Same-Day Contraception: The Quick Start

Med-Peds Forum, General Med-Peds / By

Same-Day or Quick-Start Contraception

Same-day contraception (aka quick-start contraception) is defined as initiation of hormonal contraception on the day of request, regardless of day of menstrual cycle. 

  • Shown to reduce pregnancies in adolescent patients
  • Important to ask both about LMP and current sexual activity
Source: UpToDate
  • ¶ Patient should use a barrier back-up method such as condoms for the first week after starting a new method.
  • Δ Unprotected sex includes episodes of sex in which a method of contraception was used but may not have been effective (eg, breakage of condom, multiple skipped pills).
  • § For women using ulipristal for emergency contraception, progestin-containing contraception (ie, the pill, patch, ring, injection, and implant) should not be used for 5 days following ulipristal. For women taking levonorgestrel or combined estrogen-progestin emergency contraception, the new contraceptive method can be started after the emergency contraception.
  • ¥ If the patient would like the contraceptive implant, some providers prefer to offer a single injection of DMPA today and ask the patient to return for the implant within 5 days of the first day of her next menstrual period (to avoid the need for implant removal if the repeat urine pregnancy test is positive).

Key points: 

  • Patients who have had recent unprotected intercourse can still use the quick start method. Specifically, patients who have had unprotected intercourse within 5 days of their visit can be offered emergency contraception (EC) that day, and after appropriate counseling can begin their new contraceptive method the next day.
  • The copper IUD can be used for EC as well as for long-term contraception, and is close to 100% effective when used within 5 days after unprotected intercourse. In contrast, the progestin IUD cannot be used for EC.
  • Patients who choose a hormonal method that is more difficult to discontinue in the event of pregnancy—such as hormonal injections, implants, or a progestin-releasing IUD—can use short-term hormones as a bridge until pregnancy is ruled out, or can wait until their next menses to begin their chosen method.

Further reading: 

Blog post based on Med-Peds Forum talk by the PGY3 class: Chelsea Boyd, Ashley Nguyen, Fritz Siegert, and Julia Solomon