Starting Combined Oral Contraceptives After Emergency Contraception

Timing of Combined Oral Contraceptive Initiation

• The Centers for Disease Control and Prevention (CDC) guidelines indicate that combined hormonal contraceptives can be started at any time if it is reasonably certain that the woman is not pregnant 1, 2

Effectiveness Considerations

• When starting COCs immediately after using emergency contraception, additional contraceptive protection is needed for the first 7 days 1, 2, 3
• It takes approximately 7 consecutive days of COC use to effectively suppress ovulation 4, 5

Backup Contraception Requirements

• Use backup contraception (e.g., condoms) or avoid sexual intercourse until hormonal pills have been taken for 7 consecutive days 4, 5
• This recommendation applies regardless of when in the menstrual cycle you start the COC 1, 2
• The 7-day backup period is necessary to ensure adequate hormonal levels to prevent ovulation 4, 5

Special Considerations

• Use backup contraception for 7 days after starting COCs immediately after taking emergency contraception 1, 2

Common Pitfalls to Avoid

• Do not skip using backup contraception during the first 7 days of COC use 4, 5
• If vomiting occurs within 24 hours of taking a COC pill, follow the guidelines for missed pills, as the contraceptive effectiveness might be compromised 6
• If you miss any pills during the first week of COC use after emergency contraception, consider using emergency contraception again if unprotected intercourse occurred 4, 5