Appendix B: When To Start Using Specific Contraceptive Methods
|Contraceptive method||When to start (if the provider is reasonably certain that the woman is not pregnant)||Additional contraception
(i.e., back-up) needed
|Examinations or tests needed before initiation*|
|Copper-containing IUD||Anytime||Not needed||Bimanual examination and cervical inspection†|
|Levonorgestrel-releasing IUD||Anytime||If >7 days after menses started, use back-up method or abstain for 7 days.||Bimanual examination and cervical inspection†|
|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|
Abbreviations: BMI = body mass index; HIV = human immunodeficiency virus; IUD = intrauterine device; STD = sexually transmitted disease; U.S. MEC = U.S. Medical Eligibility Criteria for Contraceptive Use, 2016.
* 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 obese women (Box 1). However, measuring weight and calculating BMI (weight [kg]/height [m]2) 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.
† Most women do not require additional STD screening at the time of IUD insertion. If a woman with risk factors for STDs has not been screened for gonorrhea and chlamydia according to CDC’s STD Treatment Guidelines (https://www.cdc.gov/std/treatment), screening can be performed at the time of IUD insertion, and insertion should not be delayed. Women with current purulent cervicitis or chlamydial infection or gonococcal infection should not undergo IUD insertion (U.S. MEC 4).