Did you know the FDA didn’t formally approve the birth control pill until 1960? Before that, contraceptives were incredibly difficult for women to obtain. Even after birth control gained federal approval, it was still taboo to discuss. It wouldn’t be something you to talk about publicly, much less walk into a store and purchase off the shelves.

Thankfully, that has changed. Over-the-counter birth control options can be found everywhere, from pharmacies to your local Target. You can even purchase birth control online if shopping in person isn’t your style.

Differences Between Prescription and OTC Birth Control

With the wide variety of options now available, though, it can be challenging to choose the right one for yourself. Depending on what’s available in your area, you may need to choose between OTC or prescription-only versions. This article will go over the main differences between the two.

Contraceptive Type

The first thing you’ll need to consider is how the contraceptive you select prevents pregnancy. Many prescription birth controls are hormone-based, using either a combination of progestin and estrogen or only progestin.

Hormonal birth control includes the pill, patch, and ring. Other prescription methods are administered, inserted or implanted by a medical professional. Some use hormones as the contraceptive, while others do not. These include the arm implant, IUDs, and the version of the shot that is administered by a medical provider. Additionally, you can purchase emergency contraceptives over the counter. However, the latter should not be used in the place of regular birth control.

In contrast, OTC methods do not use hormones. Most fall in the category of barrier methods, which are birth control approaches that block fertilization. In this category, you’ll find male and female condoms, spermicide, and the sponge.

Frequency and Timing of Use

Regular birth control use is one of the best ways to prevent pregnancy. No matter which method you choose, though, you will be responsible for using it as directed.

Prescription birth control varies quite a bit when it comes to how frequently you use it. The pill must be taken every day and at roughly the same time of day for peak effectiveness. Implants can last years, while the shot is administered every three months. Prescription birth control is taken (injected, implanted, etc.) before you have sex, not in the moment.

OTC birth control, in contrast, is used at the time of intercourse. Having condoms is great, but it won’t do anything to prevent pregnancy if you don’t use them when you need them. When deciding between prescription and over-the-counter methods, consider how frequently you want to use them and when.

Effectiveness

How good you are at remembering to use birth control will significantly impact its overall effectiveness. Skipping an over-the-counter method won’t give any protection at all. Missing a prescription pill or shot will change how well they work. However, even if each kind is used perfectly, there are still major differences in their effectiveness.

Prescription contraceptives are more effective than over-the-counter ones. The pill and patch are about 99% effective when used perfectly — but roughly 91% effective in actual practice. Implants are the most successful at preventing pregnancy around 99% of the time.

Contrast that with male condoms, which have an 18% failure rate. Female condoms and spermicide both have failure rates between 20% and 28%. Because the only birth control method that’s 100% effective is abstinence, combining methods may be the best choice.

Ability to Combine

When it comes to combining birth control methods, be careful and pay attention to any warnings. Some contraceptives can be used in tandem with no problem, such as combining a condom with the birth control pill. Others should never be combined; prescription options fall into that category. Definitely don’t use more than one prescription birth control method at the same time. Due to the active ingredients, mixing two types can be dangerous.

A safer option would be to use prescription and over-the-counter birth control together or multiple OTC options. Doing so can increase their overall effectiveness. Just be sure to pay attention to which ones you can safely and successfully combine.

While you can combine a spermicide with a female condom, you should never use male and female condoms at the same time. It’s always a good idea to use one or the other, though, since they also prevent the transmission of sexually transmitted infections (STIs).

Cost

In addition to helping prevent STIs, male and female condoms are also some of the cheapest birth control methods. That’s consistent with OTC contraceptives being more affordable overall. Of course, that cost will vary depending on how frequently you use them. The more you need, the more you’ll have to buy. Frequency of purchase can be a downside to OTC birth control methods.

On the other hand, contraceptives that require a prescription can cost more than those you buy at any store. The final cost of these depends on whether you have health insurance and what it covers. Without insurance, some prescriptions can cost $100 or more per year. If you do have insurance, you’ll need to verify which contraceptives and brands are covered. Coverage will vary from plan to plan, so something a friend has access to may be out of your reach.

Level of Access

Access is a huge consideration when it comes to birth control. Many seeking birth control live in contraceptive deserts. These are places that lack reasonable access to the full range of contraceptive methods. If you live in an area like this, over-the-counter birth control may be your best bet. Most of the time you can find some barrier contraceptive in a local store, and something is better than nothing.

If you don’t want your birth control choices dictated by what’s available in your area, you can look online. There are sites that may be able to provide prescription birth control without you having to see a doctor in person. While your birth control choices are still limited — no IUDs, for example — it’s less of an issue than in the past.

We’ve come a long way from having few birth control options and barely speaking about them openly. Now we’re able to walk into a store and buy what we need off the shelf. The next time you are considering your options, remember the big differences between types, especially prescription and over-the-counter contraception. Doing so will help you make the best choice of birth control to fit your lifestyle.

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