We need to talk about over-the-counter birth control...
We need to talk about over-the-counter birth control...
Recently, the Food and Drug Administration in the United States approved an oral progestin-only birth control pill for over-the-counter sale. It’s a progestin-only pill called Opill that should be available in early 2024 (unless the cartoon villains at the Alliance Defending Freedom file some bullsh*t lawsuit to prevent it, which is depressingly likely). This is a HUGE step for reproductive health access in the United States, and one that I fully support as a board-certified obgyn. Maybe you heard some scary-sounding reasons why this could be dangerous. Here, I’ll explain why the science itself supports this as a safe and effective method of contraception.
00:00 Intro - FDA approval
00:27 OTC hormonal BC globally
1:24 Hormonal BC use in the US now
4:35 Difficulty accessing prescription BC
6:46 Potential risk - counseling
7:36 Potential risk - self-screening
17:30 ACOG statement
20:09 Potential risk - annual screenings
25:19 Opill overview
31:52 Back-up contraception
Watch next:
Debunking viral birth control lies: • Gynecologist Debunks Viral Birth Cont…
Male birth control: • Do we really NEED male birth control …
Bizarre historical birth control: • Historical birth control was SHOCKING
Resources:
Journal of Women’s Health: https://www.liebertpub.com/doi/10.108…
Contraception journal: https://pubmed.ncbi.nlm.nih.gov/22520…
American College of Obstetricians Committee Opinion: https://www.acog.org/clinical/clinica…
Self-screening for birth control:
birth control,contraception,opill,fda,us politics,medication,over the counter birth control,prescription,medicine,reproductive health,dr danielle jones,danielle jones md,mama doctor jones
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** The information in this video is intended to serve as educational information and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/advanced practice provider. **
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Content
0.09 -> [Music]
0.24 -> let's talk about over-the-counter access
1.86 -> to contraceptives the first thing we'll
3.54 -> go through is around the world overview
5.819 -> of thoughts about this and then we'll go
8.4 -> through some of the literature on why
11.58 -> this is or is not a safe thing to have
13.98 -> and some of the reasons that people
16.26 -> advocate for that the recent news that
19.02 -> we got was the FDA has approved birth
21.24 -> control to be over the counter when
22.5 -> we're discussing birth control in the
24.539 -> context of today what we're discussing
26.58 -> is hormonal birth control birth control
28.38 -> pills are already over the counter in a
32.04 -> lot of places around the world if you
34.14 -> look at this map all the light orange
35.52 -> areas are places where you can get birth
37.92 -> control over the counter I don't know
39.66 -> the specific contraceptives that are
41.28 -> over the counter in these places but it
43.86 -> is a lot of places right so you can
46.26 -> already kind of infer by this that it
49.079 -> can't be so unsafe that it's not
51.42 -> something that is reasonable to do dark
53.1 -> orange places are prescription only and
55.559 -> I do think it's interesting that most of
57.6 -> the places where it's prescription only
59.579 -> are are there's some pattern here isn't
62.76 -> there
63.6 -> of the places where word prescription
65.939 -> only so it's interesting to me it's just
68.4 -> something to note I don't know what the
70.26 -> distinction is like why some places do
72.96 -> and don't make it over the counter but
74.46 -> there you go that's that amount oh yeah
75.9 -> so Karen my production manager pointed
77.82 -> out the same Trend that I just said
78.9 -> which was interestingly most of the
80.52 -> highly developed or wealthy countries
81.96 -> don't have over-the-counter birth
83.82 -> controls so who does it affect well I
86.52 -> think we have pretty good data and most
88.68 -> of you probably know that a whole lot of
91.259 -> people who have the need or desire to be
94.92 -> on birth control whether it's for
96.54 -> contraceptive purposes or for treating
98.64 -> other conditions now the approval of the
101.52 -> projection only being over the counter
103.02 -> is technically intended for
104.7 -> contraceptive use but obviously people
106.74 -> use it for many different reasons so
108.72 -> let's look a little bit at contraceptive
110.46 -> use in the United States you can see
112.86 -> here so this is from gutmaker this if
115.32 -> you ever need a reliable source for
117.479 -> information on abortion or reproductive
120.6 -> health care of any kind this is a
122.88 -> reliable place to look for information
124.759 -> 46 million U.S women aged 15 to 49 in
128.94 -> 2018 were sexually active and not
130.979 -> seeking to become pregnant why is this
132.599 -> important well that means that they need
134.22 -> some form of contraception in 2018 65
138.42 -> percent of U.S women aged 15 to 49 were
141.06 -> using some kind of contraceptive method
142.739 -> now these are interesting facts I'll
144.36 -> just go through them with you so
145.26 -> sexually active couples who do not use
146.76 -> any method of contraception have about
148.62 -> an 85 chance of experience of pregnancy
151.2 -> over the course of a year that is very
154.14 -> high particularly if you're not
155.819 -> interested in becoming pregnant and it's
158.64 -> very problematic particularly given the
161.64 -> state of access determination care in
163.8 -> the United States average number of
165.36 -> years children that adults think is
166.92 -> ideal is 2.7 I don't know who's having
169.08 -> 0.7 of a child but good job
171.78 -> I'm kidding I understand how averages
173.64 -> work to achieve that family size a
176.28 -> sexually active woman must use
177.3 -> contraceptives for roughly three decades
179.519 -> that I think is a very important note
182.04 -> okay so even people who do want kids and
185.879 -> they are not everybody but even people
188.04 -> who do want kids
189.66 -> have to use contraception at some point
192.3 -> if they're going to be sexually active
193.98 -> because well we all know I don't have to
196.56 -> explain this okay basically
199.26 -> she's just written in there that a whole
201.48 -> freaking lot of people use birth control
203.159 -> and that is important things we've
205.62 -> talked about before right so we know
207.36 -> that the next step for a lot of very
209.76 -> religious people and I actually just
211.56 -> listened to a debate about this I think
213.78 -> it was vosh talking to someone who's
216.12 -> Catholic I had many things to say about
218.7 -> to people who don't have a uterus
220.86 -> debating on whether contraceptive use
223.379 -> should be allowed or not it was
225.42 -> mind-boggling that whoever put that
227.4 -> together wouldn't choose like I don't
228.84 -> know someone who has a uterus not that
230.76 -> don't get me wrong I think anybody can
233.58 -> discuss contraceptives and the utility
235.799 -> of them and I also think there are many
237.959 -> people who don't have a uterus who are
239.7 -> affected by access to contraceptives and
242.159 -> things like that I just think it's a bit
244.14 -> short-sighted to have a whole debate
246.239 -> around whether contraceptives should be
247.799 -> used or not and never get the opinion of
249.48 -> somebody who might ever use hormonal
251.939 -> contraceptives over one-third of
253.92 -> hormonal contraceptive users say they've
256.859 -> had gaps in pregnancy prevention or
259.28 -> self-discontinue their medication solely
261.479 -> due to issues with prescription access
263.46 -> this is a study that was in the Journal
266.58 -> of women's health in 2016. and we talked
269.46 -> about this a bit in the last room that
271.139 -> we briefly covered kind of why birth
272.88 -> control needs to be
274.32 -> over the counter at least in summer
275.759 -> guard and I want to just show you the
277.8 -> study so this is people who are at risk
280.259 -> of unattended pregnancy now to get a
282 -> basis for this we know 50 of pregnancies
284.4 -> in the United States are occurring in
286.259 -> people who weren't intending to get
287.88 -> pregnant now that doesn't mean they're
289.62 -> all unwanted or that all of those are
292.74 -> ones that people would seek to end I
295.32 -> have a whole lot of patients who tell me
296.82 -> I'm not trying but I'm not preventing if
299.1 -> it happened it would be fine but it's
300.54 -> not something that I'm like actively you
302.46 -> know seeking to do whatever that's
304.38 -> perfectly fine but when you are in a
307.32 -> group that doesn't feel that way then
309.66 -> having an interruption to your ability
311.94 -> to get your contraception is very
314.699 -> problematic a third of women in the U.S
317.1 -> have said that at some point they had a
320.4 -> problem getting their prescription I
322.32 -> really think that this study must
323.88 -> underestimate the number of people who
325.86 -> have had trouble obtaining their
327.36 -> prescription because this has happened
329.759 -> to me more than one time many times
333 -> actually and if it happens to me
335.88 -> somebody that could literally although I
338.52 -> try not to self-prescribe I don't
340.259 -> prescribe medications to myself but if
342.539 -> it could happen to me someone who could
343.979 -> quite literally prescribe the medication
345.6 -> to myself if I absolutely had to then it
348.78 -> can happen to anyone right and it is
350.639 -> happening to anyone and it's concerning
353.34 -> to me that people don't see this
355.56 -> conclusion and think wow that is
359.16 -> alarming this should not happen
360.72 -> especially people who think that
363.24 -> abortion should be illegal because if
366.24 -> you truly would like people to not have
368.16 -> abortions and that is your true goal
370.44 -> your true north is abortion bad I think
373.74 -> you know we should not have them then
376.02 -> why would you not just put front and
378.72 -> center this number and say please
383.1 -> make contraceptives over the counter now
385.62 -> let's talk about some of the concerns
386.759 -> that people have and again I think that
389.28 -> most of the concerns that people have
390.72 -> are legitimate worries that have been
393.539 -> thoroughly addressed by the literature
396.12 -> I'll go through chat to address some of
397.8 -> these concerns because I'm sure that the
399.72 -> concerns that I bring up here are going
402.12 -> to be things that you will immediately
404.46 -> come up with in your head lack of
406.139 -> counseling on relative efficacy okay
408.78 -> great I said all of these concerns you
410.819 -> know will be addressed and the first one
413.699 -> you throw at me is one that I I wasn't
415.44 -> prepared to address with literature okay
416.88 -> so yeah lack of effective counseling on
418.919 -> efficacy I think that's a good point I
420.72 -> think that most contraceptives will have
423.18 -> a discussion of that in the package
425.52 -> insert most people who seek to use
427.979 -> contraception know that it's not 100
429.86 -> effective and I would say that they
433.62 -> always if you make birth control over
435.9 -> the counter should be provided with an
438.36 -> effective and easy to understand list of
441.9 -> efficacy and and what affects that thank
444.599 -> you for throwing at me the one thing
446.4 -> that I had not prepared to discuss today
448.38 -> I think counseling is important efficacy
450.78 -> discussions is important but I do think
452.22 -> that can effectively be done with the
453.96 -> information that's provided with
455.28 -> medication okay great forsaken a 96 says
458.099 -> the user may not be a healthy candidate
459.72 -> for pills this is a very common concern
462.66 -> I think well-meaning but not really
465.66 -> based in actual data when we look at it
468.96 -> so first off many easily accessible
472.38 -> medications have much higher side effect
474.9 -> profiles than contraceptive pills second
478.699 -> every single risk of hormonal
481.5 -> contraception is increased by a factor
484.979 -> of 2 to 10 or more if you are pregnant
487.56 -> so blood clots
489.72 -> increased with hormonal contraceptives
491.759 -> that contain estrogen but increased
494.759 -> drastically more than that with
497.099 -> pregnancy okay so you are effectively
499.86 -> you must weigh the risk of the
501.36 -> medication obviously that makes sense
502.56 -> and we can go into the overall safety
504 -> profile a bit too but you're not really
505.74 -> just looking at what is the risk of the
507.539 -> medication itself in a vacuum you're
508.979 -> looking at what is the risk of the
510.66 -> contraceptive medication itself compared
512.88 -> to what that prevents which is pregnancy
516.18 -> which is way higher risk of all of those
518.76 -> things that we worry about so we also
520.5 -> have very good data on this that says
522.599 -> people are able to effectively
525.56 -> self-screen for if they are a good
528.24 -> candidate to safely use hormonal
530.1 -> contraceptives with a screening toolkit
532.92 -> which is just like a questionnaire and
535.32 -> that they screen themselves definitely
537 -> as good as a doctor or health care
539.1 -> provider who would have been providing
540.48 -> the prescription and in some cases maybe
542.64 -> even better because sometimes that is
544.98 -> not even something that is discussed
546.54 -> when they go in to get a prescription so
549.18 -> let me show you how couple of the
550.32 -> studies on this so accuracy of
552.24 -> self-screening for contraindications to
553.86 -> combined oral contraceptive use now
555.36 -> importantly combined oral contraceptives
557.399 -> have more contraindications than
560.04 -> progestin only and the one that they've
561.6 -> made over the counter is progestin only
563.04 -> it is technically lower risk for side
566.82 -> effects so as far as a safety profile
569.16 -> goes it should broadly be applicable
571.26 -> however the other problem with that is
573.66 -> what we've already mentioned of the fact
575.76 -> that it is slightly less effective but
578.04 -> we'll get into that in a second we're
579.6 -> not going to read through all the
580.5 -> studies I can tell you you know if we
582.36 -> just want to talk a little bit about how
583.8 -> do we assess if this is a reliable place
585.54 -> to get information Obstetrics and
587.04 -> Gynecology is a very reliable Journal
590.22 -> it's peer reviewed and it's not a
592.32 -> pay-per-play journal you have to write a
594.48 -> good paper and you have to have a good
596.279 -> research set up to get published there
598.8 -> and it's peer-reviewed then you want to
601.44 -> look at their methods and they've got
603.3 -> some methods here this is probably not
605.519 -> the strongest study that I've ever seen
607.44 -> but I do think it provides us with good
609.24 -> information okay so what they've done is
612 -> take a select group of people in El Paso
614.64 -> Texas so this is not a broad study but
617.16 -> it is an interesting one and they have
620.279 -> given them a checklist so that they
622.38 -> could be screened for level three and
624.899 -> four contraindications to taking
627.12 -> combined hormonal contraceptives a three
629.279 -> and four contraindication is something
630.6 -> like you really just the risks outweigh
632.82 -> the benefits and we get this data from a
635.64 -> World Health Organization or CDC
637.88 -> basically what they've done is given
640.38 -> them a screening questionnaire that
641.82 -> helped them decide do I fall into a
644.04 -> category of people where it would be
645.66 -> less safe to use hormonal contraceptives
648.839 -> CDC has great data on this and I love
652.32 -> this chart I think this chart is very
654.6 -> useful and easy to understand although
657.24 -> it looks uh very confusing and hard to
659.339 -> understand at first glance but you can
661.26 -> see why they wouldn't be able to just
662.82 -> give somebody this and say okay screen
665.7 -> yourself right because the average
666.959 -> person is going to struggle with going
668.519 -> through this and first understanding
670.38 -> what it is and second actually screening
672.6 -> themselves for safety the medication so
674.1 -> when they say that they gave a
675.42 -> questionnaire that helped to help these
677.88 -> people decide if they fall under a level
679.56 -> three or four contraindication when you
681.66 -> just glance at this chart you're going
683.04 -> to be looking for anything that is red
684.6 -> or pink okay so they are offering a
688.019 -> questionnaire to make sure people don't
689.76 -> fall into categories where you are going
692.399 -> to see red or pink here what the red and
694.44 -> pink mean is theoretical or proven risk
697.56 -> usually outweighs advantages and number
700.68 -> four the red unacceptable health risk
703.079 -> method not to be used all right so these
704.88 -> are going to be things like you have
706.86 -> cervical cancer and you're awaiting
708.54 -> treatment higher risk for recurrent DVT
710.7 -> or PE and they're talking about
713.16 -> different ages they have different types
715.62 -> of contraceptives here so this is for
718.5 -> all different types of contraceptives
720.36 -> but we're only interested right now in
722.399 -> the CHC which is combined hormonal
724.32 -> contraception as well as the pop which
726.54 -> is a progestin only pill so we want to
728.94 -> be primary really concerned with this
730.56 -> one for this purposes of this study but
732.6 -> for the purposes of the recently
734.459 -> approved over-the-counter for just an
736.92 -> only pill you're going to be interested
738.54 -> in this category here so you want to be
740.76 -> able to effectively screen yourself out
743.16 -> from using birth control that is not
745.56 -> safe for you so this is things like
747.6 -> current breast cancer a recent history
749.76 -> of breast cancer you're less than 21
751.74 -> days from giving birth now this is an
753.839 -> interesting one right okay so that's a
755.279 -> four for Combined hormonal
756.48 -> contraceptives and a two for progestin
758.7 -> only why because the risk in that time
761.1 -> period is a risk of blood clots so
762.959 -> that's what they're concerned about and
764.399 -> that risk of blood clots is primarily
766.38 -> influenced by the estrogen in the birth
768.42 -> control pill so this number four over
770.459 -> here for Combined hormonal contraceptive
772.5 -> is a number two for progesterone only
774.3 -> because it is not as applicable there
776.76 -> and you can safely use progestin only
778.98 -> contraceptives within 21 days of having
781.86 -> birth committing birth that's right I'm
784.86 -> only phrasing it that way now so you're
787.139 -> wanting people to be able to screen
788.459 -> themselves out of things that would make
790.44 -> it really unsafe so decompensated
792.6 -> cirrhosis risk of having blood clots so
796.44 -> see here we don't care about this number
797.82 -> four and this number four right because
799.26 -> these two number fours are for copper
802.019 -> and leave an adjuster all IUD migraine
804.6 -> with aura is going to be a number four
806.88 -> for the combined hormonal contraceptives
808.56 -> although I will say that some of the
809.88 -> data we have on this is not really
811.2 -> supportive of that it is still standard
812.82 -> practice to recommend against using a
814.32 -> combined hormonal contraceptive ages
816.18 -> smoking right so if you're over 35 and
818.459 -> you're a smoker it is not safe for you
820.62 -> to use a combined hormonal contraceptive
822.42 -> and phospholipid antibodies and known
825.839 -> lupus so you have Lupus you have
827.459 -> antiphospholipid antibodies you should
829.079 -> not be on a combined hormonal
830.339 -> contraceptive the reason is because the
831.72 -> risk of blood clot so a lot of these you
833.7 -> know risks really come down to blood
835.5 -> clots and then you've got drug
837.6 -> interactions here okay so in general
839.459 -> birth control pills don't interact with
842.1 -> very many drugs all right I know you've
844.92 -> been told and everybody believes that
848.88 -> taking contra receptives at the same
850.68 -> time as antibiotics will make them not
853.68 -> work this is false for the vast majority
857.459 -> of antibiotics I'm sorry for breaking
861.18 -> your bubble but your friend who got
862.32 -> pregnant because they were on an
863.459 -> antibiotic actually just forgot a pill
865.5 -> or had a birth control pill failure or
867.36 -> not uh wasn't related to the antibiotics
869.16 -> now there are exceptions to that there
871.139 -> are a couple of antibiotics which
872.94 -> perhaps can be influenced by your birth
876.3 -> control pills and Rifampin is one of
878.82 -> them however it's not very often used
880.68 -> it's not the only one but that's the
882.66 -> main one so that is my
884.899 -> one I rant for the day and your
889.139 -> antibiotics not going to make a birth
891.48 -> control pill not work all right so we've
893.399 -> discussed now what we're looking for and
895.32 -> let's go through the study and see how
897.24 -> well could they screen themselves for
899.279 -> safety of being on a combined hormonal
901.44 -> contraceptive and I'll continue to
902.94 -> remind you that this is not the pill
905.519 -> that they introduced this is a slightly
907.68 -> less safe version that they're talking
909.06 -> about here so they gave them a checklist
910.62 -> to decide if they were a level three or
912.899 -> four contraindication now you all know
914.279 -> what that means because we looked at the
915.72 -> Mec chart and they went with the World
919.079 -> Health Organization MEC we looked at the
921.66 -> CDC one they are essentially identical
923.76 -> they were then interviewed by a nurse
926.22 -> practitioner who also measured their
928.199 -> blood pressure self-screening for
929.88 -> contraindication to oral contraceptives
932.519 -> using a medical checklist is relatively
934.68 -> accurate unaided screening is inaccurate
937.26 -> and reflects common misperceptions about
938.88 -> the safety of oral contraceptives so
940.56 -> they're saying that this study which
943.079 -> again is small is saying that they need
944.76 -> to be aided by taking a blood pressure
947.639 -> by like a nurse practitioner okay so
949.68 -> this is probably one reason that we have
952.68 -> not yet got to the point of having
954.839 -> combined contraceptives over the counter
956.76 -> however there are studies that indicate
959.399 -> that this is not necessarily the case so
961.5 -> they're comparing unaided self screen
964.079 -> which is just basically saying like do
966.24 -> you think you're safe to take them
967.68 -> versus true contraindications using a
970.86 -> checklist that's their aided not
972.959 -> necessarily just taking the blood
974.459 -> pressure so the sensitivity of the
976.26 -> checklist to detect true indications was
978.3 -> 83 percent and specificity was 88 using
981.959 -> the checklist six percent of women
983.279 -> incorrectly thought that they were
984.6 -> eligible for use when in fact they were
986.279 -> contraindicated largely due to
988.26 -> unrecognized hypertension okay so the
990 -> most common reason that somebody would
991.62 -> say with a checklist I am able to take
995.1 -> this is because they had hypertension
997.32 -> and they didn't know about it which they
999.6 -> decided was due to them not having known
1002.72 -> about it but there's some argument here
1004.459 -> that but if your blood pressure is just
1006.32 -> High when you are in part of a study and
1008.72 -> this nurse has come along and taking
1009.8 -> your blood pressure that perhaps you
1011.839 -> might have an elevated blood pressure
1012.98 -> because you're a bit nervous to be
1014.06 -> included however it's a valid criticism
1016.22 -> let's continue on because there's more
1017.959 -> studies on this but basically they've
1019.94 -> said here that with aided screening
1021.8 -> meaning a checklist you can safely
1023.42 -> decide and this is for Combined okay so
1026.36 -> this is adolescence and young adults
1028.339 -> self-screening for contraindications to
1030.26 -> contraception and this is a little bit
1032 -> less interesting but they're basically
1033.74 -> saying some people think that age plays
1036.079 -> a factor of how well you can self-screen
1038.36 -> I I don't know that I've ever heard
1039.62 -> somebody say that most of the time I
1041 -> think even people who are relatively
1043.1 -> young can effectively self-screen I'm
1044.839 -> gonna search around for a bit and see if
1046.28 -> we can find a few more of the studies
1048.679 -> because this has been very thoroughly
1050.66 -> studied this is a cog statement on it
1053.299 -> and again this is a statement that was
1054.74 -> made prior to the FDA approving this so
1058.88 -> ACOG does a lot of advocacy for helping
1062 -> to kind of get these things pushed down
1064.16 -> the line and this is one of the missions
1066.86 -> that they've had for a bit of time
1068.12 -> they're talking about barriers to access
1070.4 -> being one reason for inconsistent or
1073.58 -> non-use and we talked about that earlier
1075.5 -> and I do think it's very important they
1077.84 -> go over the fact that multiple Studies
1080.24 -> have shown that people are able to use
1082.16 -> self-screening tools to determine their
1084.44 -> eligibility and they have expanded this
1087.38 -> committee opinion recently to include
1089.419 -> not only oral contraceptive pills but
1091.88 -> vaginal ranks contraceptive patches and
1094.1 -> the Depo shot they think that those
1096.5 -> should all be available so here's the
1098.179 -> recommendations and conclusions from the
1099.679 -> American College of Obstetrics and
1101.12 -> Gynecology they support over-the-counter
1103.039 -> access to hormonal contraception without
1104.84 -> age restrictions the without age
1106.52 -> restrictions comes from the study I just
1109.16 -> showed you where it didn't matter on
1111.62 -> your age you could effectively
1113.059 -> self-screen particularly with a
1115.16 -> checklist over-the-counter access has
1117.14 -> continuation rates of hormonal
1118.46 -> contraception comparable to prescription
1119.9 -> only access and has a potential to
1122.059 -> decrease unintended pregnancy people
1123.919 -> want this duh for just an only hormonal
1126.799 -> methods are generally safe and carry no
1128.6 -> or minimal risk of VTE VTE risk with
1132.14 -> combined is small compared with the
1134.299 -> increased risk of VTE and pregnancy in
1136.039 -> the postpartum period that's what we had
1137.6 -> talked about just a bit earlier uh we'll
1139.7 -> talk about this screening concerns and
1142.419 -> they're saying yep all the things we've
1145.34 -> said now this pharmacist provided
1148.28 -> contraception I take issue with that
1149.9 -> because I don't think we should make
1152 -> pharmacists do this I don't think that
1154.64 -> it makes sense to have pharmacists
1156.919 -> prescribing birth control not because I
1158.48 -> don't think a pharmacist is capable of
1160.58 -> screening and prescribing it but because
1163.1 -> that is an unnecessary step and
1165.26 -> pharmacists are busy like why put that
1168.26 -> on them if we can say like this is safe
1171.14 -> we have data that indicates that it's
1174.02 -> safe so there's no argument for that it
1177.44 -> is silly to add to a pharmacist's
1180.86 -> already busy day to also make them have
1183.5 -> a consultation and write a book Control
1185 -> prescription when we have argued in this
1187.4 -> entire thing that it is a safe
1189.5 -> over-the-counter option so I think what
1191.9 -> ACOG says in here and I haven't read
1193.88 -> this in years but I think what ACOG says
1197.059 -> in here is basically like that might be
1199.1 -> a good step in the right direction to
1201.98 -> remove some of the barrier but it
1204.14 -> doesn't make sense to have that be like
1206.299 -> the end goal the end goal should be over
1208.46 -> the counter use all right so another
1210.08 -> common concern that people have when we
1211.76 -> talk about this is okay well if you
1213.679 -> don't have to have a prescription then
1216.08 -> nobody will come for their annual
1219.32 -> screening this this is a multifactorial
1222.28 -> problem for me to use as a reason that
1225.44 -> people shouldn't be on hormonal birth
1227 -> control first we have to address okay
1228.919 -> let's pretend that that is accurate that
1231.559 -> you won't come and get a pelvic exam or
1234.08 -> pap smear or breast exam or whatever it
1236.12 -> is that you need if you don't have to
1237.5 -> get a prescription for your
1238.4 -> contraception all right let's pretend
1239.9 -> that's true if that is the case is it
1242.66 -> ethical then to withhold something from
1245.419 -> someone purely because withholding it
1248.36 -> might mean they come and get something
1250.76 -> else that they need I don't know an
1252.62 -> excellent way to make a comparison for
1254.96 -> this of what would be similar but I
1257.299 -> would argue and I'm open to input that
1260.179 -> holding people's contraceptive pills
1263.059 -> hostage because they need routine
1266.12 -> screening is not really an ethical
1268.6 -> stance that I would agree with I just
1271.039 -> can't think of any other situation where
1272.84 -> we do that yeah anyway let's look at
1274.76 -> this data real quick we've talked about
1276.5 -> it likely not being ethical to withhold
1278.72 -> somebody's birth control pill just
1280.88 -> because you think it might increase the
1282.14 -> chances that they come to have
1284.059 -> additional screening like pap smears or
1286.82 -> breast exams now let's talk about the
1288.2 -> fact that that's not even necessarily
1289.94 -> the case so this study comes out of a
1293.12 -> journal called contraception which is
1294.919 -> also a reliable Journal study design
1297.7 -> relatively small but decent enough in
1300.5 -> that you should have reasonable belief
1302.659 -> that the results are at least broadly
1304.76 -> applicable to the population which it
1307.159 -> was studied in so this is comparing
1309.62 -> people who got their birth control pills
1312.02 -> from a U.S Family Planning Clinic which
1313.64 -> means they had to go in for a visit and
1315.08 -> have a prescription versus
1316.419 -> over-the-counter pharmacies in Mexico
1318.26 -> okay so commonly people who live in the
1320.6 -> US and have ability to cross the border
1322.64 -> they can cross border and get
1324.679 -> contraceptives there without a
1327.08 -> prescription because of the chart we
1329.179 -> looked at earlier it's over the counter
1330.62 -> a lot of places then they're going to
1331.94 -> self-report whether they've had a pap
1333.32 -> smear in the past three years or a
1335.84 -> pelvic exam or breast exam or screening
1338.12 -> for STI and there's some problems with
1341.179 -> that as well because oftentimes people
1344 -> will self-report having had a smear and
1346.76 -> what they've actually had is just an
1348.2 -> exam for something else but regardless
1350.36 -> results suggest that most women would
1352.159 -> obtain reproductive Health preventative
1353.84 -> screening if oral contraceptives were
1355.58 -> available over the counter and
1356.96 -> highlights the need to improve access to
1358.64 -> preventative screening for all
1359.72 -> low-income women okay so it's not just
1361.7 -> the study there are many studies on this
1363.08 -> but basically what we have you know now
1365.419 -> decided is okay great Not only would it
1367.82 -> be unethical to withhold contraceptive
1370.159 -> because of that it also doesn't help
1372.799 -> people don't have a higher chance of
1374.96 -> having been screened or a lower chance
1376.82 -> based on whether or not they were given
1378.2 -> a prescription for a contraception so
1380.78 -> this is one of the reasons that
1381.98 -> historically I have always said I really
1385.4 -> support the places
1387.799 -> um like new RX and various prescription
1390.679 -> birth control access apps and websites
1393.679 -> because I think that it should be over
1395.9 -> the counter because it's safe based on
1398.36 -> the data that we have with a
1400.1 -> self-screening checklist and I think
1402.38 -> that those places where you can easily
1404.539 -> get access without having to physically
1406.159 -> make an appointment and go into a
1407.48 -> doctor's office helps to avoid these
1410.659 -> delays in getting your prescription
1412.82 -> renewed and helps to avoid lapses in
1416.059 -> your prescription because you couldn't
1417.74 -> get into the doctor to get it refilled
1419.659 -> or you forgot to go to the pharmacy or
1422.179 -> the pharmacy didn't have the
1423.74 -> prescription or they were out of the one
1425.299 -> that you had been prescribed or whatever
1426.62 -> these apps all make it so that you are
1429.5 -> much more able to avoid those problems
1431.96 -> so in the absence of being able to
1434 -> completely get the pill over the counter
1436.4 -> I do think those are good options as
1437.96 -> well okay so we talked about the reason
1440.419 -> it is important to have hormonal
1443.36 -> contraceptives accessible over the
1444.86 -> counter we talked about the risks of the
1447.98 -> hormonal contraceptive and the fact that
1449.96 -> we know people are able to fairly
1452.36 -> accurately self-screen to see if they
1455.48 -> are a good candidate to use hormonal
1457.4 -> contraceptive and we talked about the
1458.659 -> fact that Not only would it be be
1460.46 -> unethical to not make that over the
1463.28 -> counter for the purposes of withholding
1465.26 -> a prescription because it might increase
1466.76 -> the chances of somebody getting a pap
1468.86 -> smear or other screening but that we
1471.32 -> don't really see that play out in the
1472.82 -> data when we look at how often people
1474.5 -> get screened and things like that I
1476.72 -> think now we should talk about the
1477.86 -> benefits of it being over-the-counter
1479.299 -> now we talked you know mainly about
1481.46 -> access but I also think that there are
1483.98 -> social benefits to this just in that
1486.679 -> people have more access to have more
1488.9 -> control over their life every benefit of
1491.12 -> contraception from Life planning
1494.059 -> pregnancy planning the outcomes that we
1495.679 -> see with families having access to be
1497.78 -> able to do Family Planning all of these
1499.64 -> things are going to be improved with
1502.76 -> improved access and you're going to see
1505.28 -> a decrease in the need for abortion as
1508.22 -> you increase accessibility of
1510.02 -> contraception so
1512 -> all of those things are benefits now
1515.24 -> let's talk about what the FDA has
1517.88 -> recently done U.S Regulators have
1520.1 -> approved the first over-the-counter
1521.659 -> contraceptive pill it is not age
1524.24 -> restricted and it's a once a day pill
1526.76 -> called Opel it is a nor gestural birth
1529.76 -> control pill at a looks like 75
1532.1 -> microgram dose once a day at the same
1534.62 -> time every day so we need to talk a
1536.84 -> little bit about that and why
1539.299 -> some pills are more sensitive to being
1541.1 -> taken at the same time each day they're
1543.32 -> going to sell it over the counter
1544.58 -> available in stores and online in the
1547.64 -> first quarter of next year so this goes
1549.32 -> into play in January of 2024 still a bit
1552.919 -> of time now to allow you know
1555.38 -> well-funded organizations to file a
1557.539 -> lawsuit against it today's approval
1559.34 -> marks the first time a non-prescription
1560.659 -> daily oral contraceptive pill will be
1562.279 -> made available for millions of people in
1564.08 -> the United States when used as directed
1566.48 -> daily oral contraception is safe and is
1568.76 -> expected to be more effective than
1569.96 -> currently available non-prescription
1571.4 -> contraceptive methods in preventing
1573.14 -> unintended pregnancy this is an
1574.76 -> important point when we're talking about
1576.98 -> the failure rate of contraceptive pills
1579.38 -> combined versus progestin only that all
1583.22 -> of them are more effective than what you
1585.5 -> can get over the counter at the moment
1586.88 -> side effects FDA talks about side
1589.22 -> effects here common side effects include
1590.779 -> irregular bleeding that would be the
1593 -> most common side effect I see that
1594.679 -> really really commonly headaches
1596.659 -> dizziness nausea increased appetite
1598.52 -> abdominal pain or bloating roughly one
1600.919 -> in four U.S women who had ever attempted
1603.14 -> to get a hormonal Birth Control
1604.34 -> prescription reported difficulty doing
1605.96 -> so often because of language barriers
1608.12 -> lack of insurance or costs yeah that's
1610.22 -> important too right because it's not
1611.539 -> free to go to the doctor in the US it's
1613.159 -> not even cheaper Easy and if you are low
1616.52 -> income and you don't have insurance even
1619.88 -> just being able to get to a doctor to
1622.279 -> get a prescription is a huge undertaking
1624.98 -> and I think that the benefit we didn't
1628.22 -> talk about when we were going over the
1629.9 -> benefits of making contraceptives over
1631.64 -> the counter or at least some of them is
1633.38 -> that there is equity in this right
1636.08 -> equality is not ever going to be fully
1639.26 -> achieved but there is something about
1641.84 -> this that makes it more Equitable
1644 -> because if you're not required to have
1646.58 -> insurance and go to a visit it still is
1649.88 -> going to be a problem because it costs
1651.5 -> money hopefully it will be an affordable
1653.539 -> price but if you can't afford to go to
1656.48 -> the doctor because you don't have
1657.74 -> insurance which can be hundreds of or
1659.779 -> more than being able to buy over the
1662.96 -> counter is very important to you under
1664.82 -> the Affordable Care Act they're required
1667.039 -> to cover preventative Services including
1668.9 -> birth control but not over-the-counter
1670.46 -> methods and they're committed to
1672.14 -> ensuring that it is Affordable there's
1673.94 -> no reason that it shouldn't be able to
1675.74 -> be made affordable this is a very old
1678.2 -> medication all right so the way that
1680.659 -> they work
1681.62 -> combined hormonal contraceptives work to
1683.659 -> prevent ovulation the primary mechanism
1686.539 -> with which progestin only contraceptives
1689 -> prevent pregnancy is by thickening the
1691.46 -> cervical mucus to keep it from allowing
1694.52 -> sperm into the uterus and up to the
1699.62 -> Fallopian tubes where it might meet an
1701.36 -> egg
1702.08 -> in some people it does also prevent
1705.08 -> ovulation but that is not the primary or
1707.659 -> intended mechanism of pregnancy
1709.7 -> prevention because this is the method of
1712.76 -> prevention it is more sensitive to
1715.46 -> alterations in your blood levels of the
1719.6 -> medication would quickly allow fertility
1722.179 -> to return does that make sense so say it
1724.4 -> works for 24 hours or whatever if you
1727.88 -> miss it by a few hours or sometimes even
1731.659 -> an hour you can have an increase in your
1734.24 -> pregnancy risk because
1736.76 -> you have a rapid change in the level of
1740.6 -> progestin circulating in your body which
1742.88 -> allows for a continual production of
1745.46 -> cervical mucus which now is going to be
1747.5 -> a different consistency than what it was
1749.48 -> before whereas with a combined hormonal
1751.46 -> contraceptive you are preventing
1753.62 -> ovulation which only happens at one
1756.74 -> point in the month right so when you
1759.679 -> miss one pill your hormonal changes are
1762.86 -> unlikely to be enough to allow you to
1766.58 -> ovulate so the difference is in the
1769.7 -> effectiveness rates which to be fair we
1772.76 -> haven't fully teased out in data whether
1774.559 -> it's actually less effective or not but
1776.299 -> it would make sense and follow to reason
1779.419 -> that with the changes being more
1782.24 -> immediate when you miss a pill or you're
1784.52 -> late for a pill with the progestin only
1786.559 -> that it would leave more room for error
1790.159 -> or confusion like if you're ever late
1791.899 -> for or you miss a pill then you should
1793.88 -> use a backup form of contraception okay
1796.76 -> here's a review specific to this pill on
1800.059 -> Effectiveness so this nor gestural 75
1803 -> micrograms is the one that they've just
1805.1 -> approved for over-the-counter use in the
1806.779 -> US and they say that this is published
1810.62 -> in contraception it's a relatively
1812 -> recent publication
1813.74 -> this is a meta-analysis which is a high
1817.039 -> level review and they said they found 13
1820.88 -> studies on this specific medication they
1823.88 -> were overall not the best studies but
1826.46 -> they still wanted to look at them they
1827.96 -> used data from 3 000 women who were not
1830.419 -> breastfeeding that's important because
1831.86 -> when you're using a mini pillar
1833.36 -> progesterone only pill while
1834.26 -> breastfeeding you have an additional
1835.46 -> layer of protection for pregnancy just
1838.279 -> by the nature of being less likely to
1840.679 -> ovulate while breastfeeding and they
1842.419 -> followed them for 35 000 months and the
1846.26 -> range of overall failure during typical
1848.299 -> use was from 0 to 2.4 and 100 woman
1852.679 -> years giving an aggregate Pearl index of
1855.32 -> 2.2 seven additional studies involve 5
1858.679 -> 000 women of whom were breastfeeding
1861.22 -> and their rates were zero to three point
1864.08 -> four percent and they were unable to
1866.74 -> calculate an aggregate Pearl index the
1869.899 -> data supports that norgesterone is
1872.48 -> highly effective in clinical use with
1874.039 -> similar failure estimates in
1875.899 -> breastfeeding and non-breastfeeding
1877.22 -> women okay well that's an interesting
1878.419 -> point I expected something different
1879.919 -> from that outcome and it provides
1882.86 -> support to the case for approval without
1884.24 -> needing to see a healthcare provider
1885.559 -> okay so there you go that's your your
1887 -> failure risk is around 2.4 with typical
1889.88 -> use so that's a fairly effective and
1892.64 -> these are not on people who always get
1894.919 -> it right always take it at the right
1896.48 -> time you know they're humans too so you
1898.22 -> should have a goal of taking it at the
1899.659 -> same time using a backup form of
1901.58 -> contraception if you're more than an
1903.14 -> hour off from that probably and know
1906.08 -> that your chances of pregnancy on this
1908.779 -> pill are you know around two percent all
1912.32 -> right here we go this is the current
1914.539 -> recommendations for when starting this
1917.12 -> is a combined pill not a progestin only
1919.46 -> okay so backup contraception
1923 -> if you are over five days from the onset
1925.82 -> of Menses then backup contraception is
1928.22 -> advised most patients are advised to use
1930.26 -> an additional non-hormonal method for
1932.059 -> the first seven days of the cycle
1933.38 -> patients taking die and adjust are using
1936.559 -> for nine basically if you are already
1939.919 -> well on your way to producing a follicle
1942.44 -> to ovulate which if you're more than
1945.38 -> seven days past your start of your last
1947.72 -> period that would be the case then you
1949.88 -> probably need to take backup
1951.44 -> contraception or use some kind of form
1953.299 -> of backup contraception for quite a
1955.039 -> while now if you start it immediately on
1958.76 -> like the first day of your period Then
1962.179 -> in theory that one should work
1965.659 -> immediately because you're not moving
1967.76 -> towards ovulation yet right so that's
1969.62 -> what they're saying here is that you
1971.779 -> don't need it like you do when you start
1974.12 -> it on like immediately the day it was
1976.64 -> prescribed can be started within seven
1979.22 -> days following abortion or miscarriage
1981.399 -> and you need it for seven days unless
1985.22 -> you start it immediately after so this
1987.32 -> is for Combined hormonal contraceptives
1988.94 -> so usually people would say to use
1990.38 -> backup contraception
1992.36 -> just across the board right because if
1994.58 -> I'm counseling or if I'm talking in an
1996.919 -> educational sense and I'm saying what
1998.72 -> you should do it would be more sensical
2001.659 -> to have a few people who don't need
2003.519 -> backup method to use it rather than a
2006.159 -> few people who did not to but if it's
2008.919 -> you and you're individually going in to
2010.48 -> talk to your doctor you should talk to
2012.399 -> them about like when was your last
2013.48 -> period versus when you're starting the
2014.74 -> medication and then we'll do the same
2016.539 -> thing for progestin only so if you start
2019.779 -> on the first day of your period just
2021.22 -> like with combined then you don't need a
2024.7 -> second form and they say for within the
2027.519 -> first five days of starting your period
2030.34 -> that you should be fine without using a
2034 -> alternative form of contraception that
2036.7 -> being said
2038.019 -> because of the way that they work this
2040.48 -> is kind of the part where I was saying
2041.62 -> earlier that in some amount of people
2043.84 -> you do actually have a lack of ovulation
2047.26 -> on progestin only pills and so that's
2050.02 -> why they include this like the first
2051.58 -> five days thing because if it truly was
2053.379 -> only thickening the cervical mucus then
2056.32 -> you wouldn't have that right it would
2057.879 -> just be how long does it take to
2058.96 -> actually start affecting the cervical
2060.159 -> mucus but because there's also a
2062.679 -> secondary effect of in some amount of
2064.839 -> people decreasing the chances of
2066.7 -> ovulation you also want to pretend that
2069.879 -> it's going to do that hope that you fall
2071.2 -> in a category that it's kind of dually
2072.76 -> affecting it so yeah you can start it
2074.859 -> any day as long as you're reasonably
2076.179 -> certain that somebody's not pregnant and
2078.7 -> backup contraception is needed for two
2081.879 -> additional days if the patient is over
2083.679 -> five days from the onset of Menses so
2085.599 -> two days of backup contraception and the
2088.72 -> reason that it's different as far as how
2091.72 -> many days here so it says two days here
2093.82 -> versus in the last one I believe it was
2096.46 -> seven is because of the difference in
2098.92 -> how they work well I'm it's going to
2100.42 -> take me forever to get back to that but
2101.68 -> does that make sense difference in how
2103 -> they work is why there's a difference in
2105.28 -> how long you know you need backup method
2108.28 -> back
2109.94 -> [Music]
Source: https://www.youtube.com/watch?v=UFXs1QtUnZE