Quick start of contraception

Quick start of contraception

Traditionally, contraception methods are started within the first 5 days of menstrual cycle. It becomes a problem when a woman comes to you for contraception during mid cycle. If you tell her to wait, she may become pregnant before she gets her next period. Quick start of contraception tries to tackle that.

Essentially, the process can be summarised in 3 steps:
1. Establish pregnancy status
2. Choose contraception method
3. Follow up

1. Establish pregnancy status 

• Pregnancy can be excluded if :
• -ve pregnancy test + no sex in the last 3 wks
• no sex since last period
• using contraception correctly and reliably
• within the first 5 days of menstrual period 
• < 21 days post part
• < 5 days post abortion or post miscarriage 
• Pregnancy cannot be excluded:
• needs follow up pregnancy testing, the current Australian guideline is in 4 weeks time

2. Choose contraception method 

• If pregnancy can be excluded: can choose any contraceptive method. Don't forget COCP, Vaginal ring, DMPA, LNG IUD and Levonorgestrel take 7 days to work. POP takes 3 days. Copper IUD effective immediately
• If pregnancy cannot be excluded
• tell her that there is a chance she could be pregnant, if it is appropriate, offer her emergency contraception 
• inform choices available for contraceptions: 
• Vaginal ring, COCP, POP, levonorgestrel have not shown to have teratogenic effects in babies. 
• DMPA injection is long acting, so it is less perferrable but also no evidence of teratogenicity
• IUD and Copper IUD not preferred as can cause miscarriage

3. Follow up 

• Women in whom the pregnancy status cannot be excluded: needs pregnancy test in 4 weeks. (This is the current Australian recommendation. Other guidelines have different timeframe)

Resources:

1. Flow chart for quick start contraception(American version, follow up testing time frame different)

2. Family planning victoria quick start guideline