Same day initiation algorithm for new birth control method (pill, patch, ring, feo, implant)

Quick-start (same-day start) approach to initiation of new birth control method: Pill, patch, ring, DMPA injection, implant

DMPA: depot medroxyprogesterone acetate; LMP: last menstrual period.

* Refer to UpToDate content on early pregnancy and pregnancy termination.

¶ Patient should use a barrier back-up method such as condoms for the first week after starting a new method.

Δ Unprotected sex includes episodes of sex in which a method of contraception was used but may not have been effective (eg, breakage of condom, multiple skipped pills).

◊ Refer to UpToDate content on emergency contraception.

§ For women using ulipristal for emergency contraception, progestin-containing contraception (ie, the pill, patch, ring, injection, and implant) should not be used for 5 days following ulipristal. For women taking levonorgestrel or combined estrogen-progestin emergency contraception, the new contraceptive method can be started after the emergency contraception.◊

¥ If the patient would like the contraceptive implant, some providers prefer to offer a single injection of DMPA today and ask the patient to return for the implant within 5 days of the first day of her next menstrual period (to avoid the need for implant removal if the repeat urine pregnancy test is positive).

Modified from: RHEDI/The Center for Reproductive Health Education In Family Medicine, Montefiore Medical Center, New York City. Available at: www.rhedi.org/clinicians.php. Accessed on July 7, 2016.