Oral contraceptives were one of the biggest, life-changing developments of the 20th century. Giving women the autonomy of birth control, in privacy, and avoiding the repercussions of unwanted pregnancies, they were a boon… and still are!
There is more than enough information out there about OCPs, how they work, and the types that are available. We are writing this article to clarify some myths, facts, and medical situations where OCPs may not be the first-line option. It’s important for you to be armed with the facts of the science behind the pill.
Some basics…
In this article, we discuss only combined oral contraceptive pills(COCPs). Combined oral contraceptive pills contain some variation of a synthetic estrogen (estradiol) with synthetic progesterone. After the approval of the first-ever birth control pill in 1957, the pills underwent many changes.
There are now four generations of COCPs, each with slightly different estrogen and progesterone types and strengths. The goal with each subsequent generation was to minimize side effects while maintaining continued efficacy.
The estrogen levels in the birth control pills are 150-500 times more potent than the estrogen produced in our body.
While these doses are generally safe, there are certain absolute and relative contraindications to the use of the birth control pills and hence the need for montoring.
How do they work?
COCPs contain much higher synthetic versions of estrogen and progesterone than those produced on a daily basis in the female body. These external hormones suppress ovulation through a feedback mechanism—basically, they fool the ovaries and the brain into thinking that the body doesn’t need any estrogen or progesterone, so the ovaries don’t produce any (or very little) and don’t produce eggs.
When are they not a good choice?
There are several contraindications to the use of synthetic combination oral contraceptives.
Here is a detailed review on the usage, indications and contra-indications of the pill.
Are oral contraceptives considered a prescription-based drug?
Yes, in the United States, the combination oral contraceptive pill is a prescription drug as per the FDA.
While it may be available OTC in other countries, the FDA still regulates all birth control prescriptions through a rigorous approval process. See a sample application form here.
I am completely healthy? Why can’t I get my prescription without being seen?
Well, we agree that you might be healthy. However, a healthcare provider still needs to perform initial and ongoing evaluations to ensure that there are no contraindications and that you are doing well on the pills.
For example, you may develop high blood pressure or migraines or abnormal uterine bleeding, in which case you need your healthcare provider to evaluate you to ensure you are taking the pills safely and appropriately.
How often do I need to see my health care provider?
At Walk IN GYN Care, our policy is at least once a year.
If you have no risk factors at the initial (in-person) evaluation and are young and healthy, we may be able to prescribe a year’s supply.
However, if you are over the age of 35, smoker, have borderline HTN, we will need to see you initially after 3 months and then every 6 months.
This is to ensure we are prescribing the pill in a safe manner.
You wouldn’t want to end up with a stroke on the pill, would you??
I don’t want a pap or an annual; why do I need to see you once a year?
As already discussed in this article and the linked articles, a healthcare provider needs to review your complete history, take vitals (including blood pressure), and determine the safety and appropriateness of use. You may choose to decline an annual, but you still need a visit.
We cannot prescribe drugs without a visit.
I don’t want to pay, but I need birth control.
Well, there are several free clinics or online clinics that can provide birth control for a fee or for free. Here are some resources for you (we have no financial or otherwise affiliation with any of these resources).
Free:
https://www.nyc.gov/site/doh/services/sexual-health-clinics.page
https://www.plannedparenthood.org/
Paid & may or may not require an in-person medical visit:
https://www.nurx.com/
https://hellowisp.com/
However, Walk IN Gyn Care believes in safe and appropriate medical care. Patient safety is key. We cannot prescribe drugs without a visit. This is for your safety.
Why do I have to pay? Or why is my insurance getting billed?
Any encounter with a medical provider that requires medical evaluation is considered a medical visit. A provider reviews your history, symptoms, and blood pressure and performs an exam as necessary. Any medical interaction takes time and resources and is a billable encounter by law.
While many free clinics may dispense birth control pills for free, Walk-In GYN Care is not a free clinic. We are a private Women’s Health Center. We pride ourselves on being a premier center that provides same-day in-person and telehealth access to women in NY and CA. We provide care without any additional membership fee, but we do have to see you to be able to prescribe anything.
What can go wrong?
Many things… while 90 percent of the time, everything may stay fine, several things can go wrong with unsupervised use of birth control pills.
- Irregular bleeding (undiagnosed pregnancy or cancer – we have seen it all)
- Elevated liver enzymes – fatty liver
- Strokes
- Migraines
- Depression or mood changes
Granted, the risks of the above are small. However, we still use our medical license and expertise to review all the risk factors so you can be safe and healthy.
I thought prescription birth control was free under the Affordable Care Act!
Yes and no.
Prescription birth control consultation once a year should be “free” or exempt from a copay.
However, if you need a 3-month or 6-month follow-up, then the insurance does not consider it a preventative visit.
In addition, if your insurance policy has a prescription copay, deductible or co-insurance to obtain the pills from the pharmacy then you need to be aware of those out of pocket costs. We do not have any control over your insurance policy.
Can you bill my birth control refill as a preventative visit?
Only if it was a part of your once a year, annual visit. If it was a follow up visit or if you declined an annual visit, we cannot commit fraud and bill wrong codes to you insurance. Fraudulent billing is a criminal offense, so please don’t ask us to change codes to save you $$.
I was told my birth control is covered, and I got a bill.
That’s a loaded question. A covered service does not mean you do not have out-of-pocket costs. You should know your policy and benefits. It is your responsibility. You can usually access the policy details through your insurance portals or by calling your insurance representative.
I heard a pill was approved for OTC use.
You are correct. The O-pill was the first non-prescription birth control pill to be approved last year. However, it is not a combined estrogen + progesterone pill. O-Pill is a progesterone-only pill and works slightly differently than the combination pill.
We hope that this brief article helps dispel some myths regarding the pill, its usage, and your coverage.
Thank you for reading and trusting Walk In GYN care for your health care needs.
Be safe, be strong and be prepared,