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IMPORTANT: A woman can start using implants 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.
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| Woman's situation |
When to start |
| Having menstrual cycles or switching from a nonhormonal method |
- If she is starting within 7 days after the start of her monthly bleeding (5 days for Implanon), no need for a backup method.
- If it is more than 7 days after the start of her monthly bleeding (more than 5 days for Implanon), she can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method* for the first 7 days after insertion.
- If she is switching from an IUD, she can have implants inserted 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 have implants inserted when the repeat injection would have been given. No need for a backup method.
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Fully or nearly fully breastfeeding
Less than 6 months after giving birth |
- If she gave birth less than 6 weeks ago, delay her first injection until at least 6 weeks after giving birth. (See p. 129, Q&A 8.)
- If her monthly bleeding has not returned, she can have implants inserted any time between 6 weeks and 6 months. No need for a backup method.
- If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
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| More than 6 months after giving birth |
- If her monthly bleeding has not returned, she can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
- If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
|
Partially breastfeeding
Less than 6 weeks after giving birth |
- Delay her first injection until at least 6 weeks after giving birth. (See p. 129, Q&A 8.)
|
| More than 6 weeks after giving birth |
- If her monthly bleeding has not returned, she can have implants inserted any time it is reasonably certain she is not pregnant.† She will need a backup method for the first 7 days after insertion.
- If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
|
Not breastfeeding
Less than 4 weeks after giving birth |
- She can have implants inserted 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 have implants inserted any time it is reasonably certain she is not pregnant.† She will need a backup method for the first 7 days after insertion.
- If her monthly bleeding has returned, she can have implants inserted as advised for women having menstrual cycles.
|
| No monthly bleeding (not related to childbirth or breastfeeding) |
- She can have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
|
| After miscarriage or abortion |
- Immediately. If implants are inserted 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 have implants inserted any time it is reasonably certain she is not pregnant. She will need a backup method for the first 7 days after insertion.
|
| After taking emergency contraceptive pills (ECPs) |
- Implants can be inserted within 7 days after the start of her next monthly bleeding (within 5 days for Implanon) or any other time it is reasonably certain she is not pregnant. Give her a backup method, or oral contraceptives to start the day after she finishes taking the ECPs, to use until the implants are inserted.
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* 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 insert implants 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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