What is the recommended follow-up timeframe after starting a new contraceptive method?

Follow-Up After Starting Contraception

No routine follow-up visit is required after initiating contraception for healthy women, though patients should be advised to return at any time to discuss side effects, concerns, or method changes. 1

General Follow-Up Recommendations

The CDC's U.S. Selected Practice Recommendations establish that routine scheduled follow-up visits are not necessary after contraceptive initiation for any method—including IUDs, implants, injectables, combined hormonal contraceptives (CHCs), or progestin-only pills. 1 This applies to healthy women in general situations, though specific populations may benefit from closer monitoring. 1

Populations That May Benefit From Earlier Follow-Up

While not required, consider scheduling follow-up for:

• Adolescents: A visit at 1-3 months after initiating combined oral contraceptives is useful for addressing persistent adverse effects or adherence issues. 1
• Women with certain medical conditions or characteristics 1
• Women with multiple medical conditions 1

What to Address at Any Follow-Up Encounter

When you do see patients using contraception (whether scheduled or unscheduled), assess the following:

• Satisfaction with the method and any concerns about use 1
• Changes in health status or medications that would affect medical eligibility (U.S. MEC category 3 or 4 conditions) 1
• Weight changes for all methods, particularly for DMPA users where early weight gain (>5% baseline weight within 6 months) predicts continued weight gain 1
• Blood pressure for combined hormonal contraceptive users only 1
• IUD string presence for IUD users (consider checking) 1

Method-Specific Considerations

Injectable Contraceptives (DMPA)

• No routine follow-up visit required 1
• Advise return for reinjection timing 1
• Weight monitoring is particularly important, as early weight gain predicts future significant weight gain 1

Combined Hormonal Contraceptives

• Adolescents benefit from a 1-3 month follow-up to address transient side effects (irregular bleeding, headache, nausea) and adherence issues 1
• The CDC recommends prescribing up to 1 year of contraceptives at a time 1

IUDs and Implants

• No routine follow-up required 1
• Advise when device needs removal 1

Evidence on Follow-Up Effectiveness

The evidence supporting routine follow-up visits is weak. A systematic review found it difficult to determine what effect, if any, follow-up visits or contacts have on contraceptive continuation or correct use. 2 The few studies identified were of poor quality, not method-specific, and had poor compliance rates. 2

However, research shows that early discontinuation is common—nearly half of women switch or discontinue within the first year, with side effects being the primary reason (73% of those who stopped). 3 One older study found that 46% of women discontinued oral contraceptives due to side effects within 6 months. 4

Clinical Pitfalls to Avoid

The most critical intervention is counseling at initiation, not scheduled follow-up. Emphasize:

• Common transient side effects and that most will resolve 4
• The importance of returning at any time for concerns 1
• Backup method identification 4
• Adherence strategies (smartphone reminders, family support) 1

Do not create barriers by requiring follow-up visits before providing extended supplies. The CDC explicitly recommends prescribing up to 1 year of contraceptives at initiation. 1