Opill, the first ever over-the counter oral contraceptive in the United States, will be available in stores and online in the coming weeks at a price of $19.99 a month.
Opill is composed only of progestin (norgestryl 0.075mg) and has a a dual mechanism of action: thickening the cervical mucous, making it more difficult for sperm to fertilize eggs, and thinning the uterine lining, making fertilized eggs less able to attach properly.
Opill should be on every dermatologist’s radars as they counsel and treat acne patients, especially those patients considering isotretinoin.
Here are the 6 most important things to keep in mind about Opill.
Opill is not an approved primary method of birth control in the iPLEDGE system
Progestin-only pills are less effective than combination pills containing both estrogen and a progestin, says Dermatology Digest Editorial Advisory Board member Hilary Baldwin, MD, an associate professor of dermatology at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ. “The biggest issue that I foresee is a patient presenting to the office for isotretinoin who tells me that she is ‘on the pill,’ she says. “It was uncommon for me to ask which brand of pill she was taking and now, I must enquire.” Dr. Baldwin stresses that all dermatologists need to ask this question once Opill is available.
If a patient is taking isotretinoin, always ask about birth control, and make sure patients are aware that Opill is not as effective as combined oral contraceptives, agrees Anate A. Brauer, MD, a reproductive endocrinologist at RMA of New York in New York City. “Progestin-only pill use has to be perfect,” she says. “They must be taken at the same time every day, and the stakes are higher when a patient is also taking teratogen.” Her advice? Dermatologists should refer patients to obstetrician/gynecologist to discuss birth control options.
Opill could worsen or cause acne
Progestin-only contraception methods may worsen or induce acne given their androgenic effects on the sebaceous gland, says Dermatology Digest Editorial Advisory Board member Emmy M. Graber, MD, MBA, the founder of the Dermatology Institute of Boston and member the Board of Directors at the American Acne and Rosacea Society.
Opill also has a variety of nuisance side effects including bloating and nausea, headache, irregular menstrual bleeding and spotting, and breast tenderness, explains Ted Rosen, MD, a Professor of Dermatology at Baylor College of Medicine in Houston and the Medical Editor of the Dermatology Digest.
Opill may interacts with drugs and supplements
Opill has some potential drug-drug interactions with many anticonvulsants, a few HIV treatments, and with the dietary supplement St. Johns Wort, Dr. Rosen says. Make sure to ask patients about any and all medications that they are taking.
Opill shouldn’t be used in women with breast cancer
“It is contraindicated in those who have or have had breast cancer,” Dr. Rosen says.
There is no age requirement for Opill
There is no legal age requirement to purchase Opill, Dr. Rosen says. “It may be obtained and used by those under 18.”
