When is the first dose of oral contraceptive (OC) taken?

From the Guidelines

The first dose of oral contraceptives, specifically combined hormonal contraceptives (CHC), can be taken at any time, but if it's more than 5 days after menses started, backup contraception, such as condoms, should be used for 7 days. This approach is based on the most recent guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1.

When starting oral contraceptives, it's essential to consider the timing in relation to the menstrual cycle to ensure maximum contraceptive effectiveness and minimize the risk of pregnancy. According to the guidelines, if the provider is reasonably certain that the patient is not pregnant, CHC can be initiated at any time, with the caveat that additional contraception might be needed for a short period if started more than 5 days after the onset of menses 1.

Key points to consider when initiating oral contraceptives include:

• Starting on the first day of the menstrual period provides immediate contraceptive protection.
• If started on any other day, backup contraception is necessary for 7 days.
• A blood pressure measurement is recommended before initiating CHC.
• The benefits of starting CHC likely exceed any risk if there's uncertainty about pregnancy, but a follow-up pregnancy test in 2–4 weeks is advised.

It's crucial to take the pill at the same time each day to maintain consistent hormone levels, which is vital for the effectiveness of the contraceptive. Missing pills, especially during the first week, increases the risk of pregnancy. If vomiting occurs within 2 hours of taking a pill, backup contraception should be used until 7 consecutive days of correct pill taking have been achieved. This guidance is based on the latest recommendations from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1.

From the FDA Drug Label

To achieve maximum contraceptive effectiveness, Kariva® must be taken exactly as directed and at intervals not exceeding 24 hours. Kariva® may be initiated using either a Sunday start or a Day 1 start. When initiating a Sunday start regimen, another method of contraception should be used until after the first 7 consecutive days of administration Using a Sunday start, tablets are taken daily without interruption as follows: The first white tablet should be taken on the first Sunday after menstruation begins (if menstruation begins on Sunday, the first white tablet is taken on that day). Counting the first day of menstruation as “Day 1”, tablets are taken without interruption as follows: One white tablet daily for 21 days, one light-green (inert) tablet daily for 2 days followed by 1 light-blue (ethinyl estradiol) tablet daily for 5 days.

The first dose of the oral contraceptive Kariva can be taken on the first Sunday after menstruation begins (Sunday start) or on the first day of menstruation (Day 1 start) 2.

• Sunday start: Take the first white tablet on the first Sunday after menstruation begins.
• Day 1 start: Take the first white tablet on the first day of menstruation. It is recommended to use another method of contraception for the first 7 days of administration when using the Sunday start regimen.

From the Research

Starting Oral Contraceptives

• The first dose of oral contraceptives can be taken up to the sixth day of the menstrual cycle 3
• It is essential to consider the individual's medical history, preferences, and the risks and benefits associated with oral contraceptives before starting the treatment 4, 5
• Effective contraceptive counseling is crucial to ensure the woman understands the risks, benefits, side effects, and contraindications of each contraceptive method 5

Factors to Consider

• The choice of oral contraceptive should be based on the individual's needs and medical history, with considerations such as estrogen content and progestin type 3, 4
• Women with certain medical conditions, such as hypertension, migraine, or breast cancer, may have contraindications to oral contraceptives 4
• Blood pressure measurement is the only physical examination or testing needed before prescribing oral contraceptives 4

Types of Oral Contraceptives

• Combined oral contraceptives, which contain both estrogen and progestin, are a popular choice for pregnancy prevention and management of menstrual-related symptoms 6, 5, 7
• Extended-cycle oral contraceptives, which reduce or eliminate the hormone-free interval, may be beneficial for women with medical comorbidities or those who desire to avoid monthly menses 6, 5