Initiating hormonal contraception

Most women can safely begin taking hormonal birth control products immediately after an office visit, at any point in the menstrual cycle. Because hormonal contraceptives do not accelerate cervical neoplasia or interfere with cervical cytology, women who have not had a recent Papanicolaou smear can begin using hormonal contraceptives before the test is performed. After childbirth, most women can begin using progestin-only contraceptives immediately. Estrogen-containing methods can safely be initiated six weeks to six months postpartum for women who are breastfeeding their infants and three weeks postpartum for women who are not breastfeeding. Women can begin any appropriate contraceptive method immediately following an early abortion. Delaying contraception may decrease adherence. Physicians can help patients improve their use of birth control by providing anticipatory guidance about the most common side effects, giving comprehensive information about available choices, and honoring women's preferences. An evidence-based, flexible, patient-centered approach to initiating contraception may help to lower the high rate of unintended pregnancy in the United States.