For decades, oral birth control in the United States was available only with a prescription from a healthcare provider. That changed in 2023, when the U.S. Food and Drug Administration (FDA) approved norgestrel (Opill), the first over-the-counter (OTC) hormonal birth control. Norgestrel shipped to retailers nationwide the following year and is now sold online, in drugstores, and in many supermarkets. When taken correctly, it’s been shown to be 98 percent effective at preventing pregnancy.
So, how is norgestrel used? And why is it still important to visit a healthcare provider (HCP) if you begin taking it? Here’s what to know.
How the OTC birth control pill works
Combination pills that combine the hormones progestin and estrogen are popular birth control options in the U.S. But they can’t be taken by people with certain medical conditions. Norgestrel is a progestin-only tablet, sometimes called a “mini” pill because it doesn’t contain estrogen. Progestin-only pills are generally considered to have fewer safety issues and not as many potential side effects.
Norgestrel is sold in a variety of package sizes, depending on a person’s needs. It’s intended to be taken each day, at roughly the same time. It's not intended to be used with other hormonal birth control methods—such as an intrauterine device (IUD) or vaginal ring—and doesn’t prevent sexually transmitted infections. People with a history of cancer should speak with a HCP before using the drug.
OTC birth control and preventing pregnancy
The American College of Obstetricians and Gynecologists (ACOG) is the leading professional association for OB/GYNs in the U.S. The group supports OTC hormonal contraception for people of all ages. In its committee opinion reaffirmed in 2025, ACOG noted that needing a prescription often prevents contraception use. OTC access removes that obstacle, improving accessibility and potentially preventing unintended pregnancies.
Each year, an estimated 3 million pregnancies in the U.S. are unintended. People experiencing them are less likely to receive early prenatal care and have a higher risk of preterm delivery, which is linked to health and developmental issues in babies and children.
Early research suggests access to OTC oral birth control is already making a difference. A 2025 study of nearly 1,000 people published in JAMA Network Open found a 31.8 percent increase in those who chose it after previously not using contraception.
The importance of continued health screenings
Many people access contraceptive prescriptions during regular visits to HCPs. During these visits, it’s common to receive essential preventive care aside from birth control, such as Pap smears, blood pressure checks, vaccinations, and physical exams.
If you choose to take OTC medications, it’s critical to continue these appointments, which can protect you from illness, identify medical conditions, catch certain issues before they become serious problems, and help you maintain overall good health. Be sure to maintain regularly scheduled wellness appointments with your provider.
