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Contraception - Management
How should a woman switch to the progestogen-only pill (POP) from another method?

Women who are changing to a progestogen-only pill (POP) from:

  • Another hormonal method:
    • The woman can start a POP immediately, provided that she has been using her hormonal method consistently and correctly, or if it is otherwise reasonably certain that she is not pregnant.
    • There is no need to wait for the next menstrual period.
  • An injectable progestogen-only contraceptive:
    • The woman should start a POP when the repeated injection would have been given.
    • No additional contraceptive protection is needed.
  • A non-hormonal method other than a copper intrauterine device (IUD):
    • The woman can start a POP within 5 days of the start of menstrual bleeding.
      • No additional contraceptive protection is needed.
    • The woman can also start at any other time, if it is reasonably certain that she is not pregnant.
    • If it has been more than 5 days since menstrual bleeding started, the woman will need to abstain from sex or use additional contraceptive protection (such as condoms) for the next 48 hours.
  • A copper IUD or levonorgestrel-releasing IUS:
    • The POP is most conveniently begun within 5 days of the start of menstrual bleeding.
      • No additional contraceptive protection is needed.
      • The IUD can be removed at this time.
    • The woman can also start a POP at any other time, if it is reasonably certain that she is not pregnant. Because the POP will become effective only after 48 hours, the IUD or IUS should not be removed before this if:
      • She has been sexually active in the past 7 days, or
      • She requires interim protection from the IUD or IUS.
Basis for recommendation
  • These recommendations are based on guidance issued by the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC) [FFPRHC, 2002; FSRH, 2008b].
  • the Faculty of Sexual and Reproductive Healthcare (FSRH), formerly the Faculty of Family Planning and Reproductive Healthcare (FFPRHC), considered the risk of ovulation when starting progestogen-only pills (POPs) within the first 5 days of menstruation to be acceptably low.
  • Suppression of ovulation was considered to be less reliable when starting after day 5.
  • An estimated 48 hours of POP use was deemed necessary to achieve the contraceptive effects on cervical mucus.
  • There was some concern about the risk of pregnancy when removing an intrauterine device within a cycle where there has already been intercourse. That concern led to the recommendation that the device be left in place until the next menstrual period.

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