The Over-the-Counter Birth Control Pill in Perimenopause: Bleeding Changes and Label Checks

Pregnancy is still possible in perimenopause until periods have stopped for good. In July 2023, the FDA¹ approved the first daily birth control pill sold without a prescription: a progestin-only pill containing norgestrel.¹ It’s available in drugstores, grocery stores and online.¹ Our guide to birth control in perimenopause explains when you can stop using contraception.

Expect bleeding changes

The label says you’re likely to notice irregular periods, spotting or bleeding between periods, or periods may stop. Keep taking the pill to stay protected.² In perimenopause, your cycles may already be changing, which can make it harder to tell what’s causing what.

Talk to a doctor, but keep taking it, if:²

• periods last more than 8 days or are unusually heavy
• you have repeated bleeding after sex
• migraines with aura start or get worse

Ask a doctor before starting if you already have bleeding between periods that hasn’t been checked.² Our article on spotting between periods covers causes.

Who should skip it or ask first

• Don’t use it if you have or have had breast cancer, or together with another hormonal method such as a ring, patch, implant, shot or IUD.¹²
• Ask a doctor first if you have liver problems or any other cancer.²
• Ask a pharmacist if you take medicines for seizures, tuberculosis, HIV or pulmonary hypertension, or use St. John’s wort.²

Using it correctly

1. Take it at the same time every day, with no breaks between packs.¹²
2. Use condoms for the first 2 days of your first pack.²
3. If you’re more than 3 hours late, take it as soon as you remember and use condoms for 2 days.²
4. If you vomit or have severe diarrhea within 4 hours, use condoms for 2 days.² See our guide on the mini-pill with vomiting or diarrhea.
5. It doesn’t protect against STIs.²

Common side effects include irregular bleeding, headaches, dizziness, nausea, cramps and bloating.¹

Seek care right away for

Sudden or severe pain low in the belly, mostly on one side, which can signal an ectopic pregnancy, or yellowing of the skin or eyes.²

Try: “I’m 46, my periods are irregular, and I’m using the over-the-counter pill. How will we tell whether new bleeding is from the pill or something else?”

Period, Handled includes a Period Scorecard and a visit script. Use them to record bleeding days, spotting and pill timing so your clinician can see the pattern. See the book.