The vast majority of OTC birth control options are nonhormonal. This means that they don’t rely on synthetic estrogen or progesterone to prevent pregnancy.

These methods typically act as physical barriers to prevent sperm from entering the vagina to fertilize an egg.

Opill, the first OTC oral contraceptive in the United States, is the exception to the rule. The progestin-based pill hit the shelves in 2024.

Most drugstores and grocery stores offer OTC birth control options in-store or online. This includes Walgreens, CVS, and Walmart, to name a few common locations.

Birth control effectiveness is usually divided by “perfect” and “typical” use. Perfect use refers to correct and consistent use without any mistakes.

Typical use refers to overall effectiveness during incorrect and correct use. Because it’s unlikely you’ll use OTC birth control perfectly every time, typical use is more accurate.

Opill

Opill is a non-estrogen birth control pill. It contains norgestrel, which is a synthetic form of progesterone. Like other birth control pills, Opill must be taken at roughly the same time every day to be effective.

It works by thickening cervical mucus, which helps prevent sperm from reaching the egg. It may also prevent ovulation.

Progestin-only pills like Opill are 91% effective at preventing pregnancy with typical use. In other words, 9 out of every 100 people who rely solely on the Opill as contraception become pregnant.

External condoms

External condoms are considered a barrier form of birth control. They’re worn on an erect penis to prevent sperm from entering the vagina and reaching an unfertilized egg.

They’re made from latex, lambskin, or polyurethane. The condoms may be lubricated or non-lubricated. They may also include spermicide for additional protection.

When used correctly, most external condoms help prevent sexually transmitted infections (STIs). Lambskin and other natural condoms don’t provide STI protection.

External condoms are 87% effective at preventing pregnancy with typical use.

Internal condoms

An internal condom is a lubricated pouch designed to prevent sperm from entering the vagina. They can be inserted into the vagina up to 8 hours before penetrative vaginal sex and help protect against STIs.

Internal condoms are 79% effective at preventing pregnancy with typical use.

Spermicide

There are several types of spermicide available. Your options usually include:

Most spermicides contain nonoxynol-9, a chemical that essentially stops sperm from reaching an unfertilized egg.

Spermicide may be used alone or with other types of birth control, such as condoms and diaphragms.

Spermicide alone is 79% effective at preventing pregnancy with typical use. It can be inserted into the vagina up to 60 minutes (1 hour) before penetrative vaginal sex and must be left in place for 6–8 hours afterward.

Nonoxynol-9 doesn’t prevent the spread of STIs. In fact, this substance may actually increase the risk of STIs, such as HIV, in some people.

Spermicide can cause irritation and inflammation in the vaginal canal, which can make it easier for infection to get through. If spermicide is used multiple times per day, your risk for infection may increase even more.

Vaginal sponge with spermicide

The sponge is about two inches in diameter, made of soft foam, and contains nonoxynol-9 spermicide.

It helps prevent pregnancy in two ways. The sponge itself is a barrier that prevents sperm from traveling through the cervix, and spermicide prevents sperm from moving beyond the sponge.

With typical use, the sponge is 86% effective at preventing pregnancy among people who have never had a vaginal delivery. That number drops to 78% among people who have had a vaginal delivery.

Before you use the sponge, you must wet it with water and squeeze it to activate the spermicide. You then insert it into the vagina, where it can remain for up to 24 hours. This is true regardless of how many times you have penetrative vaginal sex.

If you leave the sponge in for 30 or more hours, you’re at an increased risk of toxic shock syndrome (TSS). This is a serious and potentially life threatening bacterial infection.

When using OTC birth control, keep these tips in mind:

  • Follow product instructions carefully: Not using a product as instructed may increase your risk of pregnancy.
  • Using a combination of condoms and spermicide is the most effective OTC birth control: Using condoms or spermicide alone isn’t as reliable, and you run a higher risk of pregnancy.
  • Avoid oil-based lubricants such as massage oil, baby oil, or petroleum jelly: These may cause holes in the condom or cause it to break. Instead, stick to water-based lubricants.
  • Store barrier methods correctly: Minimize heat and friction, always check the expiration date, and avoid using your teeth or another sharp object to open an individually wrapped barrier.

Plan B and other levonorgestrel-based EC are pills 75% to 89% effective at preventing pregnancy when taken within 72 hours (3 days) of sex.

These pills can be taken up to 120 hours (5 days) after sex. However, effectiveness decreases over time.

Plan B and other levonorgestrel-based EC may be less effective if you weigh more than 165 pounds.

Consult with a local pharmacist or other healthcare professional to learn more about your options. They might recommend doubling the dose or trying a prescription method.

No OTC birth control is perfect. Condoms can break on occasion, sponges may be removed too soon, and any other number of things may happen to disrupt protection.

If this happens, what you do next can mean the difference between an unintended pregnancy and effective prevention.

If your OTC birth control fails, it’s important that you remain calm. Carefully remove the condom or barrier, if used, and urinate to help get rid of any sperm left behind.

OTC emergency contraception pills must be taken as soon as possible to be effective. You may be able to schedule an emergency appointment with a healthcare professional to have an intrauterine device (IUD) inserted.

Prescription-only methods can be used up to 120 hours (5 days) after sex. This includes ulipristal acetate (ella), which is an oral medication, and IUDs that must be inserted by a doctor.

The nonhormonal IUD (ParaGard) and certain hormonal IUDs (Mirena and Liletta) are over 99% effective at preventing pregnancy when inserted within 120 hours (5 days) of penis-in-vagina sex.

Whether you choose an OTC barrier method or prescription birth control is a decision best made by you and a healthcare professional.

To help narrow your options, you may find it helpful to consider:

  • whether you want to become pregnant in the near future
  • how frequently you have sex that could result in pregnancy
  • any underlying conditions that could be impacted
  • insurance coverage or out-of-pocket costs
  • your overall risk of STI transmission

When it comes to birth control, OTC options have come a long way. Most OTC birth control options are readily available, relatively inexpensive, and effective when used as directed.

Consult a doctor or other healthcare professional if you have any questions or concerns about birth control.