Appendix B: When To Start Using Specific Contraceptive Methods

At a glance

This appendix summarizes recommendations for health care providers on when to start using specific contraceptive methods. This information comes from the 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR). The U.S. SPR provides recommendations for health care providers that address a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods.

Table B1. When to start using specific contraceptive methods

Table B1. When to start using specific contraceptive methods
Contraceptive method When to start (if the provider is reasonably certain that the patient is not pregnant)* Additional contraception (i.e., back-up) needed Examination or test needed before initiation†
Cu-IUD Anytime Not needed Bimanual examination and cervical inspection§
LNG-IUD Anytime If >7 days after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days Bimanual examination and cervical inspection§
Implant Anytime If >5 days after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days None
DMPA Anytime If >7 days after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days None
CHC Anytime If >5 days after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days Blood pressure measurement
Norethindrone or norgestrel POP Anytime If >5 days after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 2 days None
Drospirenone POP Anytime If >1 day after menses started, abstain from sexual intercourse or use barrier methods (e.g., condoms) for 7 days None

Abbreviations: BMI = body mass index; CHC = combined hormonal contraceptive; Cu-IUD = copper intrauterine device; DMPA = depot medroxyprogesterone acetate; IUD = intrauterine device; LNG-IUD = levonorgestrel intrauterine device; POP = progestin-only pill; STI = sexually transmitted infection; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use.

* As appropriate, see recommendations for Emergency Contraception.

† Weight (BMI) measurement is not needed to determine medical eligibility for any methods of contraception because all methods can be used (U.S. MEC 1) or generally can be used (U.S. MEC 2) among patients with obesity (BMI ≥30 kg/m2). However, measuring weight and calculating BMI at baseline might be helpful for discussing concerns about any changes in weight and whether changes might be related to use of the contraceptive method.

§ Most patients do not require additional STI screening at the time of IUD placement. If a patient with risk factors for STIs has not been screened for gonorrhea and chlamydia according to CDC’s Sexually Transmitted Infections Treatment Guidelines , screening may be performed at the time of IUD placement, and placement should not be delayed. Patients with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD placement (U.S. MEC 4).

In situations in which the health care provider is uncertain whether the patient might be pregnant, the benefits of starting the implant, DMPA, CHC, and POP likely exceed any risk; therefore, starting the implant, DMPA, CHC, and POP should be considered at any time, with a follow-up pregnancy test in 2–4 weeks.

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health