Starting hormonal contraception without delay (Quick Start)
Hormonal contraception is traditionally started at the beginning of the next normal menstrual period (within the first 5 days of the menstrual cycle) to avoid the risk that the individual is already pregnant. It also avoids the need for an additional method of contraception for the first 7 days, because hormonal contraception is immediately effective if started at this time1.
Quick Start refers to starting a hormonal contraceptive immediately at the time of consultation even if it is later than day 5 of the menstrual cycle, when it may be impossible to exclude an early pregnancy. If following oral emergency contraception, Quick Start can be used immediately after taking levonorgestrel but not until 5 days (120 hours) after taking ulipristal.
Quick Start can be used for all methods of contraception other than:
- levonorgestrel-releasing and copper intrauterine contraceptive devices (IUDs), because early pregnancy must be excluded before starting an IUD. IUDs can cause harm to a continuing pregnancy (including late miscarriage and premature delivery) if the IUD cannot be safely removed
- combined oral contraceptives containing cyproterone, unless pregnancy can be reasonably excluded, because there is a theoretical risk of feminisation of a male fetus.
For information about excluding pregnancy, see Before starting an IUD.
Quick Start can be considered for anyone presenting for hormonal contraception, but is particularly useful if:
- the menstrual cycle is long or irregular
- unintended pregnancy would pose medical or psychological harm (to avoid delay in contraception)
- there may be difficulties accessing health services at a later time (eg for insertion of the etonogestrel implant).
If using the Quick Start approach, ensure the individual is aware that:
- as early pregnancy has not been excluded, a pregnancy test is required 4 weeks after starting the contraceptive (or 3 weeks after starting if no further episodes of unprotected sex occurred in the first week of use) regardless of whether bleeding occurs
- there are no known teratogenic effects from the contraceptive method
- the method will take 7 days to become effective1 (or 48 hours [3 consecutive tablets] for those progestogen-only pills that contain levonorgestrel or norethisterone).