Providing Combined Oral Contraceptives

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, give her COCs now and tell her to start taking them during her next monthly bleeding.)
• If she is switching from an IUD, she can start COCs immediately (see Copper-Bearing IUD, Switching From an IUD to Another 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.

• 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.

• 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, give her COCs now and tell her to start taking them during her next monthly bleeding.)
• If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.

• 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.

• 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, give her COCs now and tell her to start taking them during her next monthly bleeding.)
• If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.

• 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 p. 6, Question 2.)

• 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, give her COCs now and tell her to start taking them during her next monthly bleeding.)
• If her monthly bleeding has returned, she can start COCs as advised for women having menstrual cycles.

• 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.

• 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, give her COCs now and tell her to start taking them during her next monthly bleeding.)

• She can start COCs the day after she finishes taking the ECPs. There is no need to wait for her next monthly bleeding to start her pills.
  • A new COC user should begin a new pill pack.
  • A continuing user who needed ECPs due to pill-taking errors can continue where she left off with her current pack.
  • All women will need to use a backup method for the first 7 days of taking pills.