Contraceptive Provision and Use Guidelines

Initial Assessment and Eligibility

The Centers for Disease Control and Prevention recommends that most women can safely initiate contraception with minimal pre-screening examinations or laboratory tests 1
Blood pressure measurement is mandatory only for combined hormonal contraceptives (CHCs) before initiation, as recommended by the Centers for Disease Control and Prevention 2, 1
A bimanual examination and cervical inspection are required only for IUD placement, according to the Centers for Disease Control and Prevention 2, 3
No other routine examinations are needed for most contraceptive methods, including pelvic exams, cervical cytology, breast exams, HIV screening, or laboratory tests for lipids, glucose, liver enzymes, hemoglobin, or thrombogenic mutations, as stated by the Centers for Disease Control and Prevention 1
Weight measurement (BMI) is not required to determine medical eligibility for any contraceptive method, though baseline measurement may help address future concerns about weight changes, as recommended by the Centers for Disease Control and Prevention 2, 1

The Centers for Disease Control and Prevention recommends that combined hormonal contraceptives can be started anytime if reasonably certain the patient is not pregnant 2
No backup contraception is needed if started within 5 days of menstrual bleeding, as stated by the Centers for Disease Control and Prevention 2
Backup contraception (abstinence or barrier methods) is required for 7 days if started >5 days after menses, according to the Centers for Disease Control and Prevention 2

Smoking is not a contraindication to CHCs in women <35 years old, as stated by the American College of Obstetricians and Gynecologists 5
Progestin-only methods (pills, implants, DMPA) are generally safe (Category 1-2) even with thromboembolic risk factors, according to the American College of Obstetricians and Gynecologists 3
Copper IUDs are non-hormonal with no systemic effects, making them suitable when hormonal methods are contraindicated, as recommended by the American College of Obstetricians and Gynecologists 3

Certain anticonvulsants (phenytoin, carbamazepine, barbiturates, primidone, topiramate, oxcarbazepine) are Category 3 for CHCs and POPs, as stated by the Centers for Disease Control and Prevention 2
Rifampin or rifabutin are Category 3 for CHCs and POPs, according to the Centers for Disease Control and Prevention 2
Lamotrigine is Category 3 for CHCs (CHCs reduce lamotrigine levels), as recommended by the Centers for Disease Control and Prevention 2

No routine follow-up visit is required, as stated by the Centers for Disease Control and Prevention 6, 7, 5
Advise women to return anytime for side effects, concerns, or desire to change methods, according to the Centers for Disease Control and Prevention 6, 7
Inform users of IUDs, implants, or injectables when removal or reinjection is needed, as recommended by the Centers for Disease Control and Prevention 6, 7

For spotting, light bleeding, or heavy/prolonged bleeding, NSAIDs for 5-7 days can be used, as stated by the Centers for Disease Control and Prevention 6, 7
Hormonal treatment (if medically eligible) with COCs or estrogen for 10-20 days can be used for LNG-IUD users, according to the Centers for Disease Control and Prevention 6, 7

Implants can be inserted anytime in postpartum women (U.S. MEC 2 if <1 month postpartum, U.S. MEC 1 if ≥1 month), as recommended by the Centers for Disease Control and Prevention 4
If <6 months postpartum, amenorrheic, and fully/nearly fully breastfeeding, no backup contraception is needed, according to the Centers for Disease Control and Prevention 4

Can switch immediately if reasonably certain patient is not pregnant, as stated by the Centers for Disease Control and Prevention 4
Waiting for next menstrual period is unnecessary, according to the Centers for Disease Control and Prevention 4
If >5 days since menstrual bleeding started, backup contraception is needed for 7 days, as recommended by the Centers for Disease Control and Prevention 4

Discuss expected bleeding pattern changes before initiating any hormonal method, as recommended by the American College of Obstetricians and Gynecologists 5
Reassure that amenorrhea with hormonal contraceptives does not require treatment and is generally not harmful, according to the American College of Obstetricians and Gynecologists 5
Unscheduled bleeding is common during first 3-6 months of hormonal methods and generally decreases with continued use, as stated by the American College of Obstetricians and Gynecologists 5, 8