Contraindications to combined hormonal oral contraceptives among over the counter users in the United States.

OBJECTIVE

To determine the prevalence of self-reported medical contraindications to hormonal contraception among over-the-counter (OTC) users.

STUDY

DESIGN

We conducted a cross-sectional survey of individuals aged 15-45 obtaining oral contraception (OTC using a progestin only pill (POP) versus a prescribed combined oral contraceptive (COC) pill) to determine the prevalence of medical contraindications to use. We recruited participants online and at pharmacies from April 2024 to March 2025. We defined contraindications using a simplified list of the Center for Disease Control's Medical Eligibility Criteria for Contraceptive Use category 3/4 conditions.

RESULTS

Among OTC users, only 0.3% reported a contraindication to progestin only pill (POP) use. With regards to contraindications to a combined oral contraceptive pill (COC), the OTC users reported a higher rate of category 3/4 conditions to a COC (25.1%, n = 75) versus the prescription group (15.5%), n = 43).

CONCLUSION

Medical contraindications to a POP pill among OTC users in the United States is rare.

IMPLICATIONS: Individuals using the over the counter birth control pill are accurately self-screening for contraindications.