When to start, when to stop, should I take a break,
when to get pregnant after stopping? These are all
questions that occur frequently with regard to contraception.
Answers, however, can vary from physician to physician.
A recent pocket guide has been published, Hatcher
RA, Zieman M, Watt A, et al. Managing Contraception.
Bridging the Gap Foundation. 1999. p 36, that updates
some of the old advice that has been used.
When should I start a new prescription of birth control
pills?
Traditional advice has been to start the pills on
the nearest Sunday to when the menses starts. This
results in the menses starting every month on a Monday,
Tuesday or Wednesday because the last active pill
is taken on a Saturday. Starting it after a menses
helps assure there is no pregnancy. The problem with
this advice is that the pills are more effective that
first cycle if they are started on the first day of
the menses. Also, pills can actually begin anytime
in a cycle as long as a woman is not pregnant. Some
women will get pregnant while waiting for their next
menses to start the pill. The best advice for starting
a new prescription of oral contraceptives is to start
on the first day of a menses or start today if not
pregnant.
After several years of oral contraceptives, should
I take a prolonged break to let my body recover?
Quite a few years ago, providers were uncertain of
the long term effects of oral contraceptives. There
have been studies now over 20 years of taking pills
with no long term effects shown. This advice commonly
leads to unwanted pregnancies and confusion about
when to restart the pills if there is amenorrhea after
stopping the pills. The best instructions are to continue
taking the pills as long as you need contraception
without any breaks.
How long should I wait to get pregnant after stopping
birth control pills?
Providers used to advise waiting 3 months after stopping
pills before trying to get pregnant. This wait improved
the ability to accurately date a pregnancy. Now with
improved ultrasound dating of pregnancy it is no longer
necessary to wait this long. Women may begin attempting
conception right after the first normal menses.
If breast feeding, how long should a woman wait until
having a depo medroxyprogesterone acetate (DMPA, Depoprovera®)
contraceptive shot?
"Wait 6 weeks until the first contraceptive
shot." That is what most providers said. There
were theoretical questions about the effect of DMPA
on the baby and also on the quality and quantity of
breast milk. This advice to delay the shot resulted
in many women becoming pregnant. The current concept
is that the DMPA contraceptive shot can be given before
leaving the hospital.
Should the DMPA (DepoProvera®) contraceptive
injection be started the first time during a menses?
Menses ensured the the woman was not pregnant. Now,
doctors feel that the shot can be started any time
if there is a reasonable assurance that the woman
is not pregnant. A backup method of contraception
should be used if it is not started at the time of
the menses.
Must the intrauterine contraceptive device be inserted
during the menses?
This rule-of-thumb came about because the menses
helped reassure that the woman was not pregnant. Also
the cervical os is open at the time of the menses
making it easier and less painful to insert the IUCD.
Providers now feel this is too restrictive a policy.
Vaginal bleeding does not definitely exclude pregnancy
and there is a higher expulsion rate if the IUCD is
inserted during a menses. Current advice is that the
IUCD may be inserted any time during a cycle if there
is reasonable assurance the woman is not pregnant.
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