When is it best to start Lo Estrin (ethinyl estradiol and norethindrone) Oral Contraceptive Pill (OCP)?

When to Start Lo Estrin Oral Contraceptive Pill

Lo Estrin (ethinyl estradiol and norethindrone) should ideally be started on the first day of menstruation (Day 1 start) for immediate contraceptive effectiveness, or on the first Sunday after menstruation begins (Sunday start) with 7 days of backup contraception. 1

Optimal Starting Times

Day 1 Start (Preferred Method)

• Start on the first day of menstrual bleeding for immediate contraceptive effectiveness with no need for backup contraception 1
• Take one active pill daily for 21 days, followed by the inactive pills according to package instructions 1
• This method provides immediate protection against pregnancy 2

Sunday Start (Alternative Method)

• Start on the first Sunday after menstruation begins (if menstruation begins on Sunday, start that day) 1
• Use backup contraception (e.g., condoms) for the first 7 consecutive days of pill use 1
• This approach standardizes the day of the week when a new pack is started 1

Special Situations

Postpartum (Non-Breastfeeding Women)

• Can be initiated 4 weeks (28 days) postpartum in women who elect not to breastfeed 1
• If starting postpartum without having had a period, use backup contraception until active pills have been taken for 7 consecutive days 1
• Be aware of increased risk of thromboembolism in the postpartum period 1

Breastfeeding Women

• Progestin-only pills are generally preferred for breastfeeding women as they don't affect milk production 3
• Combined hormonal contraceptives like Lo Estrin are not generally recommended during breastfeeding before 6 weeks postpartum 3
• If breastfeeding and menses have returned, consider the impact on lactation before starting Lo Estrin 3

Postabortion

• Can be started immediately following an abortion or miscarriage 2
• Provides immediate contraceptive protection if started at the time of a surgical abortion 2

Switching from Another Contraceptive Method

• Can start immediately if reasonably certain the woman is not pregnant 2
• If switching from another combined hormonal method, start Lo Estrin on the day after taking the last active pill of the previous method 1
• If it has been >5 days since menstrual bleeding started, use backup contraception for 2 days 2

Management of Missed Pills

If One Pill is Missed

• Take the missed pill as soon as remembered, then continue with regular schedule 1
• No backup contraception needed 1

If Two Consecutive Pills are Missed (Week 1 or 2)

• Take two pills on the day remembered and two pills the next day 1
• Resume normal schedule and use backup contraception for 7 days 1

If Two Consecutive Pills are Missed (Week 3) or Three or More Pills are Missed

• Discard the current pack and start a new pack that same day 1
• Use backup contraception for 7 days 1

Important Considerations

Contraindications

• History of deep vein thrombosis or pulmonary embolism 2
• Migraines with aura, especially in women >35 years 2
• Uncontrolled hypertension, liver disease, or breast cancer 2
• Smoking in women >35 years of age 2
• Pregnancy (Category X) 2

Monitoring

• Baseline blood pressure, pregnancy test, and consideration of breast and pelvic examinations 2
• Ongoing monitoring of blood pressure and health status changes 2

Lo Estrin is a low-dose combined oral contraceptive that provides effective contraception when taken correctly. Starting on the first day of menstruation offers immediate protection, while the Sunday start requires 7 days of backup contraception but may be easier to remember for some women.