Contraception after medical abortion
Sexual intercourse should be avoided for 1 week after medical abortion to minimise risk of infection.
Provide advice about the range of contraceptive options to support informed decision-making.
Although progestogen-containing contraceptives can theoretically compete with mifepristone at the receptor site, the etonogestrel implant has not been shown to reduce the effectiveness of mifepristone. It can be inserted on the day mifepristone and misoprostol is prescribed or at any time after the abortion.
Depot medroxyprogesterone (DMPA) injection can be given any time after the abortion. Although evidence to confirm that it does not reduce efficacy of mifepristone is insufficient, DMPA can be given on the day mifepristone and misoprostol is prescribed, particularly if there is a concern the individual may be unable to return for an injection.
The combined oral contraceptive (COC) (starting with an active pill) or progestogen-only pill can be started on the day after mifepristone is taken.
The contraceptive vaginal ring can be inserted once the heaviest bleeding of a medical abortion is complete.
A levonorgestrel-releasing or copper intrauterine contraceptive device (IUD) can be inserted at a follow-up visit 2 to 3 weeks after a medical abortion, provided there is no evidence of ongoing viable pregnancy or infection. Advise another method of contraception or abstinence until the IUD is inserted.
Hormonal methods of contraception are immediately effective if started within 5 days of taking mifepristone, and take 7 days to work if started later1.