Providing Combined Oral Contraceptives | Family Planning

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When to Start

Woman's situation	When to start
IMPORTANT: A woman can start using COCs any time she wants if it is reasonably certain she is not pregnant. To be reasonably certain she is not pregnant, use the Pregnancy Checklist. Also, a woman can be given COCs at any time and told when to start taking them.
Having menstrual cycles or switching from a nonhormonal method	Any time of the month If she is starting within 5 days after the start of her monthly bleeding, no need for a backup method. If it is more than 5 days after the start of her monthly bleeding, she can start COCs any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.) If she is switching from an IUD, she can start COCs immediately (see Copper-Bearing IUD, Switching From an IUD to Another Method).
Switching from a hormonal method	Immediately, if she has been using the hormonal method consistently and correctly or if it is otherwise reasonably certain she is not pregnant. No need to wait for her next monthly bleeding. No need for a backup method. If she is switching from injectables, she can begin taking COCs when the repeat injection would have been given. No need for a backup method.
Fully or nearly fully breastfeeding
Less than 6 months after giving birth	Give her COCs and tell her to start taking them 6 months after giving birth or when breast milk is no longer the baby’s main food—whichever comes first.
More than 6 months after giving birth	If her monthly bleeding has not returned, she can start COCs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.) If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.
Partially breastfeeding
Less than 6 weeks after giving birth	Give her COCs and tell her to start taking them 6 weeks after giving birth. Also give her a backup method to use until 6 weeks since giving birth if her monthly bleeding returns before this time.
More than 6 weeks after giving birth	If her monthly bleeding has not returned, she can start COCs any time it is reasonably certain she is not pregnant.† She will need a backup method for the first 7 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.) If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.
Not breastfeeding
Less than 4 weeks after giving birth	She can start COCs at any time on days 21–28 after giving birth. Give her pills any time to start during these 7 days. No need for a backup method. (If additional risk for VTE, wait until 6 weeks. See Question 2.)
More than 4 weeks after giving birth	If her monthly bleeding has not returned, she can start COCs any time it is reasonably certain she is not pregnant.^† She will need a backup method for the first 7 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.) If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.
No monthly bleeding (not related to childbirth or breastfeeding)	She can start COCs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days of taking pills.
After miscarriage or abortion	Immediately. If she is starting within 7 days after first- or second-trimester miscarriage or abortion, no need for a backup method. If it is more than 7 days after first- or second-trimester miscarriage or abortion, she can start COCs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days of taking pills. (If you cannot be reasonably certain, see How and When to Use the Pregnancy Checklist and Pregnancy Tests.)
After taking emergency contraceptive pills (ECPs)	After taking progestin-only or combined ECPs: She can start or restart COCs immediately after she takes the ECPs. No need to wait for her next monthly bleeding. A continuing user who needed ECPs due to pill-taking errors can continue where she left off with her current pack. If she does not start immediately, but returns for COCs, she can start at any time if it is reasonably certain she is not pregnant. All women will need to use a backup method for the first 7 days of taking pills.
	After taking ulipristal acetate (UPA) ECPs She can start or restart COCs on the 6th day after taking UPA-ECPs. No need to wait for her next monthly bleeding. COCs and UPA interact. If COCs are started sooner, and thus both are present in the body, one or both may be less effective. Give her a supply of pills and tell her to start them on the 6th day after taking the UPA-ECPs. She will need to use a backup method from the time she takes the UPA-ECPs until she has been taking COCs for 7 days. If she does not start on the 6th day but returns later for COCs, she may start at any time if it is reasonably certain she is not pregnant.
^* Backup methods include abstinence, male and female condoms, spermicides, and withdrawal. Tell her that spermicides and withdrawal are the least effective contraceptive methods. If possible, give her condoms.
^† Where a visit 6 weeks after childbirth is routinely recommended and other opportunities to obtain contraception are limited, some providers and programs may give COCs at the 6-week visit, without further evidence that the woman is not pregnant, if her monthly bleeding has not yet returned.

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