- Andrew M Kaunitz, MD
Andrew M Kaunitz, MD
- Professor and Associate Chairman
- Department of Obstetrics and Gynecology
- University of Florida College of Medicine-Jacksonville
Contraceptive selection requires consideration of patient preferences and medical factors. For women who have undergone an abortion and desire contraception, additional issues include when to start the method and whether or not back-up contraception is necessary. Prompt initiation of postabortion contraception increases utilization and continuation and thus reduces the risk of future unintended pregnancy.
This topic will review contraception issues specific to women who experience first- or second-trimester abortion (typically <24 weeks of gestation). Discussions on contraceptive counseling and selection and postpartum contraception are presented separately. (See "Contraceptive counseling and selection" and "Postpartum contraception: Initiation and methods".)
WHEN TO START POSTABORTION CONTRACEPTION
The first ovulation postabortion occurs between a mean of 21 to 29 days after the procedure with a reported range of 8 to 103 days [1,2]. As the resumption of ovulation can be rapid and unpredictable, we advise women who desire contraception to begin the method at the same time the abortion occurs (ie, immediate start).
Advantages of immediate initiation of contraception include that the woman is known not to be pregnant, an additional visit is not required, and the woman leaves with a contraceptive plan in place, although a plan to use condoms or short-acting reversible contraceptives is not likely to be as reliable as immediate initiation of long-acting reversible contraception. In a retrospective cohort study that compared women who needed an additional visit to initiate the intrauterine device or depot medroxyprogesterone acetate injection with those who had immediate access, women with same-day access had significantly fewer subsequent abortions and births within 12 months and were more likely to use an effective or highly effective contraceptive (figure 1) . (See "Contraceptive counseling and selection", section on 'Reduce unintended pregnancy' and 'Long-acting reversible contraception' below.)
Postabortion women can safely use any contraceptive option that is compatible with their medical comorbidities as presented in the Centers for Disease Control and Prevention Medical Eligibility Criteria for Contraceptive Use, 2016 .To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- WHEN TO START POSTABORTION CONTRACEPTION
- CONTRACEPTIVE OPTIONS
- Long-acting reversible contraception
- - Progestin-only implant
- - Intrauterine contraception
- Short-acting hormonal contraception
- Barrier contraception
- HOW TO START POSTABORTION CONTRACEPTION
- After surgical or induction abortion
- After spontaneous or medication abortion
- DELAYED CONTRACEPTIVE START (>7 DAYS POSTABORTION)
- RESOURCES FOR CLINICIANS AND PATIENTS
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS