Birth Control Pills Going Over the Counter?

The American College of Obstetrics and Gynecologists (ACOG) have released a committee opinion statement that they recommend over-the-counter access to oral contraceptive pills (OCs). ACOG believes that access and cost are the major barriers to women using contraception, and that OTC birth control pills will greatly reduce those barriers, thus lowering the unintended pregnancy rate. ACOG feels that there is no significant safety risk when OCs are compared with medications such as aspirin, which has been OTC for decades. (Note, however, aspirin would unlikely be approved if it were starting the whole FDA approval process in 2012! Great drug, very useful, but the side effect profile is much higher than tolerated in drug trials today.)

This issue will surely be open to widespread debate, pulling in religious and political arguments as well as medical. I'd like to share my thoughts on purely the medical front. As a family physician, I appreciate the value of an "annual" physical exam and know that OC prescriptions are usually a tiny portion of that visit. As a busy mom, however, I know that many women are only motivated to make time for that exam when that visit is a requirement to continue taking a prescription medication- which for many healthy women, is only an oral contraceptive. I worry that women will push aside their other often silent health issues such as weight, blood pressure, blood sugar, cholesterol if there is not another reason "forcing" them back in to see their physician. Additionally, there is significant counseling that we pair with birth control prescriptions- from logistics about the medication itself (taking it the same time every day; what to do if spotting or missed pills, etc.), discussions about the impact of OC's on other conditions such as depression or migraines,  and of course, education about sexually transmitted diseases. Additionally, I believe most clinicians and many OC users would agree that there is an art to choosing the correct OC that goes well beyond a basic flow chart. I shudder to think of the media war that will ensue as the drug companies ramp up their ads to try and capture their piece of the OC market. The pharmacists, though well-versed in OC pharmacology, simply will not have time to individually counsel women about these issues.

BOTTOM LINE: OTC OC's? Buyer beware. 

Happy Birthday to the Pill

Did you know that "the Pill" is 50 years old? Hard to believe it's been around for so long. Of course, the pill today is nothing like our mother's "pill". The estrogen hormone content of our oral contraceptives today is almost half of the amount in the original formulas. Today we use the pill for much more than birth control, and its benefits are numerous.

Painful cramps, irregular periods, PMS, acne and anemia (from heavy periods) can all be helped by taking an oral contraceptive. Not everyone on the pill is taking it to prevent conception. In fact, in my practice, I would estimate that roughly a third of my patients on the pill are purely taking it for medical reasons.

What else should you know? Primarily, that it must be taken consistently, and at the same time every day. People who take the pill "when I go to bed or when I get up" are rarely consistent, and if the time fluxuates by several hours on the weekends, for example, they may become pregnant if they are not using another form of birth control. Also, if you take an antibiotic, be aware that it decreases the effectiveness of the pill.

Last but not least, remember that being on the pill in no way protects you against STDs. Enough said.

BOTTOM LINE: The oral contraceptive pill has been around for half a century, and the "new, improved" versions help with many different medical issues.