What is the quick start method for initiating birth control?

Quick Start Method for Birth Control

The quick start method for birth control allows women to begin contraception immediately at the time of their visit rather than waiting for their next menstrual period, as long as the provider can be reasonably certain the woman is not pregnant. 1

When to Use Quick Start

A provider can be reasonably certain a woman is not pregnant if she meets any one of these criteria:

• Is ≤7 days after the start of normal menses
• Has not had sexual intercourse since the start of last normal menses
• Has been using a reliable method of contraception correctly and consistently
• Is ≤7 days after spontaneous or induced abortion
• Is within 4 weeks postpartum
• Is fully or nearly fully breastfeeding (≥85% of feeds are breastfeeds), amenorrheic, and <6 months postpartum 1

Benefits of Quick Start

• Eliminates barriers to contraceptive initiation
• Reduces risk of unintended pregnancy during the waiting period
• Improves short-term continuation rates 2
• Increases patient satisfaction with contraceptive services 3
• Preferred by most women compared to conventional start methods 2

Implementation Process

1. Assess pregnancy status: Determine if the woman meets any criteria for reasonable certainty that she is not pregnant

2. Minimal physical assessment needed:

   • Blood pressure measurement (required before starting hormonal contraceptives)
   • Weight/BMI measurement (optional but helpful for monitoring)
   • Pelvic examination only if inserting an IUD 1

3. Provide contraception immediately:

   • Dispense or prescribe contraception onsite
   • Have the woman take the first pill during the visit if possible 3
   • Provide multiple cycles (ideally a full year's supply) of hormonal contraceptives 1

4. Provide backup method instructions:

   • For combined hormonal contraceptives: Use backup method for 7 days
   • For progestin-only pills: Use backup method for 2 days 1
   • Make condoms readily available 1

Method-Specific Quick Start Instructions

Combined Hormonal Contraceptives (Pills, Patch, Ring)

• Start immediately if reasonably certain woman is not pregnant
• Use backup method for first 7 days
• If starting >5 days after menses began, additional protection needed 1

Progestin-Only Pills

• Start immediately if reasonably certain woman is not pregnant
• Use backup method for first 2 days
• Taking at approximately the same time each day is crucial 1

Postpartum Quick Start

• Breastfeeding women:

  • Can start progestin-only methods immediately postpartum
  • Should delay combined hormonal methods until at least 6 weeks postpartum 4, 5

• Non-breastfeeding women:

  • Can start progestin-only methods immediately
  • Should wait 3 weeks before starting combined hormonal methods 5

Post-abortion Quick Start

• All hormonal methods can be started immediately after abortion
• No backup method needed if started at time of surgical abortion 1

Common Pitfalls and Caveats

• Pregnancy concerns: The benefits of starting contraception immediately likely outweigh any risks, even with uncertain pregnancy status. Follow up with pregnancy test in 2-4 weeks if uncertain 1

• Bleeding irregularities: Counsel that irregular bleeding is common with quick start and generally not harmful. It often resolves with continued use 1

• Switching methods: When switching from another method, consider continuing previous method for appropriate overlap period (7 days for combined hormonal methods, 2 days for progestin-only pills) 1

• Documentation requirements: Include patient understanding of use, benefits, risks, and individualized follow-up plan 1

Quick start is a safe, effective approach that removes unnecessary barriers to contraception initiation and should be offered whenever possible to reduce unintended pregnancies.