Can You Use Hormonal Contraception Past Its Expiration Date?

Prepping for the Trump Administration

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I’ve heard from several colleagues that they have performed more tubal ligations and inserted more IUDs since the election than they can previously remember in the same time frame. No wonder there is an urgency to protect oneself from pregnancy, given it’s almost a foregone conclusion that reproductive rights will be restricted; it’s just a matter of how quickly and by how much. Will we be boiled slowly like frogs, or will there be a sweeping ban? Will they start with the ability to mail medication abortion, or perhaps falsely claim that contraception is abortion and go for the whole shebang, which would not only get rid of contraception pills, rings, and patches but also all IUDs? The permutations and combinations of possibilities are as frightening as they are unscientific.

In 2025, the Republicans will control all branches of the government, and if Dr. Marty Makary becomes head of the FDA, then a loyal forced birther who plays fast and loose with abortion facts will have power over medical contraception and abortion. Not reassuring. And, of course, Robert Kennedy Jr, despite being responsible for almost 100 measles deaths in Samoa and a proponent of just about every medical conspiracy theory out there (this guy believes in chemtrails, and he is a step away from running Health and Human Services) is now apparently “pro-life.” Kennedy appears to oscillate between pro-choice and forced birth depending on which gets the most attention and money (not unlike Trump), but recently, he’s been singing the “Every abortion is a tragedy” tune, but apparently, a child dying from measles, not so much. I am convinced he’s regurgitating forced birth talking points to get the votes he needs from forced birthers in the Senate, who have apparently been concerned with his previous pro-choiceness. There is apparently a push to get Roger Severino into a top position. He directed the HHS Office for Civil Rights under the previous Trump administration and was the lead author for the chapter on health care in Project 2025. I suspect the Project 2025 people are only too happy to distract RFK Jr with vaccines, fluoride, and food dyes so they can have the run of the place to bring their forced birth fetishes into reality.

While it seems highly likely that initial efforts will focus on curtailing access to medication abortion, such as reversing the Biden Administration rules that allow abortion pills to be available by mail and sold in retail pharmacies, there are numerous other awful ways to erode reproductive rights. And let’s be frank. They’re unlikely to stop at abortion. Loss of contraception or making it harder to access isn’t just going to hurt people who need it for contraception; it will also affect those who are taking it for heavy periods, period pain, menstrual migraines, and, to control symptoms in the menopause transition, to name but a few of the non-contraceptive reasons to take hormonal contraception.

And so the question arises: should someone stock up on their hormonal contraception? After all, these are not normal times. But oral contraceptives have expiration dates, so if someone gets packages in early January, what happens if, a year later, they can’t get a refill or it’s much harder, and so there are delays? What if you are left with expired medication but no other option?

The expiration date on medication means the stability of the drug can be assured if it is in the original sealed container until that date. Stability means the physical and chemical properties are not altered, so the appearance, potency, pH, and how the drug dissolves are unchanged. In addition, there are no degradation products. Think of storing wine; if the cork is damaged, then the color or smell of the wine might change, or some of the wine may turn into vinegar (in this analogy, the vinegar would be a degradation product). Degradation products can potentially interfere with how a drug works or sometimes even be harmful.

Most drugs don’t become unstable immediately after their expiration date (one exception may be misoprostol, a drug used in medication abortion; it deteriorates very quickly when packaged incorrectly or when out of its packaging, so using it past its expiration date is not recommended); an expiration date just tells is that the pharmaceutical company can only guarantee the product until the expiration date as long as the packaging is intact and storage conditions are met.

As we collectively waste a lot of medications, in recent years, there has been a push to evaluate expired medications to see if they might still be effective past their expiration date. Medications do degrade over time, but by how much and how quickly? To be considered stable, most medications should have 95-105% of the original dose, although, for some medications, 90-110% of the stated dose on the package might be acceptable.

While many drug companies may have data about stability past the expiration date, they are not exactly forthcoming with that information, likely because if a medication were shown to be stable years beyond its shelf life, that would cut into profits.

One of the bigger studies evaluating expired drugs is from the US Department of Defense/FDA Shelf Life Extension Program, which has tested the stability of 122 different drugs past their expiration date. They tested the medications in several ways, including potency, pH, and impurities, and found that 88% of samples (stored in original containers and at the appropriate temperature) were stable for an average of 66 months past their expiration date. Not one failed within one year. Ibuprofen and some antibiotics were still good decades later. Unfortunately, no oral contraceptives were tested, and it’s not possible to extrapolate from one medication to another.

Another study evaluated even older medications, eight medications with 15 active ingredients that were 28-40 years past their expiration date (they were apparently found tucked away in the back of a pharmacy in their original packaging). The investigators evaluated them to see if what they contained matched the label for potency. One medication could not be tested as it was no longer used, and no test was available. Interestingly, 12 of 14 medications had ≥90% of their original potency. This study can’t tell us much more, as they only looked at the amount of drug potency, but it does tell us that it is worth investigating even long-expired medications.

Interestingly, the group that seems most interested in evaluating expired medications is NASA because long trips in space mean you have to take every medication with you in case the delivery of supplies is interrupted or simply not possible. One study that looked at medications that had been on the International Space Station found that several over-the-counter medications (including ibuprofen and aspirin) passed testing requirements several months after expiration, but melatonin failed at 11 months. As unexpired melatonin was not tested. for comparison, it’s not clear if the product never met requirements (as often happens with supplements) or if this represents a true degradation. It’s worth mentioning that medications could theoretically degrade faster in space as they are often repackaged for travel, and there is also exposure to cosmic radiation, so what happens in space may not always translate to what happens on Earth.

A group looking into expired medications from a research station in Antarctica, which were also likely not always stored under ideal temperature conditions, found several medications (including some antibiotics and the anti-inflammatory naproxen) that had expired anywhere from 19-51 months earlier were still stable with no evidence of degradation products, although there was a concern that one liquid medication that may have leaked could have some products of degradation. It seems that nonsteroidal anti-inflammatory drugs are quite stable several years after their expiration.

That’s all well and good, but what about contraception?

Sadly, this has not been studied. I did a thorough review of the literature and checked with a friend who does a lot of research on contraception, and she said she wasn’t aware of any data. It’s frustrating that I have nothing to share with you.

One group was interested in the expiration dates of drugs that would be included in a mission to Mars and tracked down publicly available information for medications, and yes, an oral contraceptive, Ortho-Novum, which is norethindrone 1 mg and ethinyl estradiol 0.035 mg, was included. Apparently, this is in a NASA space medication pack (good to know NASA is considering the needs of women in a long-term space mission). In the UK/EU, Ortho-Novum has a shelf life of 60 months per the manufacturer, but it is 36 months per the New Zealand and Australian manufacturers. No data was available from the US Manufacturer. There was no explanation for the difference between the UK/EU and Australia/New Zealand, so we don’t know if Ortho-Novum is packaged differently in the UK/EU and so has a longer expiration date there than the products in Australia and New Zealand or if regulations in the UK/EU require more transparency and/or testing and Ortho-Novum may actually be stable for at least five years and not three. It is promising that expiration dates could be longer, but it is nowhere near enough to go on.

After all that, I have no answer for you about the stability of oral contraceptives past their expiration date. The general consensus is that, like most medications that aren’t a liquid, oral contraceptives are likely stable for several months after their expiration, but without actual data, we can’t say for sure, so the recommendation is not to use expired pills, patches, or rings. Unlike expired ibuprofen, where the worst thing that will happen is there will be less pain relief (although the data seems to show ibuprofen is, in fact, stable for years after its expiration date), with hormonal contraception used for contraception if the product isn’t as effective then the risk in pregnancy. A way bigger deal, especially in a *hopefully* theoretical scenario where access to reproductive health care has been further restricted. Obviously, for someone using the medication for heavy bleeding or another non-contraceptive issue, the biggest issue with an expired contraceptive is the return of symptoms of the hormonal contraceptive.

If someone wanted to stock up on hormonal contraception before January 20th, I would not think them paranoid, but if it’s for contraception, I’d also make sure I had access to condoms because until we have more data, I wouldn’t rely on expired oral contraceptive pills, especially in a scenario where abortion isn’t available.

Because I can’t find any data, I’m looking for a lab to see if I can find someone to do the testing. I ultimately plan to publish the results. I’ve sent off some emails, so fingers crossed. I’ll keep you posted.

References

RC Lyon et al. Stability profiles of drug products extended beyond labeled expiration dates. J Pharm Sci 2006; 95:1549.

Wotring VE. Chemical Potency and Degradation Products of Medications Stored Over 550 Earth Days at the International Space Station. AAPS J. 2016 Jan;18(1):210-6. doi: 10.1208/s12248-015-9834-5. Epub 2015 Nov 6. PMID: 26546565; PMCID: PMC4706284.

Diaz TE, Ives EC, Lazare DI, Buckland DM. Expiration analysis of the International Space Station formulary for exploration mission planning. NPJ Microgravity. 2024 Jul 23;10(1):76. doi: 10.1038/s41526-024-00414-3. PMID: 39043673; PMCID: PMC11266549.

Du B, Daniels VR, Vaksman Z, Boyd JL, Crady C, Putcha L. Evaluation of physical and chemical changes in pharmaceuticals flown on space missions. AAPS J. 2011 Jun;13(2):299-308. doi: 10.1208/s12248-011-9270-0. Epub 2011 Apr 9. PMID: 21479701; PMCID: PMC3085701.

Berard V, Fiala C, Cameron S, Bombas T, Parachini M, Gemzell-Danielsson K. Instability of misoprostol tablets stored outside the blister: a potential serious concern for clinical outcome in medical abortion. PLoS One. 2014 Dec 15;9(12):e112401. doi: 10.1371/journal.pone.0112401. PMID: 25502819; PMCID: PMC4266501.