When to start taking oral contraceptive (OC) pills for contraception?

From the Guidelines

Oral contraceptive pills can be started at any time, as long as it is reasonably certain that the woman is not pregnant, and backup contraception should be used for 7 days if it has been more than 5 days since menstrual bleeding started. This approach is supported by the most recent guidelines, which prioritize the convenience and effectiveness of starting contraception as soon as possible 1.

Key Considerations

• The timing of starting oral contraceptive pills depends on the individual's menstrual cycle and the need for backup contraception.
• If it has been more than 5 days since menstrual bleeding started, backup contraception, such as condoms, should be used for 7 days to ensure maximum protection against pregnancy.
• The guidelines recommend starting oral contraceptive pills at any time, with the option to use backup contraception for a short period, to minimize the risk of unintended pregnancy and improve contraceptive effectiveness 1.

Switching from Another Contraceptive Method

• When switching from an intrauterine device (IUD), the guidelines recommend advising the woman to retain the IUD for at least 7 days after combined hormonal contraceptives are initiated and return for IUD removal, or to abstain from sexual intercourse or use barrier contraception for 7 days before removing the IUD and switching to the new method 1.
• The most recent guidelines provide a clear and concise summary of the recommendations for starting specific contraceptive methods, including oral contraceptive pills, and emphasize the importance of using backup contraception when necessary 1.

Important Details

• The pills work by preventing ovulation, thickening cervical mucus to block sperm, and thinning the uterine lining to prevent implantation.
• If a pill is missed, it should be taken as soon as possible, and backup contraception should be used for 7 days if two or more pills are missed.
• The guidelines prioritize the benefits of starting contraception as soon as possible, while minimizing the risks and ensuring maximum protection against pregnancy 1.

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 first white tablet should be taken on the first Sunday after menstruation begins (if menstruation begins on Sunday, the first white tablet is taken on that day). 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 use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed.

Initiation of Oral Contraceptive (OC) Pills:

• Sunday Start: The first white tablet should be taken on the first Sunday after menstruation begins.
• Day 1 Start: The first white tablet should be taken on the first day of menstruation.
• Postpartum: The use of Kariva for contraception may be initiated 4 weeks postpartum in women who elect not to breastfeed. It is recommended to use another method of contraception until after the first 7 consecutive days of administration when initiating a Sunday start regimen or if the patient starts on Kariva postpartum and has not yet had a period 2.

From the Research

Oral Contraceptive (OC) Pills for Contraception

• The decision of when to start taking oral contraceptive (OC) pills for contraception depends on various factors, including the woman's menstrual cycle, medical history, and personal preferences 3, 4, 5, 6, 7.
• Extended-cycle oral contraceptives, which involve taking active pills for 84 days followed by a 7-day hormone-free interval, can be a viable option for women who want to reduce the frequency of their menstrual periods 3, 4, 5.
• Continuous-cycle oral contraceptives, which involve taking active pills continuously without a hormone-free interval, can also be an option for women who want to eliminate their menstrual periods altogether 4, 5.
• Studies have shown that extended- and continuous-cycle oral contraceptives are as effective in preventing pregnancy as traditional oral contraceptives, but may be associated with more breakthrough bleeding and spotting 3, 4, 5, 6.
• The choice of when to start taking OC pills should be based on individual factors, including the woman's medical history, lifestyle, and personal preferences, and should be made in consultation with a healthcare provider 3, 4, 5, 6, 7.

Factors to Consider

• Medical history: Women with certain medical conditions, such as endometriosis or dysmenorrhea, may benefit from extended- or continuous-cycle oral contraceptives 3, 4, 5.
• Lifestyle: Women who want to reduce the frequency of their menstrual periods or eliminate them altogether may prefer extended- or continuous-cycle oral contraceptives 3, 4, 5.
• Personal preferences: Women who value the convenience and flexibility of extended- or continuous-cycle oral contraceptives may prefer these options over traditional oral contraceptives 3, 4, 5, 6.

Safety and Efficacy

• Studies have shown that extended- and continuous-cycle oral contraceptives are safe and effective for most women, but may be associated with more breakthrough bleeding and spotting 3, 4, 5, 6.
• The long-term effects of extended- and continuous-cycle oral contraceptives on efficacy and safety are not yet fully understood and require further study 5, 7.