What are the recommendations for initiating hormonal contraception (birth control)?

From the Guidelines

I strongly recommend initiating hormonal contraception based on the patient's individual medical history, preferences, and reproductive life plan, as outlined in the most recent guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1. When considering hormonal contraception, it is essential to evaluate the patient's medical history, including any chronic diseases, risk factors for thromboembolic disease, and future pregnancy intentions.

• The patient's medical eligibility for a particular method should be assessed, taking into account factors such as menstruation, pregnancy, breastfeeding, and recent intercourse 1.
• The healthcare provider should discuss potential side effects, such as spotting, nausea, breast tenderness, and headaches, which typically resolve within 2-3 months.
• The patient should be counseled on the importance of consistent use, including taking pills daily, changing patches weekly, and replacing rings monthly.
• Backup contraception, such as condoms, should be used for the first 7 days when starting a new method, and always for protection against STIs.
• The patient should be informed about the risks and benefits of each method, including the increased risk of blood clots associated with combined hormonal contraceptives, and the potential interactions with other medications.
• A follow-up visit 1-3 months after initiating contraception is recommended to address any adverse effects or adherence issues, as suggested by the American Academy of Pediatrics 1.
• The patient should be reminded that hormonal contraceptives do not protect against STIs, and that condoms should be used consistently for this purpose. The most recent guidelines from the U.S. Selected Practice Recommendations for Contraceptive Use, 2024 1 provide a comprehensive outline for initiating hormonal contraception, including the recommended timing for starting each method, the need for backup contraception, and the necessary examinations or tests before initiation.

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. The use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed. If the 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. When initiating a Sunday start regimen, another method of contraception should be used until after the first 7 consecutive days of administration 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 recommendations for initiating hormonal contraception (birth control) with Kariva are:

• Sunday start: Start taking the first white tablet on the first Sunday after menstruation begins, and use another method of contraception until after the first 7 consecutive days of administration.
• Day 1 start: Start taking one white tablet daily on the first day of menstruation, and take tablets without interruption.
• Postpartum initiation: The use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed, and another method of contraception should be used until a white tablet has been taken daily for 7 days 2.

From the Research

Initiating Hormonal Contraception

The recommendations for initiating hormonal contraception, also known as birth control, are based on various studies that have investigated the efficacy and safety of different formulations.

• The choice of hormonal contraception depends on several factors, including the woman's medical history, lifestyle, and personal preferences 3, 4, 5, 6, 7.
• Low-dose oral contraceptives have been shown to be effective and well-tolerated, with a lower risk of side effects compared to higher-dose formulations 4, 5, 7.
• Extended-cycle regimens, such as the 24-day regimen, may reduce the frequency of intracyclic bleeding and improve bleeding patterns 4.
• The use of continuous low-dose ethinyl estradiol has been shown to enhance ovarian suppression and improve tolerability 7.

Efficacy and Safety

• The efficacy of hormonal contraception is measured by the Pearl Index, which is the number of pregnancies per 100 woman-years of exposure 4, 7.
• The safety of hormonal contraception is assessed by monitoring adverse events, such as bleeding disturbances, and changes in metabolic parameters 3, 5, 6.
• Low-dose estrogen oral contraceptives may result in higher rates of bleeding pattern disruptions, but are generally well-tolerated 5.
• The use of a contraceptive vaginal ring has been shown to produce no change in angiotensinogen levels and a decrease in triglycerides, which may reduce the risk of hypertension and other serious circulatory problems 6.

Recommendations

• Women should discuss their medical history, lifestyle, and personal preferences with their healthcare provider to determine the most suitable hormonal contraception option 3, 4, 5, 6, 7.
• Low-dose oral contraceptives and extended-cycle regimens may be suitable options for women who experience bleeding disturbances or other side effects with traditional formulations 4, 5, 7.
• Continuous low-dose ethinyl estradiol may be a suitable option for women who require enhanced ovarian suppression and improved tolerability 7.