Advantages of the “Immediate-Start” Approach to Initiating Hormonal Contraception

A new Cochrane review, conducted with partial support from USAID, suggests that the "immediate-start" approach to initiating hormonal contraception may be more acceptable to clients than a standard approach. However, women who use the immediate-start approach may have different experiences depending on the contraceptive method they choose.

New users of hormonal contraception are often advised to delay initiating a method until their next menstrual period, but a delay in contraception can place women at risk of unintended pregnancies. One alternative — the immediate-start approach — is for a woman to begin hormonal contraception immediately, regardless of her menstrual status, but to use a back-up method of birth control for the first seven days.

The authors identified five well-designed clinical trials that compared the rates of discontinuation, the bleeding patterns, and the side effects among women who used different approaches to start contraception.

When the immediate-start approach to initiating the injectable depot medroxyprogesterone acetate (DMPA) was compared with a bridged approach (in which a woman used a non-injectable form of hormonal contraception until the start of her next menses, when she received DMPA), the women who started immediately were more satisfied and had fewer unintended pregnancies.

Women who used the immediate-start approach for initiating the vaginal ring were more satisfied, had less frequent bleeding, and experienced fewer side effects than women who used an immediate-start approach to initiating oral contraceptives.

The authors, from Family Health International and San Francisco General Hospital, found no strong evidence that the immediate-start approach leads to fewer unintended pregnancies or less method continuation than a standard approach to method initiation. However, they recommend that researchers conduct more studies to compare the immediate versus the menses-dependent approach among women who use the same hormonal contraceptive.

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Source
López LM, Newmann SJ, Grimes DA, Nanda K, Schulz KF. Immediate start of hormonal contraceptives for contraception. Cochrane Database Syst Rev 2008;(2):CD006260.