Timing Advice for Contraceptives
Frederick R. Jelovsek MD
When to start, when to stop, should I take a break, when to get pregnant after stopping? These are all questions that occur frequently with regard to contraception. Answers, however, can vary from physician to physician. A recent pocket guide has been published, Hatcher RA, Zieman M, Watt A, et al. Managing Contraception. Bridging the Gap Foundation. 1999. p 36, that updates some of the old advice that has been used.
When To Start The Pill
When should I start a new prescription of birth control pills?
Traditional advice has been to start the pills on the nearest Sunday to when the menses starts. This results in the menses starting every month on a Monday, Tuesday or Wednesday because the last active pill is taken on a Saturday. Starting it after a menses helps assure there is no pregnancy. The problem with this advice is that the pills are more effective that first cycle if they are started on the first day of the menses. Also, pills can actually begin anytime in a cycle as long as a woman is not pregnant. Some women will get pregnant while waiting for their next menses to start the pill. The best advice for starting a new prescription of oral contraceptives is to start on the first day of a menses or start today if not pregnant.
Taking A Break?
After several years of oral contraceptives, should I take a prolonged break to let my body recover?
Quite a few years ago, providers were uncertain of the long term effects of oral contraceptives. There have been studies now over 20 years of taking pills with no long term effects shown. This advice commonly leads to unwanted pregnancies and confusion about when to restart the pills if there is amenorrhea after stopping the pills. The best instructions are to continue taking the pills as long as you need contraception without any breaks.
Getting Pregnant After The Pill
How long should I wait to get pregnant after stopping birth control pills?
Providers used to advise waiting 3 months after stopping pills before trying to get pregnant. This wait improved the ability to accurately date a pregnancy. Now with improved ultrasound dating of pregnancy it is no longer necessary to wait this long. Women may begin attempting conception right after the first normal menses.
Breast Feeding And The Pill
If breast feeding, how long should a woman wait until having a depo medroxyprogesterone acetate (DMPA, Depoprovera®) contraceptive shot?
"Wait 6 weeks until the first contraceptive shot." That is what most providers said. There were theoretical questions about the effect of DMPA on the baby and also on the quality and quantity of breast milk. This advice to delay the shot resulted in many women becoming pregnant. The current concept is that the DMPA contraceptive shot can be given before leaving the hospital.
Should the DMPA (DepoProvera®) contraceptive injection be started the first time during a menses?
Menses ensured the the woman was not pregnant. Now, doctors feel that the shot can be started any time if there is a reasonable assurance that the woman is not pregnant. A backup method of contraception should be used if it is not started at the time of the menses.
Must the intrauterine contraceptive device be inserted during the menses?
This rule-of-thumb came about because the menses helped reassure that the woman was not pregnant. Also the cervical os is open at the time of the menses making it easier and less painful to insert the IUCD. Providers now feel this is too restrictive a policy. Vaginal bleeding does not definitely exclude pregnancy and there is a higher expulsion rate if the IUCD is inserted during a menses. Current advice is that the IUCD may be inserted any time during a cycle if there is reasonable assurance the woman is not pregnant.
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