What laboratory tests are required before starting birth control?

Laboratory Tests Before Starting Birth Control

For healthy women, no laboratory tests are required before starting birth control, with the single exception of blood pressure measurement for combined hormonal contraceptives (pills, patch, ring). 1

Essential Requirements by Method Type

Combined Hormonal Contraceptives (Pills, Patch, Ring)

• Blood pressure measurement is the ONLY mandatory test (Class A - essential and mandatory) 1
• Blood pressure can be obtained in non-clinical settings (pharmacy, fire station) and self-reported if healthcare access is limited 1
• Women with severe hypertension (≥160/100 mmHg) should not use combined hormonal contraceptives 1
• Weight/BMI measurement is optional but may be useful for baseline monitoring 1

Progestin-Only Pills (POPs)

• No examinations or laboratory tests are required 1
• All examinations including blood pressure, glucose, lipids, liver enzymes, hemoglobin, and thrombogenic mutations are classified as Class C (not contributing substantially to safe use) 1
• Weight/BMI measurement is optional for monitoring purposes only 1

Intrauterine Devices (IUDs)

• Bimanual examination and cervical inspection are required for proper placement 1
• Most patients do not require additional STI screening at time of IUD placement if already screened according to CDC guidelines 1
• Screening for gonorrhea and chlamydia may be performed at time of placement without delaying insertion 1

Implants and Injectable Contraceptives (DMPA)

• No examinations or laboratory tests are required 1

Tests That Are NOT Required

The following are classified as Class C (not contributing substantially to safe contraceptive use) for all methods 1, 2:

• Glucose testing - unnecessary despite diabetes being a contraindication, due to low prevalence of undiagnosed diabetes in reproductive-age women 1, 3
• Lipid panel - not required 1, 2
• Liver enzyme tests - not required 1, 2
• Hemoglobin measurement - not required 1, 2
• Thrombogenic mutation screening - not required 1, 2
• Pap smear (cervical cytology) - not required before contraception initiation 1, 4, 3
• Clinical breast examination - not required 1, 4
• Pelvic examination - not required for hormonal methods (except IUDs which need it for placement) 1, 4
• STI screening - not required unless indicated by risk factors or CDC screening guidelines 1, 3
• HIV screening - not required unless indicated by risk factors 1, 2

Common Pitfalls to Avoid

• Requiring unnecessary pelvic examinations: 16-23% of providers incorrectly require pelvic exams before non-IUD hormonal methods, creating unnecessary barriers to access 5
• Requiring unnecessary Pap smears: 14-33% of providers incorrectly require Pap smears before contraception initiation 5
• Delaying contraception for routine screening: Cervical cancer screening and STI testing, while important for overall health, should not delay contraceptive access 4, 3
• Over-screening for rare conditions: The low prevalence of undiagnosed diabetes, hyperlipidemia, and liver disease in reproductive-age women makes routine screening unnecessary and creates barriers to contraceptive access 3

Special Considerations

• Women with known medical conditions may require additional evaluation based on U.S. Medical Eligibility Criteria 1
• Medical history focusing on contraindications is more important than laboratory screening 2
• Contraception can be started at any time if the provider is reasonably certain the patient is not pregnant, with follow-up pregnancy testing in 2-4 weeks if uncertainty exists 1