suspect they may be pregnant should take a pregnancy test.
- Inform your healthcare provider if you develop repeated vaginal postcoital bleeding, prolonged episodes of bleeding, amenorrhea or development of severe abdominal pain.
- Opill Tablets do not protect against HIV infection (AIDS) or other sexually transmitted infections (STIs).
Norgestrel should not be used:
- If you have or ever had breast cancer
- If you are already pregnant or think you may be pregnant
- Together with another birth control pill, vaginal ring, patch, implant, injection or an IUD (intra-uterine device)
- As an emergency contraceptive (morning after pill)
- If you are male
In summary, it’s a safe birth control option with occasional side effects that usually go away. Take it on time and if you mess up sometimes, use back-up birth control. Use condoms because OPill does not protect against STIs and don’t take it if you have any of the above conditions.
Why it’s a game changer?
It offers full control to the woman without having to get permission from a provider. It allows people to access contraception without needing to go through the current hurdles. By making the purchase of a contraceptive pill as easy and affordable as a trip to the drug store or online, birth control can become more accessible to those who are uninsured or underinsured, who can’t get an OB-GYN appointment, or who live in areas where there are no clinics. ACCESS and AFFORDIBILITY done privately. Reproductive Equity gives women something men have had for thousands of years.
Unintended pregnancies are bound to decrease when you increase access and lower cost of birth control options. Studies have shown that removing barriers like cost and access can drastically cut the rate of unintended pregnancies. Another study showed this exact concept – giving women a larger supply of oral contraceptive pills allows for more consistent use, since women need to make fewer visits to a clinic or pharmacy for their next supply. OPill is definitely addressing these limitations across the country.
The Final Word
We have years of experience with progesterone only pills (POP). They work really well with very few side effects. Most women who are breastfeeding chose POP. So it’s not like this is a brand new concept. We’ve used POP for decades. There are definitely concerns that we talk about. When we start women on any birth control, we send them home with instructions, we talk through risks and benefits and alternatives.
Here are some thoughts that I want to share with you all regarding OPill:
- Take the pill at the same time. Don’t miss it. When you take combination pills, you can be off a little, but not with progesterone only pills. YOU MUST BE DILIGENT in taking them at the same time. Set your alarm. Do not skip a pill. If something happens, use back-up birth control. 🙏🏽
- Take a pregnancy test before you start the pill. Do this for any birth control that you start. I did not see this in the package insert. Not sure why? But, before you start ingesting any medication, take a pregnancy test.
- Because this is a progesterone only option, there is a higher rate ectopic pregnancies. These are pregnancies outside of the uterus, most likely in the tube. This is a big deal. One of the ways that progesterone works is by slowing down the tube. Let’s pretend that you ovulate AND the sperm gets to the egg and fertilizes the egg (unlikely if you are taking the pill like you should), the tube has to move the embryo to the uterus. The embryo cannot swim like sperm. If the tube is slowed down because of progesterone, then the embryo implants right then and there in the tube, hence causing a tubal pregnancy.
- I am very worried about people taking the pill like they should. We are human. We have things going on. We forget. But progesterone only pills are not forgiving. Combination pills are more forgiving. Bottom line – be a perfect user and you will get everything you want.
I am way too excited for the OPill to hit the market. This is huge step for reproductive equality. If done right with the right information sharing and education, OPill will definitely be a game-changer.
Share your thoughts in the comments. More to come on the OPill.
