Quick Starting Contraception FSRH Apr 2017

Question 1

“Quick starting Contraception”

if pregnancy can be excluded

Answer 1

HCPs can offer quick start of any method of
contraception at any time in the menstrual cycle if it is reasonably certain that a woman is not pregnant or at risk of pregnancy from recent UPSI.
Healthcare practitioners

Question 2

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• Pregnancy test.

Answer 2

• Pregnancy cannot be excluded by an HSUP until ≥21 days after the last UPSI.
• A follow-up HSUP is required no sooner than 21 days after the last UPSI.

Question 3

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• Emergency contraception

Answer 3

• EC may be indicated.
• A copper intrauterine device can be quick started only if the indications for use as EC are met.
• After LNG-EC, CHC, POP, IMP (and DMPA) can be quick started immediately.
• After UPA-EC, wait 5 days before quick starting suitable hormonal contraception [CHC, POP, IMP (& DMPA)].

Question 4

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• CHC, POP and IMP

Answer 4

• CHC, POP and IMP can be quick started if they prefer not to delay starting contraception. DMPA may be
  considered if other methods are not suitable or acceptable.

Question 5

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• Additional contraceptive precautions (barrier or abstinence)

Answer 5

• required until quick started contraceptive method becomes effective.

Question 6

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• LNG -IUS

Answer 6

-not generally be quick started unless pregnancy can be reasonably excluded.

Question 7

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• CHC containing cyproterone acetate

Answer 7

-not be quick started unless pregnancy can be reasonably excluded.

Question 8

“Quick starting Contraception”

• If pregnancy cannot be excluded
• Negative HSUP [detect hCG 20 mIU/ml] but are at risk of pregnancy from recent UPSI
• DMPA

Answer 8

• DMPA may be considered if other methods (CHC, POP and IMP) are not suitable or acceptable.

Question 9

Use of bridging contraception

Answer 9

If a woman’s choice of contraceptive method is not available or is not appropriate at the time of presentation, then bridging method of contraception that can be quick started.

Question 10

Pregnancy diagnosed after quick starting contraception

Answer 10

GDG advises that women should be informed that
contraceptive hormones are not thought to cause harm to the fetus and they should not be advised to terminate pregnancy on the grounds of exposure.

Question 11

Pregnancy diagnosed after quick starting contraception.
Women using CHC, POP, IMP or DMPA
Women who wish to continue the pregnancy

Answer 11

• If a pregnancy is diagnosed after starting contraception & woman wishes to continue the pregnancy, woman should be advised that the method should usually be removed or stopped.

Question 12

Pregnancy diagnosed after quick starting contraception
of CHC, POP,
Women who choose not to continue the pregnancy, chooses therapeutic abortion:

Answer 12

• A woman using CHC or POP can be advised to stop her method of contraception and restart contraception immediately after abortion with no additional
  contraceptive precautions.

Question 13

Pregnancy diagnosed after quick starting contraception
of DMPA
Women who choose not to continue the pregnancy, chooses therapeutic abortion:

Answer 13

• woman using IMP or DMPA can be advised to continue her method of contraception with no additional contraceptive precautions after abortion.
• A woman using DMPA should be advised that there may be a slightly higher risk of continuing pregnancy (failed abortion) if DMPA is administered at the time of
  mifepristone administration.

Question 14

Pregnancy diagnosed after quick starting contraception
IMP
Women who choose not to continue the pregnancy, chooses therapeutic abortion:

Answer 14

• woman using IMP or DMPA can be advised to continue her method of contraception with no additional contraceptive precautions after abortion.

Question 15

Pregnancy with IUC (Intrauterine contraception)

Answer 15

• Advise: IUP less than 12 weeks’ gestation that IUC should be removed, if threads visible or can be easily removed from endocervical canal. This is regardless of whether decides to continue with pregnancy.
• risk of adverse pregnancy outcomes is greater than
  without an IUC in situ.
• removal of the IUC in first trimester could improve pregnancy outcomes, but is associated with a small risk of miscarriage.