Birth control online in Puerto Rico: birth control pills, patch, ring and more

It's a private video visit, in English or Spanish, to start a method, switch methods, continue the one you use or get emergency contraception. You see Dr. Diana Nieves Castro, MD, a general practice physician licensed in Puerto Rico with several years of emergency-department experience.

The CDC's contraception guidance (U.S. SPR 2024) says most people need few or no exams or tests before starting a method, and that pelvic and breast exams are not needed to start the pill, patch or ring.

Here's how it works:

The doctor can prescribe these methods in your video visit, if appropriate for you:

• Birth control pills: combined (estrogen and progestin) or progestin-only.
• The patch: changed once a week.
• The vaginal ring: you place it yourself.
• Ulipristal, the emergency contraceptive pill that needs a prescription (see below).

The hormonal IUD, the copper IUD, the arm implant and the shot every three months are placed in an office or clinic. According to the CDC, they are the most effective: the implant has a 0.1% typical-use failure rate, the hormonal IUD 0.1% to 0.4%, the copper IUD 0.8% and the shot 4%. The pill, patch and ring are 7%.

If you're interested in one of these, the doctor walks you through the options in your visit and helps you find where to have it placed.

Under CDC guidance (U.S. SPR 2024), you can start birth control pills any day of your cycle if it is reasonably certain you are not pregnant; you don't have to wait for your period. If you start within 5 days of when your period began, you don't need extra protection. If you start later, use condoms for 7 days with a combined pill, or for 2 days with most progestin-only pills.

Progestin-only pills are taken at the same time every day. In 2023 the FDA approved the first over-the-counter daily birth control pill in the U.S., Opill (norgestrel, progestin-only). If you prefer a prescription pill, a combined pill, or aren't sure which suits you, the doctor helps you choose. No daily pill works as emergency contraception. If you use tirzepatide (Mounjaro or Zepbound), its FDA label says it can lower how well the pill works when you start and after each dose increase; read about Mounjaro and birth control pills.

Levonorgestrel (Plan B and generics) is sold over the counter and is taken as soon as possible, within 72 hours. Ulipristal needs a prescription and, according to the CDC, works better on days 3 to 5; the doctor can evaluate you by video. Read the Plan B pill guide for the time windows, effectiveness and what to do next.

Combined methods (the pill, patch and ring with estrogen) aren't for everyone. Under the CDC's criteria (U.S. MEC 2024), they are not recommended if, for example, you smoke and are 35 or older, have had a blood clot, have migraine with aura, or have very high blood pressure. In those cases, the doctor explains progestin-only and other options.

No hormonal birth control protects against sexually transmitted infections; the CDC recommends condoms for that. If you're worried about an infection, see STI testing and treatment.

In Puerto Rico the age of majority is 21. So if you're under 21, a parent or legal guardian signs the consent, stays on camera for the whole visit and shows photo ID. Our lawyers are reviewing the consent rules for minors in these visits; if anything changes, we'll update this page.