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Systemic hormonal contraception initiation after abortion: A systematic review and meta-analysis
Caron Kim1, Antoinette T Nguyen2, Erin Berry-Bibee3
1Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Geneva, Switzerland.
Initiating hormonal contraception immediately after abortion is generally safe and effective. However, immediate depot medroxyprogesterone (DMPA) initiation may slightly increase ongoing pregnancy risk, emphasizing informed counseling.
Area of Science:
- Reproductive Health
- Contraception
- Abortion Care
Background:
- Immediate contraceptive initiation is a convenient option for women seeking abortion care.
- Systemic hormonal contraception can be started before or after abortion procedures.
Purpose of the Study:
- To evaluate the effectiveness of medical abortion with immediate systemic hormonal contraception initiation.
- To assess the safety of hormonal contraceptive methods initiated post-abortion.
Main Methods:
- Systematic review of 16 studies (7 RCTs, 9 cohorts) identified via PubMed, Popline, Cochrane Library, and Clinicaltrials.gov.
- Studies assessed medical abortion effectiveness and safety of hormonal contraception initiation post-abortion.
- Study quality assessed using USPSTF criteria; narrative summaries and pooled relative risks were calculated.
Main Results:
- Most studies found no decreased abortion effectiveness or increased need for additional treatment with immediate hormonal contraception.
- One study showed a small increase in ongoing pregnancy with immediate depot medroxyprogesterone (DMPA) initiation (3.6% vs 0.9%).
- No significant bleeding-related safety concerns were identified with hormonal contraception initiation post-abortion.
Conclusions:
- Abortion effectiveness is not significantly impacted by immediate vs. delayed initiation of most systemic hormonal contraceptives.
- Immediate DMPA initiation showed a slight increase in ongoing pregnancy rates.
- Hormonal contraception initiation post-abortion appears safe with minimal bleeding complications.
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