From the Guidelines
When switching to a different oral birth control, a patient can start the new pill immediately without waiting for the next cycle, as long as it is reasonably certain that the woman is not pregnant. This approach is supported by the U.S. Selected Practice Recommendations for Contraceptive Use, 2013, which states that combined hormonal contraceptives can be started immediately if pregnancy can be ruled out 1. The key considerations for switching oral birth control methods include:
- Timing: The new pill can be started at any time, but if it has been more than 5 days since menstrual bleeding started, the patient should use backup contraception for the next 7 days 1.
- Need for backup contraception: If the patient has had sexual intercourse since the start of her current menstrual cycle and it has been more than 5 days since menstrual bleeding started, she should abstain from sexual intercourse or use additional contraceptive protection for the next 7 days 1.
- Switching from an IUD: The patient can start the new pill immediately, but the healthcare provider may consider advising the patient to retain the IUD for at least 7 days after starting the new pill, abstain from sexual intercourse or use barrier contraception for 7 days before removing the IUD, or use emergency contraceptive pills at the time of IUD removal 1. It is essential to note that during the first 7 days after switching, patients should use a backup method of contraception like condoms to ensure protection against pregnancy. Some patients may experience breakthrough bleeding or spotting during the transition, which is normal as the body adjusts to the new hormone levels. Overall, the immediate transition approach helps maintain hormonal contraception without gaps in coverage, which reduces the risk of unintended pregnancy.
From the Research
Switching Oral Birth Control
- Patients can switch to a different oral birth control at any time, as long as the physician can be reasonably certain that the patient is not pregnant 2.
- There is no requirement to wait until after a cycle to switch oral birth control methods.
- When switching, it is essential to assess the patient's needs and present all methods that can be used safely using a tiered effectiveness approach 2.
- High-quality contraceptive counseling includes working collaboratively with patients to find the most effective and acceptable method for them and helping to identify factors that may assist in or hinder their ability to use the method correctly over time 2.
Considerations for Switching
- Estrogen-containing contraceptives can increase the risk of venous thromboembolism, so patients with conditions associated with a risk of cardiovascular events should not use combination oral contraceptives (COCs) 2, 3.
- Blood pressure level should be assessed before initiation of oral contraceptives 2.
- Noncontraceptive benefits of oral contraceptives include reduced risk of ovarian and endometrial cancers, more favorable bleeding patterns, and improvement in menstruation-related symptoms such as acne, migraine headaches, and premenstrual dysphoric disorder 2, 3, 4.