From the Guidelines
To rule out pregnancy before starting birth control, it is essential to take a sensitive home pregnancy test or get tested at a healthcare provider's office, as this is the most reliable method to confirm whether a woman is pregnant or not. The best time to test is after you've missed your period for the most accurate results 1. Some healthcare providers may also perform a blood pregnancy test, which can detect pregnancy earlier than urine tests.
Key Considerations
- If you're starting hormonal birth control like pills, patches, or rings, many providers recommend starting on the first day of your period when pregnancy is least likely.
- If you start birth control at any other time in your cycle, use a backup method like condoms for the first 7 days, as suggested by the U.S. selected practice recommendations for contraceptive use, 2013 1.
- For IUDs or implants, a pregnancy test is typically performed right before insertion, as starting hormonal birth control during pregnancy could potentially affect the developing fetus, and some methods like IUDs are contraindicated during pregnancy.
- If you've had unprotected sex within the last 5 days, you might need emergency contraception before starting regular birth control, to prevent unintended pregnancy 1.
Preconception Care
While the primary focus is on ruling out pregnancy before starting birth control, preconception care is also crucial for women of reproductive age, as it helps reduce maternal and fetal morbidity and mortality, increases chances of conception, and prevents unintended pregnancies 1. This care includes discussing reproductive plans, taking folic acid supplements, consuming a balanced diet, and addressing health concerns and lifestyle factors that may affect fertility. However, in the context of ruling out pregnancy before starting birth control, the immediate concern is to ensure that the woman is not pregnant before initiating any contraceptive method.
From the FDA Drug Label
If there is a delay in the onset of expected menses beyond 1 week, rule out pregnancy. The FDA drug label recommends ruling out pregnancy if there is a delay in the onset of expected menses beyond 1 week after taking ulipristal acetate 2, 2, 2.
- Key points:
- Ulipristal acetate is not indicated for termination of an existing pregnancy.
- A rapid return of fertility is likely following treatment with ulipristal acetate for emergency contraception.
- If a woman wishes to initiate hormonal contraception as a regular method, she can do so, no sooner than 5 days after the intake of ulipristal acetate.
- Main idea: Ruling out pregnancy is necessary if the user experiences a delay in their menstrual cycle after taking ulipristal acetate.
From the Research
Ruling Out Pregnancy Before Starting Birth Control
To rule out pregnancy before starting birth control, it is essential to consider the following steps:
- Determine the timing of the last menstrual period and the likelihood of ovulation
- Assess the risk of pregnancy based on the timing and frequency of unprotected intercourse
- Consider the use of emergency contraception if necessary
Emergency Contraception Options
The available emergency contraception options include:
- Copper intrauterine device (IUD) 3, 4
- Levonorgestrel (LNG) 52 mg IUD 5, 4
- Oral LNG (such as Plan B One-Step, My Way, Take Action) 4, 6
- Oral ulipristal acetate (UPA) (ella) 3, 4, 6
Effectiveness of Emergency Contraception
The effectiveness of emergency contraception varies depending on the method used:
- Copper IUD: prevents over 95% of pregnancies 7
- Levonorgestrel IUD: noninferior to the copper IUD for emergency contraception 5
- Oral LNG: prevents around 50% of expected pregnancies 7
- Oral UPA: prevents almost two thirds of pregnancies 7
Considerations for Use
When considering the use of emergency contraception, it is essential to take into account: