From the Guidelines
Birth control should be resumed immediately after menstruation ends, or on any day with backup contraception for 7 days, as the timing of resumption does not necessarily depend on the menstrual cycle, according to the most recent guidelines 1. When considering the resumption of birth control, it's essential to understand that the primary goal is to prevent unintended pregnancy while minimizing interruptions in hormone levels, which can reduce effectiveness.
- For combined hormonal contraceptives, the recommendation is to start a new pack on the day after finishing the placebo pills or hormone-free week, regardless of whether the period has ended.
- For progestin-only pills, continuous use without breaks is advised.
- If restarting after completely stopping, beginning on the first day of the period is recommended for immediate protection, though starting on any day with backup contraception for 7 days is also acceptable. The importance of correct use and timing cannot be overstated, as it directly impacts the effectiveness of the contraceptive method and the user's quality of life, reducing the risk of morbidity and mortality associated with unintended pregnancies 1. Key considerations include:
- The need for backup contraception if more than 5 days have passed since menstrual bleeding started for certain methods.
- The potential for residual sperm in the genital tract if switching from an IUD and having had sexual intercourse since the start of the current menstrual cycle. Given the evidence, the most critical factor is starting the contraceptive method as soon as possible after menstruation ends or on any day with appropriate backup contraception to ensure continuous protection and minimize the risk of unintended pregnancy 1.
From the Research
Resuming Birth Control After Menstruation
- There is no specific day recommended for resuming birth control after menstruation, as it depends on the individual's menstrual cycle and the type of contraceptive method being used 2, 3.
- Most women can safely begin taking hormonal birth control products immediately after an office visit, at any point in the menstrual cycle 2.
- Immediate initiation of hormonal contraception may improve women's access to, and continuation of, hormonal contraception 3.
- The timing of initiation of birth control after childbirth depends on whether the woman is breastfeeding or not, with combined hormonal pills not recommended prior to 6 weeks postpartum for breastfeeding women 4.
- For non-breastfeeding women, elevated risk of venous thromboembolism restricts use of combined hormonal pills prior to 21 days postpartum 4.
Starting Birth Control After Abortion
- After an abortion before 12 weeks gestation, oral contraceptives should be started immediately to inhibit the ovulation which may occur 2 weeks after the abortion 5.
- If the abortion is after more than 12 weeks gestation, oral contraceptives should be started 1 week after the termination because of the intermediary aspect of the onset of ovulation with regard to the 1st menstruation 5.
General Guidance
- Women can begin any appropriate contraceptive method immediately following an early abortion 2.
- Delaying contraception may decrease adherence, and physicians can help patients improve their use of birth control by providing anticipatory guidance about the most common side effects, giving comprehensive information about available choices, and honoring women's preferences 2.
- The body of evidence suggested that pregnancy rates did not differ by the timing of CHC initiation, and bleeding patterns and other side effects did not vary with the timing of CHC initiation 6.