When to Start Contraceptive Methods

• Combined oral contraceptives, progestin-only pills, progestin-only injectables, monthly injectables, combined patch, implants, male condoms, female condoms, and withdrawal can be started immediately in every case, even if the woman has injury to the genital tract or has a possible or confirmed infection.
• IUDs, female sterilization, and fertility awareness methods can be started once infection is ruled out or resolved.
• IUDs, combined vaginal ring, spermicides, diaphragms, cervical caps, female sterilization, and fertility awareness methods can be started once any injury to the genital tract has healed.

Special considerations:

• IUD insertion immediately after a second-trimester abortion requires a specifically trained provider.
• Female sterilization must be decided upon in advance, and not while a woman is sedated, under stress, or in pain. Counsel carefully and be sure to mention available reversible methods (see Female Sterilization, Because Sterilization Is Permanent).
• The combined vaginal ring, spermicides, diaphragms, and cervical caps can be used immediately even in cases of uncomplicated uterine perforation.
• The diaphragm must be refitted after uncomplicated first-trimester miscarriage or abortion. After uncomplicated second-trimester miscarriage or abortion, use should be delayed 6 weeks for the uterus to return to normal size, and then the diaphragm should be refitted.
• Fertility awareness methods: A woman can start symptoms-based methods once she has no infection-related secretions or bleeding due to injury to the genital tract. She can start calendar-based methods with her next monthly bleeding, if she is not having bleeding due to injury to the genital tract.

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