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
- ¶ 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:
- Morgan IA, Ermias Y, Zapata LB, Curtis KM, Whiteman MK. Health Care Provider Attitudes and Practices Related to ‘Quick Start’ Provision of Combined Hormonal Contraception and Depot Medroxyprogesterone Acetate to Adolescents. J Adolesc Health. 2019 Feb;64(2):211-218. doi: 10.1016/j.jadohealth.2018.08.012. Epub 2018 Nov 2. PMID: 30392865.
- Murphy LE, Chen ZE, Warner V, Cameron ST. Quick starting hormonal contraception after using oral emergency contraception: a systematic review. J Fam Plann Reprod Health Care. 2017 Oct;43(4):319-326. doi: 10.1136/jfprhc-2017-101740. Epub 2017 Jun 29. PMID: 28663249.
- Simpson J, Craik J, Melvin L. Quick starting contraception after emergency contraception: have clinical guidelines made a difference? J Fam Plann Reprod Health Care. 2014 Jul;40(3):184-9. doi: 10.1136/jfprhc-2013-100648. Epub 2014 Apr 4. PMID: 24706265.
- Sneed R, Westhoff C, Morroni C, Tiezzi L. A prospective study of immediate initiation of depo medroxyprogesterone acetate contractive injection. Contraception 2005;71:99–103.
- Stechna S, Mravcak S, Schultz P, Santolaya J. The Quick Start Contraception Initiation Method during the 6-week postpartum visit: an efficacious way to improve contraception in Federally Qualified Health Centers. Contraception. 2013 Jul;88(1):160-3. doi: 10.1016/j.contraception.2012.10.005. Epub 2012 Nov 12. PMID: 23153901.
- Westhoff C, Heartwell S, Edwards S, Zieman M, Cushman L, Robilotto C, Stuart G, Morroni C, Kalmuss D. Initiation of oral contraceptives using a quick start compared with a conventional start: a randomized controlled trial. Obstet Gynecol. 2007 Jun;109(6):1270-6. doi: 10.1097/01.AOG.0000264550.41242.f2. PMID: 17540797.
Blog post based on Med-Peds Forum talk by the PGY3 class: Chelsea Boyd, Ashley Nguyen, Fritz Siegert, and Julia Solomon