No direct evidence was found regarding the effects of starting POPs at different times of the cycle.Īmong healthy women, no examinations or tests are needed before initiation of POPs, although a baseline weight and BMI measurement might be useful for monitoring POP users over time ( Table 5). If a woman needs to use additional contraceptive protection when switching to POPs from another contraceptive method, consider continuing her previous method for 2 days after starting POPs. An estimated 48 hours of POP use has been deemed necessary to achieve the contraceptive effects on cervical mucus ( 279). Therefore, taking POPs at approximately the same time each day is important. Peak serum steroid levels are reached about 2 hours after administration, followed by rapid distribution and elimination, such that by 24 hours after administration, serum steroid levels are near baseline ( 279). Unlike COCs, POPs inhibit ovulation in about half of cycles, although the rates vary widely by individual ( 279). In situations in which the health-care provider is uncertain whether the woman might be pregnant, the benefits of starting POPs likely exceed any risk therefore, starting POPs should be considered at any time, with a follow-up pregnancy test in 2–4 weeks. POPs can be started no sooner than 5 days after use of UPA.Ĭomments and Evidence Summary. POPs can be started immediately after use of ECPs (with the exception of UPA). If the woman cannot return for IUD removal and has not abstained from sexual intercourse or used barrier contraception for 7 days, advise the woman to use ECPs at the time of IUD removal.Advise the woman to abstain from sexual intercourse or use barrier contraception for 7 days before removing the IUD and switching to the new method.Advise the women to retain the IUD for at least 2 days after POPs are initiated and return for IUD removal.A health-care provider may consider any of the following options: Switching from an IUD: If the woman has had sexual intercourse since the start of her current menstrual cycle and it has been >5 days since menstrual bleeding started, theoretically, residual sperm might be in the genital tract, which could lead to fertilization if ovulation occurs.Need for back-up contraception: If it has been >5 days since menstrual bleeding started, she needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days.Waiting for her next menstrual period is unnecessary. Timing: POPs can be started immediately if it is reasonably certain that the woman is not pregnant ( Box 2).Switching from Another Contraceptive Method Need for back-up contraception: The woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days unless POPs are started at the time of a surgical abortion.Timing: POPs can be started within the first 7 days, including immediately postabortion (U.S.Need for back-up contraception: If a woman is 5 days since menstrual bleeding started, she needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days.MEC 1), if it is reasonably certain that the woman is not pregnant ( Box 2). Timing: POPs can be started at any time, including immediately postpartum (U.S.MEC 2 if 5 days since menstrual bleeding started, she needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days. Need for back-up contraception: The woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days.Timing: POPs can be started at any time if it is reasonably certain that the woman is not pregnant ( Box 2).Special Considerations Amenorrhea (Not Postpartum)
If POPs are started >5 days since menstrual bleeding started, the woman needs to abstain from sexual intercourse or use additional contraceptive protection for the next 2 days.If POPs are started within the first 5 days since menstrual bleeding started, no additional contraceptive protection is needed.POPs can be started at any time if it is reasonably certain that the woman is not pregnant ( Box 2).
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