Hormonal Contraceptives Should Be Available OTC, ACOG Recommends

By Joe Elia

Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM

All hormonal contraceptives — pills, patches, injections, and vaginal rings — should be available as over-the-counter (OTC) items and without age restrictions, according to an American College of Obstetricians and Gynecologists committee opinion published in Obstetrics & Gynecology.

Expanding a 2012 ACOG opinion that advocated OTC status for oral contraceptives, the new document cites evidence to refute possible objections. It advocates that wider availability should not come at the expense of affordability.

One objection, the risk for venous thromboembolism (VTE) associated with combined oral contraceptives, is answered with the observation that those VTE risks are small compared with those encountered during pregnancy and postpartum.

Another, that adherence may slip with OTC availability, isn't supported by published studies, which find contraceptive adherence equal to or higher than that noted with prescription-only availability.

The committee notes that hormonal contraception should not be initiated before menarche, and that oral contraceptives, for example, "are safe and effective for adolescent users and there is no scientific rationale for limited access."