Providing Progestin-Only Pills

When to Start

Woman's situation	When to start
IMPORTANT: A woman can start using POPs 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 POPs at any time and told when to start taking them.
Fully or nearly fully breastfeeding Less than 6 months after giving birth	If she gave birth less than 6 weeks ago, give her POPs and tell her to start taking them 6 weeks after giving birth. If her monthly bleeding has not returned, she can start POPs any time between 6 weeks and 6 months. No need for a backup method. If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles.
More than 6 months after giving birth	If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method^* for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.) If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles.
Partially breastfeeding Less than 6 weeks after giving birth	Give her POPs 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 POPs any time it is reasonably certain she is not pregnant.^† She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.) If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles.
Not breastfeeding Less than 4 weeks after giving birth	She can start POPs at any time. No need for a backup method.
More than 4 weeks after giving birth	If her monthly bleeding has not returned, she can start POPs any time it is reasonably certain she is not pregnant.^† She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.) If her monthly bleeding has returned, she can start POPs as advised for women having menstrual cycles.
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 POPs when the repeat injection would have been given. No need for a backup method.
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 POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.) If she is switching from an IUD, she can start POPs immediately (see Copper-Bearing IUD, Switching From an IUD to Another Method).
No monthly bleeding (not related to childbirth or breastfeeding)	She can start POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 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 POPs any time it is reasonably certain she is not pregnant. She will need a backup method for the first 2 days of taking pills. (If you cannot be reasonably certain, give her POPs now and tell her to start taking them during her next monthly bleeding.)
After taking emergency contraceptive pills (ECPs)	She can start POPs 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 POP 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 2 days of taking pills.
^* 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 limited, some providers and programs may allow a woman to start POPs 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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