Providing Combined Oral Contraceptives | Family Planning

Maybe your like

Introduction
- Welcome to FPHandbook.org!
- Foreword From the World Health Organization
- Foreword From the United States Agency for International Development
- Acknowledgements
- WHO’s Family Planning Guidance
- Human Rights: Family Planning Providers’ Contribution
- Gender Equality and Gender Inclusiveness
  - Gender Equality and Gender Inclusiveness - Introduction
  - Gender Inclusiveness
  - Considerations for Transgender and Gender-Diverse Clients
  - References for the Section on Gender Equality and Gender Inclusiveness
- Collaborating and Supporting Organizations
Chapters
- Combined Oral Contraceptives
  - Combined Oral Contraceptives - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Facts About Combined Oral Contraceptives and Cancer
  - Who Can and Cannot Use Combined Oral Contraceptives
  - Medical Eligibility Criteria for Combined Oral Contraceptives
  - Using Clinical Judgment in Special Cases
  - Providing Combined Oral Contraceptives
  - Giving Advice on Side Effects
  - Explaining How to Use
  - Supporting New and Continuing Users
  - Come Back Any Time: Reasons to Return
  - Managing Any Problems
  - Extended and Continuous Use of Combined Oral Contraceptives
  - Questions and Answers About Combined Oral Contraceptives
- Progestin-Only Pills
  - Progestin-Only Pills - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Progestin-Only Pills
  - Medical Eligibility Criteria for Progestin-Only Pills
  - Using Clinical Judgment in Special Cases
  - Providing Progestin-Only Pills
  - Giving Advice on Side Effects
  - Explaining How to Use
  - Supporting New and Continuing Users
  - “Come Back Any Time”: Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Progestin-Only Pills
- Emergency Contraceptive Pills
  - Emergency Contraceptive Pills - Introduction
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Emergency Contraceptive Pills
  - Providing Emergency Contraceptive Pills
  - Pill Formulations and Dosing
  - Giving Emergency Contraceptive Pills
  - How Can a Partner Help?
  - When to Start or Restart Contraception After ECP Use
  - Supporting Users
  - Questions and Answers About Emergency Contraceptive Pills
- Progestin-Only Injectables
  - Progestin-Only Injectables - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Delivering Injectable Contraception in the Community
  - Who Can and Cannot Use Progestin-Only Injectables
  - Medical Eligibility Criteria for Progestin-Only Injectables
  - Using Clinical Judgment in Special Cases
  - Providing Progestin-Only Injectables
  - Giving Advice on Side Effects
  - Giving Intramuscular Injection with a Conventional Syringe
  - Giving the Injection with Subcutaneous DMPA in Uniject (Sayana Press)
  - Self-Injection Can Be an Option
  - How to Give Yourself an Injection with Sayana Press
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Progestin-Only Injectables
- Monthly Injectables
  - Monthly Injectables - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Monthly Injectables
  - Medical Eligibility Criteria for Monthly Injectables
  - Using Clinical Judgment in Special Cases
  - Providing Monthly Injectables
  - Giving Advice on Side Effects
  - Giving the Injection
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Monthly Injectables
- Combined Patch: Only the Essentials
  - Combined Patch: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Combined Patch
  - Supporting New and Continuing Users
- Combined Vaginal Ring: Only the Essentials
  - Combined Vaginal Ring: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Combined Vaginal Ring
  - Supporting New and Continuing Users
- Progesterone-Releasing Vaginal Ring: Only the Essentials
  - Progesterone-Releasing Vaginal Ring: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing the Progesterone-Releasing Vaginal Ring
  - Supporting New and Continuing Users
- Implants
  - Implants - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can and Cannot Use Implants
  - Medical Eligibility Criteria for Implants
  - Using Clinical Judgment in Special Cases
  - Providing Implants
  - Giving Advice on Side Effects
  - Inserting Implants
  - Supporting New and Continuing Users
  - Follow-up Visits With Implant Users
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing Implants
  - Questions and Answers About Implants
- Copper-Bearing Intrauterine Device
  - Copper-Bearing Intrauterine Device - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can and Cannot Use the Copper-Bearing IUD
  - Medical Eligibility Criteria for Copper-Bearing IUDs
  - Using Clinical Judgment in Special Cases
  - Screening Questions for Pelvic Examination Before IUD Insertion
  - Assessing Women for Risk of Sexually Transmitted Infections
  - Providing the Intrauterine Device
  - Preventing Infection at IUD Insertion
  - Giving Advice on Side Effects
  - Inserting the IUD
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Post-Insertion Follow-Up Visit (3 to 6 Weeks)
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing the Intrauterine Device
  - Switching From an IUD to Another Method
  - Questions and Answers About the Intrauterine Device
- Levonorgestrel Intrauterine Device
  - Levonorgestrel Intrauterine Device - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can and Cannot Use Levonorgestrel IUDs
  - Medical Eligibility Criteria for Levonorgestrel IUDs
  - Using Clinical Judgment in Special Cases
  - Screening Questions for Pelvic Examination Before IUD Insertion
  - Assessing Women for Risk of Sexually Transmitted Infections
  - Providing the Levonorgestrel Intrauterine Device
  - Giving Advice on Side Effects
  - Inserting the LNG-IUD
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Post-Insertion Follow-Up Visit (3 to 6 Weeks)
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Removing the Intrauterine Device
  - Switching From an IUD to Another Method
  - Questions and Answers About the LNG-IUD
- Female Sterilization
  - Female Sterilization - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can Have Female Sterilization
  - Medical Eligibility Criteria for Female Sterilization
  - Providing Female Sterilization
  - Ensuring Informed Choice
  - Performing the Sterilization Procedure
  - Supporting the User
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Managing Ectopic Pregnancy
  - Questions and Answers About Female Sterilization
- Vasectomy
  - Vasectomy - Introduction
  - How Effective?
  - Side Effects, Health Benefits, Health Risks, and Complications
  - Correcting Misunderstandings
  - Who Can Have a Vasectomy
  - Medical Eligibility Criteria for Vasectomy
  - Providing Vasectomy
  - Vasectomy Techniques
  - Performing the Vasectomy Procedure
  - Supporting the User
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Vasectomy
- Male Condoms
  - Male Condoms - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Bringing Up Condom Use
  - Correcting Misunderstandings
  - Who Can and Cannot Use Male Condoms
  - Providing Male Condoms
  - What Condom Users Should Not Do
  - Lubricants for Latex Condoms
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - New Problems That May Require Switching Methods
  - Questions and Answers About Male Condoms
- Female Condoms
  - Female Condoms - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Female Condoms
  - Providing Female Condoms
  - Lubricants for Female Condoms
  - Supporting New and Continuing Users
  - "Come Back Any Time": Reasons to Return
  - Managing Any Problems
  - Questions and Answers About Female Condoms
- Spermicides and Diaphragms
  - Spermicides and Diaphragms - Introduction
  - How Effective - Spermicides?
  - Side Effects, Health Benefits, and Health Risks - Spermicides
  - Correcting Misunderstandings - Spermicides
  - Who Can and Cannot Use Spermicides
  - Providing Spermicides
  - Supporting the Spermicide User
  - Diaphragms
  - How Effective - Diaphragms?
  - Side Effects, Health Benefits, and Health Risks - Diaphragms
  - Correcting Misunderstandings - Diaphragms
  - Who Can and Cannot Use Diaphragms
  - Using Clinical Judgment in Special Cases of Diaphragm Use
  - Providing Diaphragms
  - Explaining the Fitting Procedure
  - Explaining How to Use the Diaphragm
  - Supporting the Diaphragm User
  - Tips and Follow-up for Users of Spermicides and the Diaphragm
  - Managing Any Problems
  - Questions and Answers About Spermicides and Diaphragms
- Cervical Caps: Only the Essentials
  - Cervical Caps: Only the Essentials - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Providing Cervical Caps
- Fertility Awareness Methods
  - Fertility Awareness Methods - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use Calendar-Based Methods
  - Providing Calendar-Based Methods
  - Explaining How to Use Calendar-Based Methods
  - Who Can Use Symptoms-Based Methods
  - Providing Symptoms-Based Methods
  - Explaining How to Use Symptoms-Based Methods
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About Fertility Awareness Methods
- Withdrawal: Only the Essentials
  - Withdrawal: Only the Essentials - Introduction
  - How Effective?
  - Who Can and Cannot Use Withdrawal
  - Using Withdrawal
- Lactational Amenorrhea Method
  - Lactational Amenorrhea Method - Introduction
  - How Effective?
  - Side Effects, Health Benefits, and Health Risks
  - Correcting Misunderstandings
  - Who Can Use the Lactational Amenorrhea Method
  - The Lactational Amenorrhea Method for Women With HIV
  - Providing the Lactational Amenorrhea Method
  - When Can a Woman Use LAM?
  - Explaining How to Use
  - Supporting New and Continuing Users
  - Managing Any Problems
  - Questions and Answers About the Lactational Amenorrhea Method
- Serving Diverse Groups
  - Serving Diverse Groups - Introduction
  - Adolescents
  - All Contraceptives Are Safe for Young People
  - Men
  - Many Ways to Help Men
  - Women Near Menopause
  - When a Woman Can Stop Using Family Planning
  - Relieving Symptoms of Menopause
  - Clients with Disabilities
- Sexually Transmitted Infections, Including HIV
  - Sexually Transmitted Infections, Including HIV - Introduction
  - Who Is at Risk for STIs?
  - What Causes STIs?
  - Symptoms of Sexually Transmitted Infections
  - Common Vaginal Infections That May Not Be Sexually Transmitted
  - Avoiding STIs
  - Contraceptives for Clients with STIs, Including HIV
  - Cervical Cancer
  - Questions and Answers About STIs, Including HIV
- Family Planning for Adolescents and Women at High Risk for HIV
  - Family Planning for Adolescents and Women at High Risk for HIV - Introduction
  - Who is at High Risk for Acquiring HIV?
  - What Family Planning Methods Can Be Used by Adolescents and Women at High Risk for HIV?
  - Providing HIV Testing and Prevention Services
  - Who Should Be Offered an HIV Test?
  - Talking about HIV Testing
  - HIV Testing Options
  - Preventing HIV Acquisition
  - Male Partner HIV Testing and Prevention Messages
  - Questions and Answers about Family Planning for Adolescents and Women at High Risk for HIV
- Maternal and Newborn Health
  - Maternal and Newborn Health - Introduction
  - Planning Pregnancy
  - During Pregnancy
  - Planning for Family Planning After Delivery
  - Preparing for Childbirth and Complications
  - After Childbirth
  - Earliest Time That a Woman Can Start a Family Planning Method After Childbirth
  - Preventing Mother-to-Child Transmission of HIV
  - Managing Any Breastfeeding Problems
- Reproductive Health Issues
  - Reproductive Health Issues - Introduction
  - Family Planning in Postabortion Care
  - Help Women Obtain Family Planning
  - When to Start Contraceptive Methods
  - Violence Against Women
  - What Can Providers Do?
  - Infertility
  - Preventing Involuntary Infertility
  - Counseling Clients With Fertility Problems
- Family Planning Provision
  - Family Planning Provision - Introduction
  - Successful Counseling
  - Who Provides Family Planning?
  - Infection Prevention in the Clinic
  - Make Infection Prevention a Habit
  - Managing Contraceptive Supplies
- Providing Family Planning Services During an Epidemic
  - Providing Family Planning Services During an Epidemic - Introduction
  - Maintaining Family Planning Services in an Epidemic
  - Safe Use of Contraceptive Methods in an Epidemic
  - Self-Care for Contraception
  - Use of Digital Health Technologies
Job Aids
- Comparing Combined Methods
- Comparing Injectables
- Comparing Implants
- Comparing Condoms
- Comparing IUDs
- If You Miss Pills
- Female Anatomy
- External Anatomy
- The Menstrual Cycle
- Male Anatomy
- Identifying Migraine Headaches and Auras
- Can a Woman With Migraines and/or Aura Use a Hormonal Method?
- Considering Progestin-Only Injectables Where HIV Risk Is High: Counseling Tips
- Ruling Out Pregnancy
- How and When to Use the Pregnancy Checklist and Pregnancy Tests
- Pregnancy Checklist
- Comparing Effectiveness of Family Planning Methods
APPENDIXES
- APPENDIX A - Contraceptive Effectiveness
- APPENDIX B - Signs and Symptoms of Serious Health Conditions
- APPENDIX C - Medical Conditions That Make Pregnancy Especially Risky
- APPENDIX D - Medical Eligibility Criteria for Contraceptive Use
  - APPENDIX D - Medical Eligibility Criteria for Contraceptive Use - Introduction
  - PERSONAL CHARACTERISTICS AND REPRODUCTIVE HISTORY
  - CARDIOVASCULAR DISEASE
  - NEUROLOGICAL CONDITIONS
  - REPRODUCTIVE TRACT INFECTIONS AND DISORDERS
  - HIV/AIDS
  - OTHER INFECTIONS
  - ENDOCRINE CONDITIONS
  - GASTROINTESTINAL CONDITIONS
  - ANEMIAS
  - DRUG INTERACTIONS
  - ADDITIONAL CONDITIONS
Glossary, Methodology, and WHO Guidance Document
- Glossary
- Methodology
- WHO Guidance Documents Used in Preparation of This Edition of the Handbook

Scroll More

We're looking for your feedback! Please answer a few questions to help us improve our website.

Take The Survey

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.

Nortrel

cartDown ArrowDownload ArrowIcon / Downloadelearningfphandbookghspleftphotosharepoplinerightsearchtoctoolkitstranslate

Tag » When To Take Pills After Miscarriage

Providing Combined Oral Contraceptives | Family Planning

Explore the Handbook

When to Start

How Soon Can I Start Birth Control Pills After A Pregnancy?

Contraception After Miscarriage Or An Ectopic Pregnancy

Common Treatments For Miscarriage

Abortion Pill Effective, Safe After Miscarriage

Birth Control Options You Can Use Before Conceiving After Miscarriage

Would You Consider Medication To Help Manage A Miscarriage?

Contact