Are follow-up tests required for a female patient of childbearing age using birth control?

Follow-Up Testing Requirements for Birth Control

No routine follow-up visit is required after initiating birth control for healthy women. 1

General Follow-Up Recommendations

The CDC's U.S. Selected Practice Recommendations clearly state that for all contraceptive methods—including combined hormonal contraceptives (CHCs), progestin-only pills (POPs), implants, injectables, and IUDs—no mandatory routine follow-up visit is necessary for safe and effective continued use in healthy women. 1

What Women Should Know

• Women should be advised to return at any time to discuss side effects, problems, or if they want to change methods 1
• For IUDs, implants, and injectables: Women need to know when the device requires removal or when reinjection is needed, but this is for continuation of the method, not a safety requirement 1

Method-Specific Considerations at Routine Visits

When women do present for routine healthcare visits (not specifically contraception-related), providers should assess the following based on contraceptive method:

Combined Hormonal Contraceptives (Pills, Patch, Ring)

• Blood pressure measurement is the only specific test recommended 1
• Assess satisfaction with the method and any concerns 1
• Assess changes in health status or medications that would affect safety (U.S. MEC category 3 or 4 conditions) 1
• Consider assessing weight changes if the woman is concerned about perceived weight gain 1

Progestin-Only Pills

• No specific tests or examinations are required 1
• Assess satisfaction and concerns about the method 1
• Assess changes in health status or medications affecting safety 1
• Consider weight assessment if the woman has concerns 1

Injectable Contraceptives (DMPA)

• No specific tests required, though monitoring weight changes over time is important given evidence that early weight gain (>5% baseline weight within 6 months) predicts continued weight gain 1, 2
• Assess satisfaction and concerns 1
• Assess changes in health status or medications 1

IUDs (Copper or Levonorgestrel)

• Consider checking for IUD string presence (not mandatory) 1
• Assess satisfaction and concerns 1
• Assess changes in health status or medications 1
• Consider weight assessment if concerned 1

Implants

• No specific tests or examinations required 1
• Assess satisfaction and concerns 1
• Assess changes in health status or medications 1
• Consider weight assessment if concerned 1

Important Caveats

Populations Requiring More Frequent Follow-Up

Certain groups may benefit from more frequent visits, though specific testing requirements remain the same: 1

• Adolescents
• Women with certain medical conditions or characteristics
• Women with multiple medical conditions

Pre-Initiation vs. Follow-Up

The FDA labels note that annual history and physical examinations are good medical practice for all women, but the physical examination may be deferred until after contraceptive initiation if requested by the woman and deemed appropriate by the clinician. 3, 4 This is distinct from follow-up requirements after initiation.

Common Clinical Pitfall

Do not routinely schedule follow-up visits solely for contraceptive monitoring in healthy women. The evidence shows no benefit to routine follow-up visits for improving correct or continued contraceptive use. 1 This practice creates unnecessary barriers to contraceptive access and continuation.

When Testing IS Indicated

Testing becomes necessary only when:

• New symptoms develop (e.g., persistent abnormal bleeding, severe headaches, chest pain) 3
• Changes in health status occur that might contraindicate the current method 1
• The woman requests evaluation for side effects or concerns 1