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More states offer over-the-counter hormonal birth control: What to know

While laws like this increase access to birth control, some people might have questions. The experts explain what people need to know.
/ Source: TODAY

At the end of July the governor of Illinois signed a bill that allows people to receive up to a year of hormonal birth control over-the-counter. Starting in January 2022, Illinois will become the latest state in the country to offer hormonal birth control without a prescription. Currently, 12 states and the District of Columbia provide over-the-counter hormonal birth control, according to the Guttmacher Institute, a policy organization focused on advancing sexual and reproductive rights.

People hoping for over-the-counter hormonal birth control, which includes pills, rings or patches, in Illinois need to undergo a self-assessment and counseling from a pharmacist before receiving their birth control. In 2019, The American College of Obstetricians and Gynecologists issued a committee opinion supporting over-the-counter access to hormonal contraception without age restrictions, yet some states do only provide over-the-counter hormonal birth control to adults.

Other organizations like ACOG support legislation that allows people to receive hormonal contraception from a pharmacist at any age.

“Certainly, the pharmacy boards and pharmacists associations, I’ve seen their support. I’ve seen ACOG's,” Elizabeth Nash, a state policy analyst with Guttmacher Institute, told TODAY. "Planned Parenthood is in favor.”

Though it's important to note these products aren't available on shelves; they're available in the pharmacy section. Still experts agree that pharmacy-provided hormonal birth control offers people easier access.

“You don’t have to go in there with a prescription. So that part is being cut out for the patient,” Nash said. “There’s so much unmet need for contraceptive services and access. And we need to make sure that we as a society, government, are able to provide people multiple ways to access care.”

While laws like this make it easier for people to receive birth control, some might have questions. Experts say that it’s important for people to understand their health history when selecting an over-the-counter hormonal birth control.

Types of hormonal birth control and who can take it

“There are two different types of hormonal contraception in the pill form: either combination, meaning they have estrogen and progesterone, or there’s just progesterone,” Dr. Christine Greves, an OB-GYN at Orlando Health's Winnie Palmer Hospital for Women & Babies, told TODAY. “The progesterone-only pill is acceptable for women to take if they are over 35, have migraines, for example … high blood pressure.”

The self-assessment required is conducted by the pharmacist and should help people understand their health and what birth control might work best for them.

“They call it a self-risk assessment — basically you answer some questions for yourself to determine if there are methods that might be best for you or if there’s something that is a contraindication," Nash explained. "Usually there's some counseling that has to be provided."

That counseling from a pharmacist might explain why people with high blood pressure and migraines might want to avoid birth control with estrogen in it. The hormone increases their risk for blood clots and other health problems.

“If you take the combined birth control pills along with those predisposing factors that can increase your risk for even more conditions, stroke, heart attack and things like that,” Greves said. “It’s the estrogen in there that does that.”

Estrogen also impacts a breastfeeding person’s milk supply, making a combination pill wrong for those nursing.

“It’s recommended if you’re breastfeeding to only be using progesterone (birth control),” Greves said.

The ring or the patch include both estrogen and progesterone and wouldn’t be a good option for those with high blood pressure, migraines or who may be breastfeeding.

“They work very similarly to the mechanism of the pill because they are combined, there’s estrogen and progesterone in both the pill, patch and ring,” Greves said.

Progesterone-only pills work best if people take them at the same time every day. If they are taken outside of a three-hour window they might be less effective, Greves explained. People need to change the patch every week and the ring every three weeks. When selecting a birth control, it’s important for people to understand their schedule and their ability to take their birth control at the same time.

Common side-effects from birth control:

  • No menstruation.
  • Spotting.
  • Nausea.
  • Breast tenderness.
  • Headaches.

“You may have no period and don’t be scared of that,” Greves said. “It happens sometimes.”

While some believe that taking hormonal birth control causes people to gain weight, there’s no evidence that this is true.

“There is no good data that says that (hormonal birth control) can cause weight gain or weight loss,” Greves said.

When to visit a doctor:

If people notice persistent headaches or pain in their arms or legs when taking birth control, they might want to see a doctor.

“If you notice pain, especially in one of your extremities, that can be a blood clot,” Greves said. “Be aware of your body. And if you notice any changes in your body that’s when you should get seen.”

Many people spot especially if they take progesterone-only birth control. While it might be upsetting, that’s not always an indication that something is wrong.

“If you take a progesterone-only pill, expect spotting,” Greves said. “If it continues you may want to get it evaluated, you may want to talk to your doctor about changing the different doses of hormones.”

People might want to talk to their doctor first before considering birth control. But hormonal birth control is safe for many.

“As long as you don’t have any of the direct contraindications it should be OK,” Greves said. “But I always recommend that if you have that history, you may want to touch base with your doctor.”