Safety without the counter: transparency of online safety information for women's over-the-counter medicines across markets.

BACKGROUND: The rapid expansion of e-pharmacy platforms has shifted over-the-counter (OTC) medicine selection from physical pharmacies to digital environments, where consumers increasingly rely on online product pages for safety-critical information. For women's health OTC products, this shift raises particular concerns due to pregnancy- and lactation-related risks, frequent self-care use, and reduced access to professional counseling at the point of purchase. Despite growing reliance on e-pharmacies, evidence on the completeness of online safety information across regulatory contexts remains limited. METHODS: A cross-sectional observational study assessed the transparency of safety information for women's health OTC medicines and supplements sold on licensed e-pharmacy platforms across seven markets (United States, United Kingdom, Canada, Australia; United Arab Emirates, Saudi Arabia, Qatar). Product pages were evaluated using a standardized 12-item transparency framework capturing essential safety elements. Comparative analyses employed nonparametric tests and multivariable regression to identify regional, platform-level, and product-related predictors of transparency. RESULTS: A total of 119 products were analyzed. The mean Transparency Score was 6.25 (SD 1.81) out of 12, indicating moderate completeness. Critical elements, including expiry date, batch or lot number, and drug interaction information, were rarely disclosed. While overall transparency differed modestly by region, warnings and precautions were significantly less likely to appear on Middle Eastern platforms. Independent or regional pharmacies demonstrated lower transparency than chain platforms. Pregnancy and lactation guidance was inconsistently provided outside pregnancy-specific categories. CONCLUSION: Licensed e-pharmacy platforms frequently provide incomplete safety information for women's health OTC products, with meaningful variation by market region, platform type, and availability of supplementary digital resources. Transparency deficits are embedded within regulated digital pharmacy systems rather than limited to illicit sellers. These findings underscore the need for harmonized regulatory standards, mandatory digital safety disclosures, and strengthened platform accountability to support safe, informed self-care in online pharmacy environments.