What laboratory investigations should be ordered before initiating hormonal or intra‑uterine contraception?

Laboratory Testing Before Contraception Initiation

For healthy women seeking contraception, blood pressure measurement is the ONLY mandatory laboratory test required before starting combined hormonal contraceptives (pills, patch, ring), while no laboratory tests are required for progestin-only methods or implants. 1, 2

Essential Testing by Contraceptive Method

Combined Hormonal Contraceptives (Pills, Patch, Ring)

• Blood pressure measurement is Class A (essential and mandatory) before initiating combined hormonal contraceptives 1, 3
• Women with severe hypertension (≥160/100 mmHg) should NOT use combined hormonal contraceptives (U.S. MEC Category 4) 1, 3
• Women with moderate hypertension (140-159/90-99 mmHg) generally should NOT use combined hormonal contraceptives (U.S. MEC Category 3) 1, 3
• If healthcare access is limited, blood pressure can be measured in non-clinical settings (pharmacy, fire station) and self-reported to the provider 1
• Weight/BMI measurement is optional but may be useful for baseline monitoring, though NOT required for medical eligibility determination 1, 2

Progestin-Only Methods (Pills, Implants, DMPA Injectable)

• No examinations or laboratory tests are required before initiating progestin-only contraceptives 1, 2
• Weight/BMI measurement may be useful for monitoring changes over time but is not essential 3, 2

Intrauterine Devices (IUDs)

• Bimanual examination and cervical inspection are required for proper IUD placement 1, 2
• Most patients do NOT require additional STI screening at the time of IUD placement if already screened according to CDC guidelines 1, 2

Tests That Are NOT Required for Healthy Women

The following are all classified as Class C (not contributing substantially to safe and effective use) and should NOT be routinely performed: 1, 2

• Glucose testing - unnecessary despite diabetes being a contraindication, due to low prevalence of undiagnosed diabetes in reproductive-age women 2
• 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
• Cervical cytology (Pap smear) - not required before contraception initiation 1, 2, 4
• Clinical breast examination - not required 1, 5
• Bimanual examination and cervical inspection - not required for hormonal methods (only needed for IUD placement) 1, 2
• STI screening - not required unless indicated by individual risk factors or CDC screening guidelines 1, 2
• HIV screening - not required unless indicated by individual risk factors 1, 2

Special Considerations and Clinical Pitfalls

When Additional Testing May Be Needed

• Women with known medical problems or special conditions may require additional examinations or tests based on U.S. Medical Eligibility Criteria 1, 3, 2
• Medical history focusing on U.S. MEC contraindications is more important than laboratory screening 3, 2

Quick Start Approach

• Contraception can be started at any time if the provider is reasonably certain the patient is not pregnant 1, 2, 4
• If uncertainty exists about pregnancy status, the benefits of starting contraception likely exceed any risk; start the method with follow-up pregnancy testing in 2-4 weeks 1, 2

Common Pitfall to Avoid

• Do NOT delay contraception initiation waiting for unnecessary tests (Pap smear, pelvic exam, breast exam, or laboratory work) as this creates unnecessary barriers and increases risk of unintended pregnancy 4, 5
• Requiring unnecessary examinations reduces access to highly effective contraceptive methods and may increase women's overall health risks 5