Blind spots of OTC contraception
Lack of private consultations discourages correct pill use
By Noh Hyun-gi
Over the counter at a pharmacy is not the ideal place to discuss sex life, vaginal bleeding or tenderness of the breasts. It definitely is not appropriate to have a thorough conversation on how to manage one’s hormones. However, these are crucial topics to cover when one is taking oral contraceptives which are categorized as over-the counter (OTC) drugs in Korea.
As a result, wary of the lack of privacy and professional attention, Korean women purchase birth control pills without adequate knowledge on their use.
Ironically, the current practice which supposedly facilitates birth control consumption may divert Korean women from effectively enjoying the option to control their reproductive health.
Only 2.5 percent of Korean women take birth control pills compared to 14.3 percent in the United States and 40 percent in New Zealand, according to the Korean Association of Obstetricians and Gynecologists (KAOG).
Currently, the Korea Food and Drug Administration (KFDA) categorizes all contraceptives as OTC drugs except for two products.
Oral contraceptives contain varied levels of estrogen and progestin that prevent pregnancy by suppressing ovulation and thickening the cervical mucus to impede sperm from reaching an egg. The change in cervix also inhibit fertilized eggs from settling on the uterus walls. Taken properly, the pills are up to 99 percent effective.
Women can buy the pills at any pharmacy without a doctor’s prescription. On the other hand, emergency contraceptives, commonly known as morning-after pills that women can take after unprotected intercourse, require a prescription.
This categorization is the opposite in countries such as the U.S., Japan, New Zealand and England. Women under 18 need to see a doctor to purchase the emergency pills in the U.S.
“This is an outdated policy from the 1970s when contraceptive pills were distributed to pharmacies as a population control initiative,” explained Cheong Ho-jin, vice-president of the KAOG. “The gaping low level of pill use shows that this is not helping women.”
The most common methods of protection in Korea are condoms, withdrawal (ejaculating outside the vagina) and menstrual cycle timing (avoiding the most fertile dates). These options have 15 to 20 percent chance of allowing pregnancy.
A KFDA official explained that the main distinction from OTC and prescription medication is the clinical safety. “We approve drugs for OTC sales because they are proven to be safe over time.”
Cheong disagrees; “The first and foremost responsibility of a doctor is to provide consultation,” she said.
“The purpose is not to run complicated diagnostics on women because we are worried about the safety of the medication. It is necessary to talk about what one can expect from taking birth control pills and how to take them correctly, in a safe environment to discuss sexual health. Such a practice will encourage women to take the medication.”
Cheong believes that the introduction of prescription contraception in 2008 contributed to the decrease in the number of abortions from 340,000 in 2005 to 170,000 in 2010. Currently, two products by Bayer Schering Pharma are available with a doctor’s note in Korea.
Yaz and Yasmin are combination hormone pills that contain dropirenone, a synthetic version of progesterone. This compound may eliminate the bloating women experience during their period, but it could also cause possible heart problems, which has resulted in thousands of lawsuits.
On April 10, the U.S. Food and Drug Administration announced that it will add stronger warnings on contraceptives containing dropirenone. This prompted the KFDA to issues a statement shortly after urging doctors and pharmacists to inform the patients.
Oral contraceptives must be taken every day at the same time for maximum protection. First time users should first day of their period; and the pills take effect within a week.
Most types available in Korea have 21 tablets that contain the same amount of manmade derivatives of progestin and estrogen. After three weeks of taking the pill, the woman can either stop for seven days and have regular menstruation, or start on a new batch to avoid having a period.
Understanding the appropriate response to missed pills is crucial. For example, if a woman misses two pills during the first two weeks of a cycle, she must take the tablets immediately and use alternative contraception such as condoms for the following seven days. However, if a woman skips more than three pills, she should start a new batch.
In addition to the intake rules, intricate differences in hormone composition across brands call for consulting a doctor. Women can experience varying side effects and physicians can examine the degree of the problem and suggest switching products if necessary.