An Over-the-Counter Pill Isn’t Safe

Congress wants to make oral contraceptives available sans prescription. The benefits are overwhelming —but the risks of prescribing it without screening for blood disorders are huge.

Ever since the first FDA-approved contraception was introduced in 1960, women in need of hormonal birth control have always needed a physician’s prescription to obtain it.

In 2015, all that is about to change.

Last week, Senate Democrats introduced a bill that would allow pharmacists to prescribe birth control to patients without a physician’s oversight. In the past year, several similar bills have been introduced into the state legislatures in California and Oregon, both gaining significant bipartisan support.

Republican Representative Knute Buehler, who introduced a birth control bill into the Oregon House of Representatives in April, expressed his frustration that emergency contraception was available over the counter, while preventative contraception was not. Making birth control available over the counter, he said in one statement, would improve contraceptive access and reduce unintended pregnancies by 25 percent.

Special interest groups like the American College of Obstetricians and Gynecologists (ACOG) agree: In 2012, ACOG issued a statement that supported OTC birth control, saying that since the absolute risk for serious side effects was so low, it should be made widely available to the general population. Overwhelmingly, OTC birth control seems like a great idea.

But not every medical professional thinks so.

Dr. Poppy Daniels is an OBGYN and hormone specialist with over ten years of clinical experience. Daniels specializes in treating blood clotting disorders at her clinic in St. Louis, MO., and sees a substantial amount of patients who have developed blood clots thanks to their hormonal birth control. Most patients, she says, want to transition to another contraceptive method and have come to her for help.

“I rarely see the happy pill patients,” she says.

In Daniel’s experience, many of her patients suffer from undiagnosed clotting disorders that only became apparent after taking hormonal birth control. According to Daniels, blood-clotting disorders are extremely common, and are typically related to a gene mutation that affects an estimated forty percent of the population. For this reason, Daniels will only prescribe hormonal contraception—including the pill, the patch, or the NuvaRing—after she has carefully evaluated the risks for each patient, including a rundown of the patient’s family history for blood clots, strokes, and heart attacks.

“Hormonal birth control is not without risk,” Daniels says, who adds that she thinks over-the-counter birth control, available without a physician’s oversight, is “ridiculous.”

“My concern is that you’re basically taking women who have no counseling, no family history, no risk assessment, and they’re just getting [hormonal birth control] with no guidance,” she says. “Why would you take that risk?”

The absolute risk for serious side effects among large populations, Daniels says, is low—she and ACOG agree on that point. But only talking about the absolute risk “makes it seem like [complications] rarely happen,” she says, which couldn’t be further from the truth. When complications arise, says Daniels, they can be catastrophic, necessitating hospital stays or months of anticoagulants. “To put [hormonal contraception] on the same aisle as Tylenol and Zantac is absurd.”

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Proponents of over-the-counter birth control have said that putting prescriptions over the counter could improve contraceptive access as well as drive down costs, which Daniels thinks is important. But with so much emphasis on access and convenience, Daniels feels that women are losing something more important in the process. “We’re losing the doctor-patient relationship,” she says. “We’re losing the opportunity for risk-factor assessment. We also lose the ability to know if a woman is having side effects from the birth control.”

ACOG and others have suggested that pharmacists can screen patients for side effects, but Daniels considers that wishful thinking. “Pharmacists don’t have the time to do the level of counseling that I think is needed and warranted. They’re busy. The people picking up [the prescription] are busy. It’s just not realistic.”

Daniels, for the record, is not against hormonal birth control. “People think I have some nefarious, right-wing agenda,” she says, “And that’s just not true. I’m medically responsible for the patients I see, and they deserve to know the potential risks and benefits of each medication.”

Holly Grigg-Spall is no medical professional, but her experience with hormonal birth control, in some ways, rivals Daniels’. At seventeen, Grigg-Spall started taking hormonal contraception and spent the next several years battling severe side effects.

“I took four or five different brands [of birth control] over the next ten years,” Grigg-Spall says, which led to “profound” side effects ranging from adrenal fatigue to extreme paranoia. “It started off like PMS at first, and then it got progressively worse,” she says.

It wasn’t until Grigg-Spall joined an online forum for other birth control users that she discovered she wasn’t alone. Many women were going through what Grigg-Spall was experiencing, and others much worse: “I heard from people who had lost relationships, lost their jobs, had nervous breakdowns,” she says. “Those cases are rare, but probably not as rare as we think.”

Speaking to hundreds of women about their experiences inspired Grigg-Spall to not only ditch the pill for herself, but to write a book about her personal experience, offering what she calls a “feminist critique” of the birth control pill. Currently, Grigg-Spall has teamed up with Ricki Lake to produce a documentary based on the book.

Grigg-Spall is quick to point out that taking hormonal birth control can lead to a battery of physical and psychological problems. But medical groups like ACOG point out that taking hormonal birth control is less risky than having an unintended pregnancy or giving birth. Grigg-Spall sees this as a false dilemma.

“[ACOG] creates this dichotomy where women only have a choice between hormonal contraceptives or pregnancy,” she says, and “that’s misleading.” Daniels agrees: “We’re not talking about pregnancy. We’re talking about whether it is safe for non-pregnant women to buy birth control over the counter. And I don’t think it is.”

Grigg-Spall isn’t as opposed as Daniels when it comes to over-the-counter birth control. Pharmacists could provide a reasonable amount of counseling and risk assessment to women who get their birth control from the pharmacy, she thinks. But in order to make over-the-counter birth control safe, a lot needs to change.

“In a perfect world, women would be screened for blood-clotting disorders. They would know their medical history. We’d have full access and affordability,” Grigg-Spall says. “But instead you have over the counter birth control in a context that’s very different than that. And that’s a problem.”