A review of recommendations, efficacy, and patient safety for over-the-counter norgestrel for daily contraception

Purpose

This narrative review examines the implications of norgestrel, a progestin-only oral contraceptive, becoming newly available over-the-counter (OTC) in the United States. The objectives are to explore the pharmacotherapy,mechanism of action, efficacy, safety, and implications to clinical practice of OTC progestin-only pills (POPs), and how this may impact contraceptive access and public health.

Methods

The review synthesizes data from clinical studies, public health reports, global perspectives, and recent policy changes to assess the potential impact of OTC access to norgestrel in the United States. The analysis includes the evaluation of the pharmacodynamics of norgestrel 0.075 mg on ovarian activity, the effectiveness of POPs, and benefits and barriers to contraceptive access.

Findings

The evidence indicates that POPs thickens cervical mucus, providing effective contraception within 48 h of use. While ovulation inhibition may take up to 28 days and occurs in approximately half of users, the availability of POPs OTC is anticipated to significantly reduce barriers to contraceptive access. This could lead to a broader use of effective contraception and potentially reduce unintended pregnancies. Additionally, the review highlights that the introduction of OTC contraceptives could increase access among populations historically facing difficulties in obtaining prescriptions.

Conclusions

Making norgestrel available OTC represents a critical advancement in contraceptive access with the potential to enhance public health by reducing unintended pregnancies. However, the extent of its impact will depend on widespread education and adherence to proper use. The review underscores the need for further research to monitor outcomes post-OTC availability and to assess the broader implications for reproductive health and equity.