Over-the-counter access to combined oral contraceptives for individuals with hypertension: an expert review

Efforts are underway to move a combined oral contraceptive over the counter in the United States. However, hypertension is an important contraindication and questions exist regarding how users should screen for it in an over-the-counter setting. An expert panel convened in April 2022 to review the literature related to hypertension and an over-the-counter switch for combined oral contraceptives and vote on a set of blood pressure screening recommendations for future over-the-counter combined oral contraceptives. Research indicates that people can accurately self-screen for contraindications to combined oral contraceptives using simple checklists, and the absolute risk of adverse events is low among people with hypertension who use combined oral contraceptives and must be balanced against substantially higher risks of pregnancy as well as benefits of increased contraceptive access. Based on these data, the panel concluded that 1) individuals who have not had their blood pressure checked in the last year or do not know their blood pressure should be advised in product labeling to get it checked prior to purchase; 2) blood pressure documentation should not be required to purchase over-the-counter combined oral contraceptives, provided over-the-counter switch behavioral studies demonstrate individuals can correctly self-screen for use; and 3) blood pressure screening should be made more accessible and affordable. Over-the-counter combined oral contraceptives may increase access to the most commonly used reversible contraceptive method. They may also provide an opportunity for enhanced education and awareness of hypertension and preventive cardiovascular screenings among people of reproductive age, particularly young people and people of color.