Birth control pills, patches and rings can be prescribed after an online questionnaire, often without a video call. This guide covers how well each method works, which health conditions rule out estrogen, what CDC says a prescriber should check, and what one online service, Wisp, charges. The sources are FDA's birth control guide, CDC's 2024 contraception guidelines and the drug labels.
This page explains contraception options and is not medical advice. Your prescriber should review your health history before you start any method.
How well each method works
FDA and CDC give typical-use figures, which count real-world slips such as missed pills. For comparison, FDA says "about 85 out of 100 sexually active women who do not use any birth control can expect to become pregnant in a year" (FDA: Birth Control Guide).
| Method | Pregnancies per 100 users in a year (typical use) | Can an online service prescribe it? |
|---|---|---|
| Implant | 0.1 | No: placed by a clinician |
| Hormonal IUD | 0.1 to 0.4 | No: placed by a clinician |
| Copper IUD | 0.8 | No: placed by a clinician |
| Shot (injection) | 4 | Given by a clinician, or self-injected with a prescription |
| Combined pill | 7 | Yes |
| Progestin-only pill | 7 | Yes (Opill needs no prescription) |
| Patch | 7 | Yes |
| Vaginal ring | 7 | Yes |
| External condom | 13 | No prescription needed |
Source: typical-use failure rates from CDC: contraception and birth control methods, which cites Contraceptive Technology (2023), and FDA's Opill announcement. CDC also says "The shot can be self-injected or given by a health care provider."
CDC gives the same typical-use failure rate, 7%, for the pill, patch and ring. The main difference is what you have to remember: a pill every day, a patch every week or a ring every month. The most effective reversible methods, implants and IUDs, cannot be started online. If you want one, a clinic or health department can place it.
What an online prescriber should check
CDC's 2024 practice recommendations (U.S. SPR) list the checks needed before starting each method.
- Blood pressure, for estrogen-containing methods. "Blood pressure should be measured before initiation of combined hormonal contraceptives." CDC rates this check as "Essential and mandatory in all circumstances for safe and effective use of the contraceptive method", and says a reading taken outside a clinic can be reported when a provider cannot measure it (CDC U.S. SPR: combined hormonal contraceptives).
- No pelvic exam. CDC says "Pelvic examination is not necessary before initiation of CHCs because it does not facilitate detection of conditions for which hormonal contraceptives would be unsafe", and gives the same advice for progestin-only pills (CDC U.S. SPR: combined hormonal contraceptives; progestin-only pills).
- Progestin-only pills need no tests. "Among healthy patients, no examinations or tests are needed before initiation of POPs" (CDC U.S. SPR: progestin-only pills).
So an online visit can be safe, provided the prescriber gets an honest health history and a blood pressure reading. CDC says providers might recommend that patients "obtain blood pressure measurements in other settings, including self-measured blood pressure" (CDC U.S. SPR: combined hormonal contraceptives).
Who should avoid estrogen
The combined pill, patch and ring all contain estrogen and a progestin. Tier: FDA-approved prescription medicines. The Sprintec (norgestimate and ethinyl estradiol) label carries a boxed warning: "Cigarette smoking increases the risk of serious cardiovascular events from combination oral contraceptive (COC) use. This risk increases with age, particularly in women over 35 years of age, and with the number of cigarettes smoked." Its contraindications include smoking over age 35, a past or current blood clot in the legs or lungs, stroke, coronary artery disease, uncontrolled high blood pressure, "migraine headaches with aura", any migraine in women over 35, liver tumors or liver disease, and "Current diagnosis of, or history of, breast cancer, which may be hormone-sensitive" (Sprintec — DailyMed Drug Label).
CDC's 2024 Medical Eligibility Criteria (U.S. MEC) grade conditions from 1 (no restriction) to 4, "A condition that represents an unacceptable health risk if the contraceptive method is used" (CDC U.S. MEC: how to use). For estrogen-containing methods, the conditions CDC rates as category 4 include (CDC U.S. MEC summary chart):
- Age 35 or over and smoking 15 or more cigarettes a day (fewer than 15 a day is category 3, where risks "usually outweigh the advantages").
- Migraine with aura.
- Systolic blood pressure of 160 mm Hg or higher, or diastolic of 100 or higher, or vascular disease. Lower readings of 140–159 systolic or 90–99 diastolic, and high blood pressure that is adequately controlled, are category 3.
- A past blood clot with a higher risk of recurrence.
- Under 21 days after giving birth.
- Current breast cancer. CDC rates this category 4 for progestin-only pills too.
Being 40 or over is category 2, where benefits generally outweigh risks. CDC notes that "The risk for cardiovascular disease increases with age and might increase with CHC use" (CDC U.S. MEC: combined hormonal contraceptives).
The patch. FDA says the patch "may expose you to higher levels of estrogen compared to most combined oral contraceptives" and that "There may be an increased risk of blood clots among women who use the patch as compared to women who use certain combination oral contraceptives" (FDA: Birth Control Guide). CDC adds that "Effectiveness of the patch might be reduced in women with BMI ≥30 kg/m2 or weight >90 kg" (CDC U.S. MEC: combined hormonal contraceptives).
Progestin-only pills
Progestin-only pills ("mini pills") contain no estrogen, so they are an option for many people who cannot take it. Tier: FDA-approved medicines (one sold without a prescription). There are three kinds:
- Norethindrone (for example Errin). CDC counts a dose as missed "if it has been >3 hours since it should have been taken" (CDC U.S. SPR: progestin-only pills), so timing matters.
- Drospirenone (Slynd). Each active tablet "contains 4 mg of drospirenone", taken as 24 active and 4 inactive tablets. CDC counts a dose as late, not missed, until 24 hours have passed. Its label's contraindications include kidney impairment, adrenal insufficiency, cervical or other progestin-sensitive cancers, liver tumors or liver impairment, and undiagnosed abnormal uterine bleeding. Because drospirenone can raise potassium, the label advises checking potassium in people on long-term medicines that raise it (Slynd — DailyMed Drug Label).
- Norgestrel (Opill), the first daily birth control pill approved for sale without a prescription. FDA's 2023 announcement says it "should be taken at the same time every day", that it "should not be used by those who have or have ever had breast cancer", and that it "is not for use as emergency contraception" (FDA: first nonprescription daily oral contraceptive).
FDA lists acne, breast tenderness, headache, irregular bleeding, nausea and weight gain among progestin-only pill side effects (FDA: Birth Control Guide).
Starting, and what to do about missed pills
When you start, you may need a backup method such as condoms. CDC's guidance (CDC U.S. SPR: combined hormonal contraceptives; progestin-only pills):
- Combined pill, patch or ring: no backup if started within 5 days of the start of your period. Otherwise, use condoms or avoid sex "for the next 7 days".
- Norethindrone or norgestrel pills: if started more than 5 days after your period began, use backup "for the next 2 days".
- Drospirenone pills: no backup if started on the first day of your period. Otherwise, use backup for 7 days.
Missed combined pills. CDC counts a pill as late under 24 hours and missed at 24 hours or more. For one late or missed pill: "Take the late or missed pill as soon as possible" and "No additional contraceptive protection is needed." If two or more are missed, "Take the most recent missed pill as soon as possible. (Any other missed pills should be discarded.)" Then use condoms or avoid sex "until hormonal pills have been taken for 7 consecutive days". If the missed pills were in the last week of hormonal pills, skip the hormone-free week: "Omit the hormone-free interval by finishing the hormonal pills in the current pack and starting a new pack the next day." CDC says emergency contraception other than ulipristal (Ella) should be considered if the pills were missed in the first week and you had unprotected sex in the previous 5 days (CDC U.S. SPR: combined hormonal contraceptives).
Late patch or ring. The same CDC page says no backup is needed if a patch or ring change is less than 48 hours late. At 48 hours or more, use condoms or avoid sex "until a patch has been worn for 7 consecutive days", or until a ring has been in place for 7 days in a row. Check CDC's page or your product leaflet for the exact steps.
Missed norethindrone or norgestrel pills. Take one as soon as possible, and use backup "until pills have been taken correctly, on time, for 2 consecutive days". CDC says emergency contraception (other than ulipristal) should be considered after unprotected sex.
Missed drospirenone pills. If one pill is late or missed (under 48 hours), take it as soon as possible; "No additional contraceptive protection is needed." If two or more are missed (48 hours or more), use backup "until hormonal pills have been taken for 7 consecutive days", and consider emergency contraception other than ulipristal if the pills were missed in the first week (CDC U.S. SPR: progestin-only pills).
Some medicines make hormonal birth control less effective. Wisp's product pages say "Tell your doctor about all your current medicines and any medicine you start or stop using", and the Sprintec label says "Tell your healthcare provider about all the medicines you take" (Sprintec — DailyMed Drug Label).
Emergency contraception
Emergency contraception is for after unprotected sex or a method failure, and FDA says it "should not be used as a regular form of birth control" (FDA: Birth Control Guide).
- Levonorgestrel 1.5 mg (Plan B and generics) is sold without a prescription. FDA says to take it "as soon as possible within 72 hours (3 days)".
- Ulipristal (Ella) needs a prescription and can be taken "as soon as possible within 5 days after unprotected sex" (FDA).
- The copper IUD can be placed "within 5 days of the first act of unprotected sexual intercourse", and CDC says copper IUDs "are highly effective as emergency contraception".
CDC adds that levonorgestrel "might be less effective than UPA among women with obesity", and that ulipristal works better than levonorgestrel 3 to 5 days after sex. After ulipristal, CDC advises waiting at least 5 days before starting or restarting hormonal birth control, using condoms or avoiding sex meanwhile. After that, use backup "for the next 7 days after starting or resuming regular contraception or until their next menses, whichever comes first". After either pill, CDC advises a pregnancy test if there is no bleeding within 3 weeks (CDC U.S. SPR: emergency contraception).
Birth control does not prevent STIs
FDA's guide answers "No" to whether any hormonal method protects against sexually transmitted infections. Its Opill announcement says "Condoms should be used to prevent sexually transmitted diseases" (FDA: first nonprescription daily oral contraceptive). Our condom guide compares latex and latex-free condoms, and our at-home STI test guide covers testing.
Getting birth control online from Wisp
Tier: telehealth service (prescribes FDA-approved contraceptives). Wisp LegitScript status not verified prescribes the pill, patch and ring online. On October 13, 2026, its birth control page listed most generic pills "Starting at $15", Slynd at $25, the generic NuvaRing at $22 and the patch at $12, with a "1, 3, or 6-month supply" and "HSA & FSA Eligible". Its FAQ separately says options start "at $5 per month for a 90-day supply" and that "there's no extra cost for a consultation" (Wisp, birth control). Check the total at checkout. The prices depend on the supply length, and for pharmacy pickup Wisp says "Medication costs may apply at pharmacy" (Wisp, Errin).
Other points from Wisp's pages:
- Ages. "Wisp treats patients 18 - 54 for this area of care", and says it "does not offer hormonal birth control, hormonal cycle control, or emergency contraception to patients over the age of 55" (Wisp, birth control).
- What you provide. ID, height and weight, current medicines, allergies and conditions. For hormonal treatments, Wisp says patients "may need to provide" "Blood pressure readings taken within the last year (required for combination birth control pills)". CDC's blood pressure check applies to the patch and ring as well as combined pills, so expect to give a reading for those too. It also asks for the date of your last period (Wisp, birth control patch).
- Delivery. Free delivery "Arrives in 3 to 5 days", or same-day pharmacy pickup (Wisp, Errin). Wisp says it ships "to all 50 states regardless of health insurance".
- Patches. CDC rates a BMI of 30 or more as category 2 for estrogen-containing methods, but Wisp's patch page goes further: "Patches such as Xulane, Zafemy, and Twirla are contraindicated for use in women with a BMI ≥ 30 kg/m 2" (Wisp, birth control patch).
- Emergency contraception. Generic levonorgestrel "Starting at $12.50", delivery only, so Wisp advises ordering ahead. Ella costs $44 and is pickup only (Wisp, emergency contraception).
Wisp's site shows a LegitScript seal, which this site has not yet confirmed on LegitScript's directory (what this means).
Questions to ask any online service:
- Will a clinician review my history, and how do I report my blood pressure?
- Is the price for the medicine, the visit or both, and what will the pharmacy charge?
- How do I switch methods if I get side effects?
- Can I get a supply long enough to avoid gaps?
If you have insurance, compare your pharmacy copay with the cash price before you pay.