A barrier has been removed for women who use birth control pills as a treatment for hormonal disorders. North Carolina legislature passed a bill in August of 2021 that enables women to get hormonal birth control pills without a doctor’s prescription effective on February 1. Pills will now be available at local pharmacies. 

 

Birth control pills are used as a treatment for a myriad of things, from clearing up acne to regulating irregular periods. For hormonal disorders where there is no cure, such as polycystic ovary syndrome (PCOS) and endometriosis, birth control is one of the most common treatments. 

 

A study by the Guttmacher Institute, a sexual and reproductive health research organization, found that 58% of all pill consumers use it for more than just strictly contraception.

 

PCOS is a common hormone disorder in which women have high levels of androgen–a hormone that is higher in men–that hinders ovulation, causes cysts to form on the outside of the ovaries, irregular periods, and excess hair growth. Not all women experience any or all symptoms, but birth control pills are commonly prescribed to treat this disorder to help regulate the hormones and menstruation. 

 

“It was the first option for me because at that point I didn’t even have a regular period. If I did have a period, it was extremely heavy and very painful. I’ve found it to be very helpful for me. I went off it for a couple months last year and immediately wanted to go back on it,” said Maeve Cannell, on starting the pill after being diagnosed with PCOS more than two years ago. 

 

Endometriosis is a reproductive disorder in which the tissue that normally lines the uterus and is flushed out with menstruation grows on the outside of organs, causing inflammation and irritation. This abnormal tissue growth is hormone-related, and causes incredible pain during menstruation and intercourse, among many other symptoms. Birth control pills are one of several recommended hormone treatments for this disorder, as there is no cure.

 

“There were times I would be walking through the grocery store and would be like ‘I’m gonna have to use my cart as a walker right now’ because it’s so hard to stand up. After I started the pill that was progesterone only, it stopped all of the cycle behavior,” said Elizabeth Nelson. “So instead of having some weeks where I was okay and others where I was barely functional, it really has changed the game where I barely have to use other medications to relieve pain.”

 

Nelson, an elementary school teacher in Durham, expressed that since starting birth control as a treatment, her chronic endometriosis pain doesn’t interfere with her job nearly as much as she thought it would.

 

“With insurance it’s not expensive, but you still have to pay for it and have to count it into the budget. It definitely plays a role in more equitable treatment and across the board providing more equity for women to just be able to work and go about their daily lives,” said Nelson.

 

In a review published by MDPI, an open access scientific journal, in October of last year, medical professionals Dr. Jacquez Donnez and Dr. Marie-Madeleine Dolmans seek to present a new form of hormone treatment for endometriosis pain. This is an oral gonadotropin-releasing hormone (GnRH) antagonists for women who have built up a resistance to progesterone only pills. GnRH antagonists lower the production of estrogen by decreasing the secretion of hormones in the pituitary gland that are in control of reproductive functions. 

 

Their proposed hormone treatment would also be in the form of an oral pill. According to Dr. Dolmans, access to this treatment would be by prescription from gynecologists only.

 

Birth control can even be used as preventive care for cancer. Gabi Wahba, who immigrated from Brazil in 2014, went on the pill when she was 14 years old because she would pass out from her period cramps, causing her to miss weeks of school at a time. In Brazil, she didn’t need a prescription for these pills. Years later, she considered getting off the pill but her mom was diagnosed with a form of breast cancer that was hormone-related. 

 

“I needed to stay on birth control to keep my hormone levels very stable throughout the month. I couldn't have the fluctuations that would come with a regular period,” said Wahba.

 

This new North Carolina legislation is a win for reproductive health, but is only the first step in making healthcare and treatment more accessible. New forms of hormone treatments like the GnRH antagonists will likely still require prescriptions. Not all health insurance plans will cover over the counter pills–not to mention the many state residents who don’t have health insurance at all.

 

“Women’s health care is getting better and there's more attention there, but historically something we've struggled with in the OBGYN community is getting appropriate kind of recognition for certain diseases that women go through,” said Dr. Douglas Timmons, a fellow at the Reproductive Endocrinology Infertility department at UNC Chapel Hill.