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Ramifications of Over-the-Counter Availability on Oral Contraceptive Use

Users of over-the-counter oral contraceptive pills were more likely to continue their contraceptive method but were more likely to have contraindications.

About half of women who initiate oral contraceptive pills (OCPs) discontinue use during the first year. Over-the-counter availability could promote continuation by lowering barriers to access; however, such access might allow women with contraindications to obtain OCPs. In two 9-month studies in El Paso, Texas, researchers used baseline and periodic surveys to assess rates of continuation and contraindications in women (age range, 18–44; primarily Mexican-born) who obtained OCPs by prescription from a city clinic versus over the counter in neighboring Mexico.

At baseline in the continuation study, most women reported that they intended to use OCPs for longer than 1 year. At 9 months, 119 of 474 prescription users (25%) and 97 of 466 over-the-counter users (21%) had discontinued OCPs, mostly because of side effects or other OCP-associated problems. In adjusted analysis, risk for discontinuation was similar in over-the-counter users and in women who were prescribed 6 packs at a time (hazard ratio for discontinuation, 1.1) but was higher in women who received 1 to 5 packs at a time (HR, 1.8).

In the contraindication study, investigators used data from 514 prescription and 501 over-the-counter OCP users who self-reported conditions consistent with relative (category 3) or absolute (category 4) OCP contraindications according to WHO Medical Eligibility Criteria. Over-the-counter OCP users were substantially more likely to have relative contraindications than were prescription users (13% vs. 9%; P=0.006). Prevalence of absolute contraindications was similar between groups at about 6%. Hypertension was the most commonly reported contraindication.

Comment: The design of this study is intriguing, and, although the results do not make a convincing argument for over-the-counter OCP dispensing, they offer some insights. Over-the-counter pill users were more likely to continue the method, whether because of cost, convenience, or other factors that were not examined. Women who were prescribed 6 packs were also more likely to continue, suggesting that we should prescribe multiple OCP packs at a time. However, the authors comment that clinicians might have judged who would continue OCPs and prescribed accordingly; furthermore, some insurance plans limit the number of OCP packs dispensed at one time. Women who chose OCPs without medical guidance were more likely to have contraindications; nonetheless, for some of these women, OCPs still might have been appropriate, given the risks associated with pregnancy.

— Diane E. Judge, APN/CNP

Published in Journal Watch Women's Health March 17, 2011

Citation(s):

Potter JE et al. Continuation of prescribed compared with over-the-counter oral contraceptives. Obstet Gynecol 2011 Mar; 117:551.

• Medline abstract (Free)

Grossman D et al. Contraindications to combined oral contraceptives among over-the-counter compared with prescription users. Obstet Gynecol 2011 Mar; 117:558.

• Medline abstract (Free)

Reader Remarks:

Review and add to remarks on this article

• Was Cost Factor a variable
  Marie T Davis, 18 Mar 2011 11:25 AM EST
  Specialty: Other Specialty
  During your study did you take into account the cost factor involved in purchasing the BCP's? Don't women go to... [more]
• OTC available for BCPs in Mexico
  Larry A Grissom, 21 Mar 2011 8:05 AM EST
  Specialty: Radiology
  I suspect cost is a huge factor. The BCP cost in Mexico is a fraction of the US prices.

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