Opill: A Potential for Over-The-Counter Birth Control

Independent experts voted to recommend the U.S. Food and Drug Administration (FDA) make Opill the first over-the-counter birth control pill. The FDA is expected to make a final decision this summer. We review everything you need to know to safely and effectively take Opill.

Key takeaways:

What is Opill?

Opill is a progesterone-only birth control pill that contains 0.075 mg of norgestrel. Norgestrel is a progestin (synthetic progesterone). Progestin-only contraception has been around since the early 1970s and is sometimes called "POPs" or "mini-pills."

Norgestrel prevents pregnancies by thickening the cervical mucus which inhibits sperm from reaching the egg. It also prevents the release of eggs from your ovary and thins the lining of your uterus to impair implantation. Opill, when taken as directed, is highly effective in preventing pregnancy and has a failure rate of approximately 3% which is significantly better than other options available without a prescription.

How to take Opill

When taking Opill, it is important to take the pill at the same time every day. Forgetting to take the medicationor taking it even a few hours latecan decrease its effectiveness in preventing pregnancies. Therefore, set an alarm or take with a specific event that occurs at the same time every day.

It is important to follow the package directions and always have the next pack readily available when you are getting to the end of your pack. With Opill, you start the next pack the day after you finish the current pack; there is no interruption between packs.

Opill can be taken with or without food.

Side effects of Opill

As with all medications, Opill has side effects that may occur but they typically resolve over time. However, if they are severe, stop taking the medication and contact your doctor.

The most common side effects include:

  • Headache
  • Nausea
  • Dizziness
  • Changes in menstrual bleeding
  • Increased appetite
  • Bloating
  • Acne

What to do if you miss a dose?

Missing a dose can prevent the medication from working effectively. The table below details what to do if you miss a dose.

Missed dosesAppropriate action
Missed one dose by less than 3 hoursTake the missed dose immediately. Then go back to taking the next dose at your usual time the following day.
Missed one dose by more than 3 hoursTake the missed dose immediately, even if this means taking 2 pills in 1 day. Then go back to taking the next dose at your usual time the following day. Use a barrier form of contraception, such as condoms, for the next 48 hours.
Missed multiple doses by more than 3 hoursTake the first missed dose immediately, even if this means taking 2 pills in 1 day. Then go back to taking one pill a day at your usual time the following day. It is advised to use backup contraception for the next 48 hours.
Missed more than 3 dosesIf you miss 3 or more doses, confirm that you are not pregnant. Restart the medication as explained above. Contact your doctor if you have any questions.

Who should not take Opill?

If you have any of the following conditions, you should go for a thorough evaluation from your healthcare provider before taking Opill.

  • Pregnancy. Women that are pregnant or may be pregnant should not take Opill.
  • Abnormal bleeding. Women having abnormal uterine bleeding should not take norgestrel and should be evaluated by their doctor.
  • Cancer. If you have ever had breast cancer or a progesterone-sensitive cancer, you should avoid taking Opill as it can lead to the recurrence of the tumor.
  • Liver disease. If you have liver disease do not take norgestrel and contact your doctor to discuss other contraception methods.
  • Allergies. If you are allergic to norgestrel, Yellow #5 dye, or any other ingredients in Opill, do not take this medication.

Drug interactions

Norgestrel can interact with multiple medications — decreasing its effectiveness and resulting in an unwanted pregnancy. Therefore, it is important to discuss with your doctor or pharmacist all the medications you take before starting Opill to make sure there are not any interactions.

Medications used to treat seizures, tuberculosis, HIV/AIDs, and pulmonary hypertension can interact with Opill and may require you to use a backup method of contraception while using these medications. Many herbal supplements, especially St. John's Wort, can interact with norgestrel and should be discussed with your doctor or pharmacist.

Important information

The following points are important to take note of:

  • Abdominal pain. If you have severe, sudden-onset abdominal pain, seek medical attention immediately as this could indicate an ectopic pregnancy.
  • Unusual bleeding. With everyday use, spotting or bleeding between your periods can occur. However, if it lasts more than 8 days, is brought on by sex, or is unusually heavy or concerning, contact your doctor as soon as possible.
  • Missed periods. If you have missed two periods or one period and missed doses, obtain a pregnancy test to confirm you are not pregnant.
  • Migraines. If you have a history of migraine or develop new-onset migraines after starting Opill, call your doctor as norgestrel can increase your risk of having a stroke in these circumstances.
  • STDs. Opill does not protect against sexually transmitted diseases, including HIV.
  • Timing. Take Opill at the same time every day to ensure maximum protection against an unwanted pregnancy.


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