No Laboratory Tests Required for Progesterone-Only Pills
For a healthy patient switching from an expired Nexplanon to a progesterone-only pill (POP), no laboratory tests are required before initiation. 1, 2
What You Need to Do
Required Before Starting POP
- Nothing. No examinations or laboratory tests are needed for progestin-only pills in healthy women. 1, 2
- Blood pressure, glucose, lipids, liver enzymes, hemoglobin, thrombogenic mutations, Pap smear, breast exam, and pelvic exam are all classified as Class C (not contributing substantially to safe use) for POPs. 1, 2
When to Start the POP
- Start immediately if you are reasonably certain she is not pregnant. 1
- When switching from Nexplanon (or any contraceptive method), POPs can be started at any time without waiting for her next menstrual period. 1
Backup Contraception Needed
- If starting >5 days after menses began: She needs to abstain from sex or use barrier methods (condoms) for 2 days after starting the norethindrone POP. 1
- If starting within 5 days of menses: No backup needed. 1
Important Clinical Considerations
Pregnancy Assessment
- The key is being "reasonably certain" she's not pregnant—this is based on clinical criteria, not lab tests. 1
- If uncertain about pregnancy status, the benefits of starting POPs exceed any risk, so start the POP anyway with a follow-up pregnancy test in 2-4 weeks. 1
Optional Baseline Measurement
- Weight/BMI measurement is optional but may be useful for monitoring over time if she's concerned about weight changes. 1, 2
- This is not required for medical eligibility—obese women can safely use POPs. 1
Common Pitfall to Avoid
- Do not delay contraception initiation to obtain unnecessary lab work. The CDC guidelines explicitly state that requiring labs creates barriers to contraceptive access without improving safety. 1, 2
- Medical history focusing on contraindications (current breast cancer, certain liver diseases) is more important than laboratory screening. 2