Opill is an over-the-counter (OTC) birth control pill used to prevent pregnancy, now available in all 50 states as of March 2024 without a prescription. It is manufactured by Perrigo Company. Containing only progestin (norgestrel), Opill distinguishes itself from other birth control pills that combine both estrogen and progestin. These progestin-only pills are sometimes called mini-pills. While Opill offers a convenient option for pregnancy prevention, understanding its ingredients, usage, potential side effects, and relationship to weight management is crucial.
Understanding Opill
Opill (norgestrel) is a progestin-only contraceptive pill, sometimes called a minipill, because it does not contain estrogen. As a progestin-only pill, Opill works primarily by thickening cervical mucus, which hinders sperm from reaching the egg. It may also prevent the release of an egg from the ovary.
How Effective is Opill?
Opill begins working 48 hours (2 days) after the first dose. For continued effectiveness, it must be taken daily, at the same time each day. Opill is 93% effective at preventing pregnancy with typical use and 98% effective when used perfectly. Perfect use includes taking one tablet every day, and at the same time each day without any breaks between monthly packs. It also includes always using back-up birth control, like condoms, when the person misses or is delayed in taking the daily tablet for more than 3 hours. However, like any birth control method, it is not 100% effective. Opill is NOT for use as an emergency contraceptive and will not prevent pregnancy after unprotected sex. If a dose is missed, or if vomiting or severe diarrhea occurs within 4 hours of taking a tablet, consult the label for instructions. The recommended course of action may involve taking the missed pill as soon as possible and continuing with the remaining pills as scheduled.
Dosage and Administration
Take one Opill tablet at the same time every day, with or without food. Choosing a consistent time is crucial, and the pill should be taken no more than 3 hours outside the usual time. Taking a pill late, or missing a pill, increases the likelihood of pregnancy.
Opill OTC vs Other Birth Control Pills
Opill is a progestin-only pill, unlike combination pills that contain both estrogen and progestin. While prescription progestin-only pills like Cerazette, Errin, and Heather are available, Opill is accessible over the counter.
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Important Considerations Before Taking Opill
Before starting Opill, it's important to consider several warnings and precautions:
Allergies
Do not take Opill if you are allergic to norgestrel or any of the inactive ingredients. Do not take Opill if you are allergic to FD&C Yellow No. 5 (tartrazine). Some people who are allergic to aspirin can also have a tartrazine allergy. Symptoms include hives, facial swelling, asthma (wheezing), shock, skin redness, rash, and blisters. If you have symptoms of an allergic reaction, stop this medicine and seek medical help immediately.
Ectopic Pregnancy
Be aware of the possibility of ectopic pregnancy in women who become pregnant or complain of lower abdominal pain while on Opill. If you think that you are pregnant or experience unusual vaginal bleeding or lower stomach area (abdominal) pain, talk to your healthcare provider right away.
Delayed Follicular Atresia/Ovarian Cysts
In some cases, delayed follicular atresia/ovarian cysts are associated with mild abdominal pain, and rarely they may twist or rupture, requiring surgical intervention. If you have symptoms of ovarian cysts while taking Opill, contact your doctor. They may recommend a pelvic exam or ultrasound to investigate the cause of your symptoms. If you have symptoms of a ruptured or infected cyst or ovarian torsion, this is a medical emergency. Go to your local emergency department or call 911 right away.
Bleeding Pattern Alterations
Irregular menstrual patterns are common among women using Opill. Undiagnosed abnormal uterine bleeding should be evaluated before Opill is taken. If uterine bleeding, together with the clinical history, is suggestive of infection, malignancy, pregnancy, or other conditions, rule out these conditions. If periods stop altogether, consider the possibility of pregnancy.
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Hepatic Neoplasia/Liver Disease
Stop Opill if jaundice or acute disturbances of liver function develop. Talk with your doctor about whether Opill is right for you. If you have liver cancer, your doctor will likely recommend that you do not take Opill. Talk with your doctor about other forms of birth control that may be better options for you.
Drug Interactions
Tell your pharmacist about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Opill may affect the way other medicines work, and vice versa. Any herbal preparations containing St. John's Wort should be disclosed. Norgestrel may interact with certain drugs, potentially making norgestrel less effective in preventing pregnancy.
Existing Conditions
If you’ve ever had breast cancer, your doctor will likely recommend that you do not take Opill. Opill could make your breast cancer get worse or come back. Talk with your doctor about other forms of birth control that may be better options for you. If you’ve ever had cancer sensitive to progestin hormones, your doctor will likely recommend that you do not take Opill. Opill could make your cancer get worse or come back. Talk with your doctor about other forms of birth control that may be better options for you. If you have migraine episodes, Taking Opill could make them worse or more frequent. Talk with your doctor before taking Opill. Other forms of birth control may be better options for you.
Other Considerations
If you use other hormonal forms of birth control, such as the combined pill, patch, vaginal ring, implant, injection, or IUD, you should not take Opill as well. Doing so could raise your risk of side effects. If you’re pregnant or think you could be pregnant, you should not take Opill. If you’ve had sex without a condom or other barrier method, you should not take Opill to try and prevent pregnancy. Opill will not work as an emergency contraceptive (morning-after pill). If you’re breastfeeding your child, Opill should be safe for you to take. However, you should still talk with your doctor about the possible effects of Opill while you’re breastfeeding.
Potential Side Effects of Opill
Like all medications, Opill can cause side effects. The most common side effect is changes in menstrual periods (bleeding). Symptoms of overdosage may include nausea, vomiting, breast tenderness, dizziness, somnolence (drowsiness/fatigue), and withdrawal bleeding in females.
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Common Side Effects
- Changes in periods (bleeding)
- Headache
- Nausea
- Abdominal pain, cramps, or bloating
- Breast tenderness
- Backache
- Acne
- Dizziness
- Increased appetite
- Fatigue
- Vaginal discharge
- Nervousness
Serious Side Effects
- Migraine episodes
- Liver problems
- Ectopic pregnancy
- Ovarian cysts
- Severe allergic reaction
If you develop serious side effects while taking Opill, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.
Side Effect Specifics
- Changes in Periods: Opill can cause irregular periods, periods that are heavier or lighter than usual, spotting or bleeding between periods, or the stopping of periods. These changes are more likely if Opill is not taken regularly at the same time each day, if doses are missed, or if vomiting or severe diarrhea occurs within 4 hours of taking Opill. Certain medications or supplements can also cause this problem. If any of these things happen, Opill may also be less effective at helping to prevent pregnancy.
- Ovarian Cysts: Opill can sometimes cause ovarian cysts, which are small fluid-filled sacs that develop on the ovaries. These cysts may not cause any symptoms and often go away on their own. But they may sometimes cause abdominal pain or bloating, pelvic pain, pain in your lower back or upper thighs, pain during sex, nausea and vomiting, frequent urges to urinate or pass a bowel movement. In rare cases, an ovarian cyst may rupture, become infected, or cause ovarian torsion (twisted ovary).
- Allergic Reaction: As with most drugs, Opill can cause an allergic reaction in some people. Symptoms can be mild or serious and can include skin rash, itching, flushing, swelling under your skin, swelling of your mouth, tongue, or throat, which can make it hard to breathe. Opill contains FD&C Yellow No. 5 (tartrazine), which can lead to allergy-like reactions, such as bronchial asthma, in some people.
Opill and Weight Loss: Is There a Connection?
While Opill is primarily a contraceptive, many women are concerned about its potential impact on their weight. It's essential to understand the available evidence and separate fact from fiction.
Progestin-Only Contraceptives and Weight Change: What the Studies Say
Research on progestin-only contraceptives (POCs) and weight change has yielded mixed results. A review of 22 studies including 11,450 women, examined the effects of POCs on weight and body composition. The review found limited evidence of significant weight change with POC use. Mean weight gain at 6 or 12 months was less than 2 kg (4.4 lb) for most studies. Those with multiyear data showed mean weight change was approximately twice as much at two to four years than at one year, but generally the study groups did not differ significantly.
The groups compared did not differ much for weight change or other body measures in 15 studies. Five studies with moderate or low quality results showed a difference between study groups. Three studies showed differences for users of the injectable ‘depo’ versus no hormonal method. Depo users had a greater weight gain in two studies. In the third study, adolescents had a greater increase in body fat (%) and decrease in lean body mass (%). Two studies showed a greater increase in body fat (%) for users of hormonal intrauterine contraception versus women not using a hormonal method. One also showed a similar difference with a progestin‐only pill.
Factors Influencing Weight Change
It's important to recognize that weight gain is a complex issue influenced by various factors, including:
- Fluid retention
- Muscle mass changes
- Fat deposition
- Age
- Lifestyle factors (diet and exercise)
- Underlying medical conditions
During adolescence, some weight gain is developmentally normal and appropriate. Also, people tend to gain weight over time. In the US, the prevalence of overweight or obesity is higher for men and women 40 to 59 years of age compared with those aged 20 to 39 years.
Weight Management Medications: An Overview
While Opill is not a weight loss medication, it's important to distinguish it from other drugs specifically designed for weight management. The pharmacological treatment of obesity is a fast-changing landscape, and care providers must strive continuously to stay current. The Food and Drug Administration (FDA) has approved several prescription drugs for long-term weight loss use. People who are overweight and have related health conditions, such as high blood pressure or diabetes, may also be approved to take these medications.
Some FDA-approved anti-obesity medications (AOMs) are safe, evidence-based therapies that target specific physiology to improve the disease and are most effective when used as part of a comprehensive treatment plan. A treatment plan for obesity can comprise multiple forms of treatment, including medications, diet, exercise, and/or surgery. All weight loss medications work best in the context of a healthy eating plan and exercise.
Common Weight Loss Medications
- Wegovy (semaglutide): A GLP-1 receptor agonist administered as an injection, approved for use in adults and children aged 12 years or more with obesity or some adults with excess weight who also have weight-related medical problems.
- Zepbound (tirzepatide): A dual GIP and GLP-1 receptor agonist approved to treat obesity in adults.
- Liraglutide: A daily injectable medication that acts on hormones that send signals from the gut to the brain to make the patient feel full quicker and decrease hunger signals.
- Phentermine: The oldest and most widely used weight loss medication, often combined with topiramate to decrease appetite and cravings.
- Naltrexone-bupropion: Combines an opioid receptor antagonist with an antidepressant to affect the pleasure-reward areas of the brain and thereby decrease cravings and appetite.
- Orlistat: A lipase inhibitor that comes in a capsule, preventing the body from absorbing fat.
Emerging Weight Loss Medications
With fervent consumer demand for weight loss medications, combined with rising obesity rates, more medications are bound for the market in the coming years. Pharmaceutical platform Ozmosi predicts one to two GLP-1 launches annually starting in 2026. Lilly is developing at least two new options. The first, orforglipron, is an oral GLP-1 inhibitor that completed a Phase 3 clinical trial in early 2025. It could provide a welcome alternative for people who do not want injections. The other, retatrutide, targets GLP-1, GIP, and glucagon. At this writing, it is in Phase 3 clinical trials. Amgen is developing MariTide, a monoclonal antibody designed to increase GLP-1 receptor activity while reducing GIP receptor activity. The once-monthly injection entered Phase 3 clinical trials in March 2025. Researchers continue to study hormones that play a role in appetite for other ways to target obesity with medication. Those of interest include not only GLP-1, but also peptide tyrosine-tyrosine (PYY) and cholecystokinin (CCK).
Lifestyle Modifications for Weight Management
Healthy eating and exercise are the most recommended ways to lose weight. Medications can help with obesity, but they're not a magic bullet. It's also important to remember that no one drug works for all people. While medications may be part of the answer for some, exercise is beneficial for everyone. It's nearly impossible to maintain weight loss without it. Start small and work your way up. For example, begin with just 5-10 minutes a day walking around your neighborhood. To help encourage getting your steps in, wear a fitness tracker to record how many steps you walk each day. You can also aim to stand up for a few minutes every waking hour. Don't get discouraged. Even without losing weight, you can be healthier by being physically active and eating healthy foods. This includes fruits, veggies, whole grains, lean fish, lean meat or tofu, and foods high in calcium. There are some foods that you love and may not want to give up when you're managing your weight. These may be eaten in limited quantities. Moderation is the key here. Small changes will add up over time. If you want a few chips on occasion, put them in a small bowl instead of taking the whole bag to the couch. Remember: For any weight-loss plan, it helps to have a support group. Enlist friends and family to help hold you accountable or consider participating in a reputable weight loss program.