Why arent OCPs over the counter yet?

[MacGyver]

Yes I know they increase the risk of MI, stroke, DVTs, and pulmonary embolisms, but so does emergency contraception yet its available OTC now.

Whats the FDA's reasoning on requiring a script for OCPs but not for ECs? Yes ECs are for immediate use and presumably dont have the same risk of long term side effects, but are those risks SO GREAT that it makes OTC out of the question?

I submit to you that aspirin has a worse side effect profile than OCPs do and that aspirin causes FAR more morbidity and mortality per year than OCPs do.

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[BayAreaOB]

Plan B is progesterone only and does not increase the risk of DVT/PE, MI, stroke. In fact, it is safe to use in people who traditionally cannot take combined OCPs. There are virtually no contraindications to EC. Combined OCPs require some counseling prior to use as well as monitoring and have many contraindications.

 

[civic4982]

^ +1

 

[Global Disrobal]

There is a great deal of politics behind family planning in the US especially in light of the conservative control in the past several years and its strong hand within the FDA.

If you're interested, read the material by family planning advicates such as Grimes from UNC to get an idea about the battles behind the scenes.

 

[dejerine]

Hmmm.

Let me guess. Ten years after over the counter OC's are given, an article will appear in OB Gyn News suggesting a side effect after all. DES was safe too, for about fifty years, until it suddenly wasn't safe at all.

I would take another look at studies on personality of female children born to mothers who took progesterone during pregnancy. Progesterones feed into the cyclopentanophenanthrene group to lead to androgen influence. Progesterone can convert to female hormones as well. When you say there are no side effects, it seems to say too much.

Over the counter OC's will save money at one end, but may result in women already pregnant taking the pill, which is not good. They are also less effective. Admittedly something is better than nothing, but is that the entire point? I have seen even some texts which say progesterone to pregnant women is harmless because the placenta puts out so much anyway. However, the psychological studies have pretty unformly shown less mothering instinct and more engineering degrees and such in female offspring of women given progesterone. Masters and Johnson reported that sixty percent of the homosexuals in their cohort were male offspring of women given progesterone or progesterone/estrogen mix to "prevent" threatened miscarriage. I would have to disagree that progesterone only contraception has NO side effects. I don't think you will be protected if someone you have given Plan B to has a stroke or MI, even if no clear link can be shown. Malpractice exposure is a risk in itself. Of course on OC it would be the manufacturer, but your patients will pay the higher costs in the end. I would like to see risk numbers before I make my mind up on this one.

I have watched the debate over hormones in menopause and I suspect it will still being going on fifty years from now.

 

[oldbearprofessor]

However, the psychological studies have pretty unformly shown less mothering instinct and more engineering degrees and such in female offspring of women given progesterone.

Could you give us a reference for this? It doesn't show up as a risk in the summary of the Cochrane review this year on progesterone therapy for threatened miscarriage.

Also, why would getting engineering degrees be considered a negative side-effect in females? I would be thrilled if my engineering-minded daughter went ahead and got a degree in engineering.