Q&A: Dr. Brian McKenna on non-prescription oral contraceptive

The Food and Drug Administration-approved Opill (norgestrel), the first daily oral contraceptive approved for use in the U.S. without a prescription, on July 13.

Riverhead News-Review spoke with longtime obstetrician and gynecologist Dr. Brian McKenna of Northwell Health’s Peconic Bay Medical Center about what this will mean for women on the North Fork.

Last summer, Northwell Health named Dr. McKenna managing director of women’s health for eastern Suffolk County, with a mission to spearhead expansion of its new women and children’s unit to advance health services on the North Fork.

“I’ve been in women’s health care now for 35 years, and this is a very important step forward,” Dr. McKenna said. “The old-school attitude was that no one should really get a prescription without having a thorough medical inventory and exam. Being able to get the pill over the counter doesn’t replace the fact that any woman who is of reproductive age should have regular health exams with a with a provider, whether that’s an OB GYN or family doctor or nurse practitioner midwife.”

News-Review: How will the pill work?

Dr. McKenna: The pill that they just approved from the FDA is a progesterone-only pill, which means there’s no estrogen in that pill and what that pill does is “fool” your body into thinking that you’re pregnant by elevating your progesterone levels. That suppresses your body’s process for ovulation. So, by taking progesterone-only birth control, you don’t ovulate like you would if you were not on the pill, so you don’t release the egg. And also, it changes the environment inside the uterus, it thickens the cervical mucus, and it also thins out the endometrial lining where pregnancy would be setting up shop if you do get pregnant.

What are the benefits of a progesterone-only contraceptive?

The benefits are, there’s no estrogen, so there’s very low concern for estrogen-related side effects and progesterone is time-honored and true. It’s been used successfully for a long time. And there’s very few concerns for someone on a progesterone-only pill.

Are there side effects? What are they?

It does have some effects on some women. It may cause water retention and a little sense of bloating, and there might be an adjustment period. But by having it available over the counter, it’s another positive step in allowing women the autonomy of making decisions and controlling their reproductive health without having to get permission or an appointment or go through the typical maneuvers that [they] have to do normally to get medication and medicine, so it’s a huge, huge step forward.

Any advice for those deciding whether or not to take this medication?

My advice to all women is for them to be reflective — really [think about whether] they’ve been properly counseled and cared for by their provider, their doctor, midwife, or whatever source of health care they seek … I think this helps everyone reflect on what it means to be really preventative and what it means to have good healthcare.

Anything else you’d like to add that’s important for the community to know?

I would like to stress that many people have many different opinions, and many people have different rules in their family about what’s okay, what’s not okay. It’s very important for us to respect everyone’s opinion, and our job as physicians … we really are educators, and guardians of good health, and we just have to be respectful of where they’re coming from, and what they want to do, but at the same time provide the educational platform and the support that they need.