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Birth control pills have been safely used in the US (and sold only by prescription) for more than half a century. In 2023 the FDA approved Opill, the first daily contraceptive pill intended for sale over the counter with no prescription needed. This offers many more people access to a new nonprescription option for preventing pregnancy.

Opill is available online and soon to be stocked on drugstore shelves. Here’s what anyone interested — adults, parents, and teens — should know.

What is in Opill and how does it work?

Opill is a progestin-only form of birth control. That means it uses a single hormone called progestin (or norgestrel) to prevent pregnancy. It works by

• affecting ovulation so that the ovaries do not release an egg every month
• thickening cervical mucus, which blocks sperm from reaching an egg
• changing the uterine lining in ways that keep a fertilized egg from implanting.

How effective is Opill at preventing pregnancy?

It depends on how consistent you are about taking Opill:

• Perfect use means taking the pill every single day at the same time. With perfect use, Opill is 98% effective. That means that if 100 people take the medication perfectly, two or fewer people would become pregnant. Taking a pill perfectly can be difficult, though.
• Typical use averages how well a method works to prevent pregnancy when real people use it in real life. It considers that people sometimes use the pill inconsistently, like forgetting a dose or not taking it at the same time every day. With typical use, Opill is 91% effective. This means that if 100 people use Opill, but don’t take it perfectly, at least nine could become pregnant in a year.

It’s also important to know that some medications make Opill less effective at preventing pregnancy. These include medicines used to treat migraines and seizures. Even though this birth control pill will be available over the counter, you should ask your health care provider if any medicines you take could make it less effective.

How do you take Opill?

• Take it once a day at the same time each day until you finish the entire pack.
• Sticking to a consistent time of day, every day, is crucial. Timing matters with progestin-only pills like Opill because this medication works by raising progestin levels. However, progestin only stays elevated for 24 hours after you take each pill. After that, the progestin level will return to normal.
• After you complete a 28-day pack, you should immediately start a new pack of pills the next day.

What happens if you forget to take a dose at the specific time or miss a dose?

• If you take the pill more than three hours late it will not be as effective at preventing pregnancy.
• Take the missed pill as soon you remember.
• You will need to use a backup birth control method such as condoms every time you have sex for the next 48 hours.

Is Opill safe for teenagers?

Opill is generally safe for most people who could get pregnant, including teenagers. There’s no evidence to suggest that safety or side effects are different in teenagers compared with adults.

Research done by the manufacturer has established the safety of Opill in people as young as 15 years old. It will be available without an age restriction.

When teens use birth control, what is the best choice for them?

There isn’t a one-size-fits-all birth control method for all teenagers. The best method is the one a teen personally prefers and is committed to using consistently.

For teens who struggle with taking medication at the same time every day –– or anyone else who does –– Opill may not be the right choice. Fortunately, there are many options for preventing pregnancy, catering to individual preferences and goals.

Learn more about different contraception methods at the Center for Young Women’s Health website.

What side effects are common with Opill?

Progestin-only pills are usually associated with mild side effects. The most common side effects are:

• unexpected vaginal bleeding or spotting
• acne
• headache
• gastrointestinal symptoms such as nausea, abdominal pain, and bloating
• change in appetite.

Opill does not cause problems with getting pregnant in the future, or cause cancer. Unlike birth control pills that combine the hormones estrogen and progestin, Opill will not increase the risk of a developing a blood clot.

Will Opill cause any mood changes?

Research looking at possible effects of progestin-only pills on mood is limited, so this is unclear. We do know that most people who take hormonal birth control methods do not experience negative mood changes.

Fortunately, there are many different types of effective birth control. If one method causes you unwanted side effects, talk to your health care provider. Together, you can figure out if another type of birth control may work better for you.

Can it be used as emergency birth control?

No, it should not be used as emergency birth control.

What should you know about STIs?

This type of birth control does not protect you from sexually transmitted infections (STIs) such as syphilis, gonorrhea, or chlamydia.

You can reduce the chance of getting STIs by correctly using condoms each time you have sex. There are different types of condoms: one made for penises and one made for vaginas.

Vaccines help protect against some STIs such as hepatitis B and human papillomavirus (HPV). A medicine called PrEP can help prevent HIV. Ask your medical team for more information about the right choices for you.

About the Authors

Candice Mazon, MD, Contributor

Dr. Candice Mazon is a second year adolescent medicine fellow at Boston Children's Hospital. She's a board certified pediatrician and received her training at MedStar Georgetown University Hospital. She earned her MD degree from Drexel University … See Full Bio View all posts by Candice Mazon, MD

Amy Desrochers DiVasta, MD, MMSc, Contributor

Amy Desrochers DiVasta MD, MMSc, is chief of the division of adolescent medicine at Boston Children’s Hospital. She is the co-director of the adolescent long-acting reversible contraception program, and co-director of the reproductive endocrinology and PCOS … See Full Bio View all posts by Amy Desrochers DiVasta, MD, MMSc

Maybe we should add toothbrushes to the bouquet of flowers we bring to friends and family members in the hospital — and make sure to pack one if we wind up there ourselves.

New Harvard-led research published online in JAMA Internal Medicine suggests seriously ill hospitalized patients are far less likely to develop hospital-acquired pneumonia if their teeth are brushed twice daily. They also need ventilators for less time, are able to leave the intensive care unit (ICU) more quickly, and are less likely to die in the ICU than patients without a similar toothbrushing regimen.

Why would toothbrushing make any difference?

“It makes sense that toothbrushing removes the bacteria that can lead to so many bad outcomes,” says Dr. Tien Jiang, an instructor in oral health policy and epidemiology at Harvard School of Dental Medicine, who wasn’t involved in the new research. “Plaque on teeth is so sticky that rinsing alone can’t effectively dislodge the bacteria. Only toothbrushing can.”

Pneumonia consistently falls among the leading infections patients develop while hospitalized. According to the Agency for Healthcare Research and Quality, each year more than 633,000 Americans who go to the hospital for other health issues wind up getting pneumonia. Air sacs (alveoli) in one or both lungs fill with fluid or pus, causing coughing, fever, chills, and trouble breathing. Nearly 8% of those who develop hospital-acquired pneumonia die from it.

How was the study done?

The researchers reviewed 15 randomized trials encompassing nearly 2,800 patients. All of the studies compared outcomes among seriously ill hospitalized patients who had daily toothbrushing to those who did not.

• 14 of the studies were conducted in ICUs
• 13 involved patients who needed to be on a ventilator
• 11 used an antiseptic rinse called chlorhexidine gluconate for all patients: those who underwent toothbrushing and those who didn’t.

What were the findings?

The findings were compelling and should spur efforts to standardize twice-daily toothbrushing for all hospitalized patients, Dr. Jiang says.

Study participants who were randomly assigned to receive twice-daily toothbrushing were 33% less likely to develop hospital-acquired pneumonia. Those effects were magnified for people on ventilators, who needed this invasive breathing assistance for less time if their teeth were brushed.

Overall, study participants were 19% less likely to die in the ICU — and able to graduate from intensive care faster — with the twice-daily oral regimen.

How long patients stayed in the hospital or whether they were treated with antibiotics while there didn’t seem to influence pneumonia rates. Also, toothbrushing three or more times daily didn’t translate into additional benefits over brushing twice a day.

What were the study’s strengths and limitations?

One major strength was compiling years of smaller studies into one larger analysis — something particularly unusual in dentistry, Dr. Jiang says. “From a dental point of view, having 15 randomized controlled trials is huge. It’s very hard to amass that big of a population in dentistry at this high a level of evidence,” she says.

But toothbrushing techniques may have varied among hospitals participating in the research. And while the study was randomized, it couldn’t be blinded — a tactic that would reduce the chance of skewed results. Because there was no way to conceal toothbrushing regimens, clinicians involved in the study likely knew their efforts were being tracked, which may have changed their behavior.

“Perhaps they were more vigilant because of it,” Dr. Jiang says.

How exactly can toothbrushing prevent hospital-acquired pneumonia?

It’s not complicated. Pneumonia in hospitalized patients often stems from breathing germs into the mouth — germs which number more than 700 different species, including bacteria, fungi, viruses and other microbes.

This prospect looms larger for ventilated patients, since the breathing tube inserted into the throat can carry bacteria farther down the airway. “Ventilated patients lose the normal way of removing some of this bacteria,” Dr. Jiang says. “Without that ventilator, we can sweep it out of our upper airways.”

How much does toothbrushing matter if you’re not hospitalized?

In case you think the study findings only pertain to people in the hospital, think again. Rather, this drives home how vital it is for everyone to take care of their teeth and gums.

About 300 diseases and conditions are linked in some way to oral health. Poor oral health triggers some health problems and worsens others. People with gum disease and tooth loss, for example, have higher rates of heart attacks. And those with uncontrolled gum disease typically have more difficulty controlling blood sugar levels.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD