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US Selected Practice Recommendations for Contraceptive Use, 2016

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).

 

 

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