Starting Combined Oral Contraceptives After Emergency Contraception
Yes, you can start taking the combined oral contraceptive (COC) pill on the same day as taking emergency contraceptive pills, but you will need to use backup contraception for 7 days to ensure effectiveness.
Timing of Combined Oral Contraceptive Initiation
- The Centers for Disease Control and Prevention (CDC) guidelines indicate that combined hormonal contraceptives can be started at any time if it is reasonably certain that the woman is not pregnant 1
- When starting COCs after using emergency contraception, you can begin immediately rather than waiting for your next menstrual period 2
- Starting the COC on the same day as taking emergency contraception is considered a "quick start" approach to contraception 3
Effectiveness Considerations
- When starting COCs on the same day as taking ulipristal acetate (ella) emergency contraception, studies show that the COC does not interfere with ella's ability to suppress ovarian activity 3
- However, when COCs are started immediately after using emergency contraception, additional contraceptive protection is needed for the first 7 days 1, 2
- This is because it takes approximately 7 consecutive days of COC use to effectively suppress ovulation 1
Backup Contraception Requirements
- Use backup contraception (e.g., condoms) or avoid sexual intercourse until hormonal pills have been taken for 7 consecutive days 1
- This recommendation applies regardless of when in the menstrual cycle you start the COC 1
- The 7-day backup period is necessary to ensure adequate hormonal levels to prevent ovulation 1
Special Considerations Based on Type of Emergency Contraception
After Levonorgestrel Emergency Contraception:
- You can start COCs immediately after taking levonorgestrel emergency contraception 4, 5
- Use backup contraception for 7 days 1
After Ulipristal Acetate (ella):
- Starting COCs immediately after ulipristal acetate may reduce the effectiveness of the emergency contraception 3
- Some research suggests waiting 5 days after ulipristal acetate before starting hormonal contraception to avoid reducing its effectiveness 3
- However, if you choose to start COCs immediately, use backup contraception for 7 days 3
Common Pitfalls to Avoid
- Do not wait until your next menstrual period to start COCs after emergency contraception, as this increases the risk of unintended pregnancy 4, 6
- Do not skip using backup contraception during the first 7 days of COC use 1
- If vomiting occurs within 24 hours of taking a COC pill, follow the guidelines for missed pills, as the contraceptive effectiveness might be compromised 1
- If you miss any pills during the first week of COC use after emergency contraception, consider using emergency contraception again if unprotected intercourse occurred 1
By following these guidelines, you can effectively transition from emergency contraception to regular combined oral contraceptive use while maintaining contraceptive protection.