Contraceptive method | When to start (if the provider is reasonably certain that the woman is not pregnant) | Additional contraception (ie, back-up) needed | Examinations or tests needed before initiation* |
Copper 380 mm2 IUD | Anytime | Not needed¶ | Bimanual examination and cervical inspectionΔ |
Levonorgestrel 52 mg, 19.5 mg, and 13.5 mg IUDs | Anytime |
| Bimanual examination and cervical inspectionΔ |
Etonogestrel implant | Anytime | If >5 days after menses started, use back-up method or abstain for 7 days | None |
Injectable | Anytime | If >7 days after menses started, use back-up method or abstain for 7 days | None |
Combined hormonal contraceptive | Anytime | If >5 days after menses started, use back-up method or abstain for 7 days | Blood pressure measurement |
Progestin-only pill | Anytime | If >5 days after menses started, use back-up method or abstain for 2 days | None |
IUD: intrauterine device; BMI: body mass index; STD: sexually transmitted disease; CDC: Centers for Disease Control and Prevention.
* Weight (BMI) measurement is not needed to determine medical eligibility for any methods of contraception, because all methods can be used (United States Medical Eligibility Criteria for Contraceptive Use 2010, US MEC 1) or generally can be used (US MEC 2) among obese women. However, measuring weight and calculating BMI (weight [kg]/height [m2]) at baseline might be helpful for monitoring any changes and counseling women who might be concerned about weight change perceived to be associated with their contraceptive method.
¶ The copper 380 mm2 and levonorgestrel 52 mg IUDs both act as emergency contraception and therefore do not require additional contraception.
Δ Most women do not require additional STD screening at the time of IUD insertion if they have already been screened according to CDC's STD Treatment Guidelines (available at http://www.cdc.gov/std/treatment). If a woman has not been screened according to guidelines, screening can be performed at the time of IUD insertion, and insertion should not be delayed. Women with purulent cervicitis or current chlamydial infection or gonorrhea should not undergo IUD insertion (US MEC 4). Women who have a very high individual likelihood of STD exposure (eg, those with a currently infected partner) generally should not undergo IUD insertion (US MEC 3). For these women, IUD insertion should be delayed until appropriate testing and treatment occurs.Do you want to add Medilib to your home screen?