From the Guidelines
Oral birth control can be initiated on any day of the cycle if pregnancy can be reasonably excluded, with a backup contraceptive method like condoms used for the first 7 days when starting mid-cycle, as recommended by the most recent guidelines 1. When starting oral birth control, it is essential to consider the type of contraceptive and the individual's medical history. For combined oral contraceptives containing estrogen and progestin, take one pill daily at the same time for 21 days, followed by 7 days of placebo pills or no pills, depending on the pack. For progestin-only pills, take one pill daily at the same time without breaks. Some key points to consider when initiating oral birth control include:
- Screening for contraindications, such as history of blood clots, stroke, certain cancers, liver disease, uncontrolled hypertension, migraines with aura, smoking after age 35, or breastfeeding (for combined pills only) 1.
- Informing patients about potential side effects, including nausea, breakthrough bleeding, breast tenderness, and mood changes, which typically resolve within 2-3 months 1.
- Counseling patients on the importance of taking the pill at the same time every day and what to do if a pill is missed, with additional precautions needed for 7 days if more than one pill is missed 1.
- Discussing the effectiveness of oral birth control, which is approximately 91-99% with perfect use, but decreases with missed pills 1.
- Recommending a follow-up visit 1 to 3 months after initiating oral birth control to address any adverse effects or adherence issues 1.
From the FDA Drug Label
The use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed. When initiating a Sunday start regimen, another method of contraception should be used until after the first 7 consecutive days of administration If a patient starts on Kariva postpartum, and has not yet had a period, she should be instructed to use another method of contraception until a white tablet has been taken daily for 7 days.
The guidelines for initiating oral birth control (oral contraceptive) in a patient are as follows:
- Postpartum initiation: 4 weeks after delivery in non-breastfeeding women.
- Sunday start regimen: Use another method of contraception for the first 7 days.
- Postpartum initiation without a period: Use another method of contraception until a white tablet has been taken daily for 7 days. 2
From the Research
Guidelines for Initiating Oral Birth Control
The guidelines for initiating oral birth control involve several key considerations, including:
- Medical history and current health status
- Blood pressure measurement
- Potential contraindications, such as hypertension, migraine, breast cancer, and risk of venous thromboembolism (VTE) 3
- Discussion of patient values and preferences 4
Required Examinations and Tests
Before initiating oral birth control, the following examinations and tests may be required:
- Blood pressure measurement, which is the only physical examination or testing needed before prescription 3, 5
- Pelvic examination, which may be required for intrauterine contraception (IUC) but not for non-intrauterine hormonal methods 6
- Laboratory screening, such as glucose, lipid, liver enzyme, cervical cytology, STI or HIV screening, which may not be necessary for asymptomatic women prior to initiation of contraceptive methods 7
Contraindications and Precautions
Certain medical conditions may present contraindications or precautions for initiating oral birth control, including:
- Hypertension, which may increase the risk of cardiovascular events 3, 5
- Migraine, breast cancer, and risk of VTE, which may be affected by hormonal contraception 3
- Other medical conditions, such as diabetes, hyperlipidemia, liver disease, cervical cancer, STIs or HIV, which may require special consideration before initiating contraception 7