Birth control has come a very long way over the past few decades. Now people with ovaries have more contraceptive options than ever before, and more people have access to birth control thanks to online pharmacies and prescribers.
In this post, we’ll dig into the world of online birth control — how it works, the studies evaluating its safety, and what to know about the process.
Here are the key takeaways:
- There are some types of birth control you can get prescribed online (the pill, the vaginal ring, and the patch) and some you can’t (like IUDs or implants).
- Getting birth control online is proven to be as safe as getting it prescribed in person.
- Getting birth control prescribed online isn’t for everyone (like people who have migraines with an aura or those with a history of blood clots).
- Before you start an online visit to get birth control prescribed, make sure you’ve done some research about the method(s) you’re interested in, and that you have a blood pressure measurement from the last 6 months in hand.
What kinds of birth control can you get prescribed online?
The types of birth control you can get prescribed online are called “user-controlled” methods. As the name suggests, these are methods that don’t require seeing a healthcare provider for placement or administration. Oral contraceptive pills, vaginal rings, and patches are always user-controlled, because the user, not the healthcare provider, has to take specific actions, like taking a pill or replacing a ring/patch.
Intrauterine devices and implants always require a provider for placement, and therefore can’t be prescribed via telehealth.
The shot is a special case. It’s the one method that can be either user-controlled, or be administered by a healthcare provider. While the commonly used Depo-Provera shot is administered by a healthcare provider, a version of the shot called Depo-SubQ was approved for use in 2004, and can be administered by the user. If you're looking for a DIY version of the shot, it's possible to get a prescription for the self-administered injection through an online birth control visit with a healthcare provider.
Why get birth control prescribed online vs. in person?
Back in the days before online birth control prescriptions existed, getting birth control prescribed required visiting your healthcare provider in-person.
While regular physical check-ups are important for staying on top of your health, birth control can be prescribed without a physical exam. But, there are a few exceptions here where someone could benefit from a physical exam prior to starting on a new birth control. For example, someone who’s experiencing heavy menstrual bleeds or significant vaginal bleeding between menstrual bleeds may benefit from a physical exam to understand what may be causing these symptoms. However, cases like this are exceptions rather than the rule.
Requiring an in-person visit with a provider introduces several barriers to birth control access, and barriers usually mean that there is not equal access to care, and that not all people are getting the care that they need.
Think of all of the steps involved in getting your prescription via an in-person visit:
- You’d schedule an appointment (often way in advance)
- You’d have to get to an office (which isn’t always easy, given that 1 in 4 people with ovaries between the ages of 15 and 49 live in contraceptive care deserts)
- You might need to take time off of work, arrange childcare, or get someone to cover for you in your other responsibilities
- Depending on your insurance (if you have any), you might have a copay for the visit (or pay out of pocket without insurance)
- You’d have to go to a pharmacy to pick up the prescription
Each of these steps introduces challenges and additional complexity that makes the entire process harder to complete. Enter online birth control services, where most of these barriers are avoided.
Most pathways for getting birth control online today involve the following:
- You’ll answer a series of questions about your medical history and your preferences.
- A provider reviews the answers you’ve submitted. In some cases, if they need more info before writing a prescription, they’ll follow up via text message, email, phone call, or video chat.
- A provider reviews all your info. If they determine that it’s an appropriate treatment for you, they write your prescription.
- Your medication is then mailed straight to your doorstep.
By eliminating so many of the obstacles that in-office visits require, online birth control services do some seriously heavy lifting to make prescription birth control more accessible and convenient.
Is it safe to get birth control prescribed online?
The key takeaway up front? Studies have shown it *is* safe to get birth control prescribed online.
A common concern about telehealth (and, by extension, online birth control prescriptions) is that without face-to-face conversations with providers, people will end up getting prescribed medications that present some sort of safety risk.
A person’s safety and well-being is non-negotiable. Whether or not a medication poses a risk to someone based on their medical history, lifestyle, or family history should is something providers seriously consider when evaluating treatment options.
The good news is that studies have shown telehealth is just as safe as more traditional healthcare visits.
And this is also true for online birth control services.
Recently, a group of researchers went ‘undercover,’ pretending to have medical conditions that would potentially make certain types of birth control more risky for them. Their goal was to see how many companies that offer online prescription birth control did in fact follow the CDC’s medical eligibility criteria, which outlines all the different conditions and characteristics that can make certain types of birth control less safe. (In other words, they tried to dupe the system.)
In the 45 online visits that the researchers completed where they indicated a condition that would make a birth control method less safe for them, they did *not* get a prescription 93% of the time. This means that 93% of the time, telehealth providers perfectly followed the prescription criteria set out by the CDC. This may be even higher than what we see for in-person visits, with some data suggesting that the CDC’s prescription criteria is followed closer to 91% of the time in-person visits.
Are there people who shouldn’t get birth control prescribed online?
Yes — some people are better candidates than others for getting birth control prescribed via telehealth.
There are two main reasons someone might not be a candidate for online birth control: health conditions that are incompatible with the methods offered via telehealth, and complicating factors that make more in-depth contraceptive counseling a better option. We’ll dig into these below!
Some people have health conditions that are contraindicated with (aka, aren't medically compatible with) certain types of birth control offered via telehealth
There are some people that should not take combined hormonal birth control (that’s birth control that contains both estrogen + progestin), because it’s not compatible with certain health conditions, and can lead to an increased risk of deep vein thrombosis (DVT), heart attack, or stroke.
Here’s a list of the most common conditions that are not compatible with combined hormonal birth control:
- Women over 35 who smoke 15+ cigarettes per day
- Women who have multiple risk factors for cardiovascular disease, such as high cholesterol, high blood pressure, and diabetes
- Women who have history of stroke, heart attack, or deep vein thrombosis (DVT)
- Women with a history of migraine headaches with aura
Note: This list is not exhaustive — you should always discuss risk factors with a doctor.
Some people have complex medical situations that require more in-depth counseling
There are some conditions and characteristics that don’t make someone *ineligible* for a specific birth control, but require a more in-depth conversation with a healthcare provider about the potential pros and cons.
Here’s an example: Certain forms of weight loss surgery make the body’s absorption of oral medications (like oral contraceptives) less effective. People who have had these surgeries can technically use oral contraceptives, but there’s a risk of reduced effectiveness (aka, a higher risk of pregnancy). In cases like this, it’s important that a provider has taken the time to lay out the pros and cons so a patient can make an informed decision.
With a deep understanding of your medical history and preferences, your healthcare provider should be able to provide you with a solid recommendation of whether you may benefit from further counseling with someone trained in complex family planning.
What can I expect during an online appointment for birth control?
The things you and your healthcare provider will cover in an online birth control visit are pretty similar to those covered during an in-person visit.
During in-person visits, some providers will walk you through the different birth control options before diving into medical questions, but this is not the norm — 35-50% of people report receiving no education or counseling about different birth control methods.
Online visits for birth control usually assume you have an idea of what method you’re interested in getting prescribed, and skip the up-front education about the pros and cons of the different method types.
Both in-person and online visits require three additional things: answering lots of questions about your medical history, confirmation that you aren’t currently pregnant, and a recent (i.e., within the last 6 months) blood pressure reading.
Whether in-person or online, you’ll be asked to provide *lots* of details so that your provider has a holistic picture of your medical history, including any surgeries you’ve had or any medications and supplements you're taking.
Next up is confirmation that you are not currently pregnant (since birth control won’t work if you’re already pregnant). When we say “confirmation,” it isn’t necessary to take a pregnancy test. There are a couple of ways providers can be reasonably certain someone isn’t pregnant:
- It’s less than 7 days after the start of your last period
- You haven’t had penile-vaginal intercourse since the start of your last period
- You’ve been correctly and consistently using reliable birth control
- You experienced a miscarriage or had an abortion in the last 7 days
- You gave birth within the past month
- You are breastfeeding/chestfeeding an infant and all or nearly all of the baby’s diet is breast/chest milk, you’re not getting a period, and you are less than 6 months postpartum
Last, your provider will require a blood pressure reading from within the last six months. Why is this such a strict requirement? People who have high blood pressure (aka hypertension) have a heightened risk of stroke or heart attack while using methods of birth control that contain estrogen. That being said, the overall risk of stroke or heart attack is still quite low.
If you’ve gotten your blood pressure measured in the last six months, you’ll be asked to provide both the top number (aka your systolic blood pressure — the higher number) and the bottom number (aka your diastolic blood pressure). If you haven’t gotten it measured recently, head to a clinic, doctor’s office, or pharmacy near you, or use an at-home blood pressure cuff to get those numbers. For those deciding to go the online birth control visit route, we’d recommend knowing your blood pressure before starting the process.
The bottom line
There are more ways to access birth control than ever before. More access means fewer barriers, and more people getting the contraceptive care they need. And all the research we currently have points to online birth control prescriptions being as safe as birth control prescribed in person. In other words, online birth control checks the boxes for both “convenient” and “safe.”
This article was medically reviewed by Dr. Yael Cooperman. She holds a bachelor’s degree in Life Sciences from Tel Aviv University in Israel and an M.D. from the Azrielli Faculty of Medicine at the Bar-Ilan University in Israel. Dr. Cooperman has worked as a medical writer on clinical research projects as well as the publication of peer-reviewed research for universities and hospitals around the world.